Disparities in Synthetic Cannabis Use Among U.S. Adults, 2022–2024
1
Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY 40536, USA
2
Center for Health, Engagement, and Transformation, College of Medicine, University of Kentucky, Lexington, KY 40536, USA
3
Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
4
Myrlie Evers-Williams Institute for the Elimination of Health Disparities, University of Mississippi Medical Center, Jackson, MS 39213, USA
5
Department of Communication, College of Arts and Sciences, University of Louisville, Louisville, KY 40292, USA
6
Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY 40202, USA
*
Author to whom correspondence should be addressed.
Psychoactives 2026, 5(2), 9; https://doi.org/10.3390/psychoactives5020009
Submission received: 16 February 2026
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Revised: 18 March 2026
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Accepted: 24 March 2026
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Published: 1 April 2026
Abstract
Synthetic cannabinoids are widely available in the United States, yet contemporary national data on who uses these products, and disparities in use, are limited. To assess disparities in lifetime and past-year synthetic cannabis use (each yes/no), we used 2022–2024 National Survey on Drug Use and Health data from adults aged ≥18 years (n = 139,532) and fit two multivariable logistic regression models adjusted for survey year and sociodemographic and policy characteristics. We also calculated proportions of lifetime and past-year use by various plant-based cannabis use modalities. The proportions of adults with lifetime and past-year synthetic cannabis use were 2.7% and 0.3%, respectively. Younger age, male sex, lower education and household income, and non-metropolitan residence were linked to both lifetime and past-year synthetic cannabis use. For example, past-year synthetic cannabis use was associated with living in non-metropolitan (vs. large metropolitan) areas (AOR = 1.54; 95% CI: 1.03–2.30). Past-year use was also linked to residence in states without medical cannabis law coverage (AOR = 1.45; 95% CI: 1.09–1.94). Finally, past-year synthetic cannabis use was most prevalent among adults who smoked (67.3%) or vaped (52.5%) plant-based cannabis. Synthetic cannabis use was uncommon overall but exhibited clear disparities, underscoring the need for continued surveillance amid evolving cannabinoid policies and markets.
1. Introduction
Synthetic cannabis products—commonly referred to as synthetic cannabinoids, “K2,” or “Spice”—are laboratory-manufactured and designed to mimic the psychoactive effects of delta-9-tetrahydrocannabinol (THC) [1,2,3,4,5,6]. Although these compounds are structurally distinct from THC, they are engineered to activate the same cannabinoid receptors, often with greater potency [7]. These products bind to cannabinoid receptors and have been associated with a wide range of adverse health outcomes, including acute intoxication, psychosis, cardiovascular events, and death [1,2,3,4]. Despite federal scheduling of many synthetic cannabinoids and ongoing regulatory efforts, these products remain available through illicit markets and, in some cases, are misrepresented as legal alternatives to cannabis [8,9]. One challenge for regulators is the rapid emergence of novel synthetic cannabinoid compounds, which are often created via small structural modifications to previously controlled substances while retaining similar pharmacologic effects [8,9]. Although United States (U.S.) law allows some analogue compounds to be controlled under the Federal Analogue Act, enforcement may lag behind the continual introduction of new variants [8,9]. Internationally, regulatory approaches vary across jurisdictions and are similarly challenged by the evolving chemical landscape of these products [8,9].
Surveillance of synthetic cannabis use has trailed behind that of plant-based cannabis and other more established substances, including tobacco/nicotine, alcohol, and other illicit drugs in the U.S. [1,9]. Much of the existing literature relies on outbreak investigations, poison control center data, or clinical case series, which provide important insights into harms but limited information on population-level prevalence and patterns of use [3]. As a result, contemporary estimates of synthetic cannabis use—and the sociodemographic groups most likely to use these products—remain poorly characterized in the U.S. Since 2020, the National Survey on Drug Use and Health (NSDUH) has included questions on synthetic cannabis use in its Emerging Issues section, allowing for population-based surveillance and recent national prevalence estimates [10]. These inclusions have led to recent research detailing use patterns, disparities, and correlates of use. For example, one study found past-year use to be rare but to correlate with substance use disorders of other drugs and low socioeconomic status (SES) [11]. However, important gaps remain, including a need to better understand contextual disparities in synthetic cannabis use, the impact of policy changes, and how synthetic cannabis use patterns vary by cannabis use modality (e.g., smoking vs. vaping).
In recent years, the evolving cannabis policy landscape, including the expansion of state medical and recreational cannabis laws (MCLs and RCLs, respectively), has coincided with the diversification of consumer cannabinoid product availability [12,13,14,15]. Synthetic cannabinoids occupy a distinct and often overlooked position within this landscape, particularly as they are sometimes marketed as “legal,” “natural,” or undetectable alternatives to cannabis [1,16]. These dynamics raise concerns about differential exposure and risk across populations. Further, the extent to which synthetic and plant-based cannabis use overlap, particularly given the multiple modalities through which plant-based cannabis can be consumed (e.g., smoking, vaping, ingesting, dabbing), is underexamined [17,18,19]. Given recent increases in plant-based cannabis use [20,21], examinations of its co-occurrence with synthetic cannabis use and potential disparities in use are needed.
Using pooled data from the 2022–2024 NSDUH, the present study aims to characterize the prevalence of lifetime and past-year synthetic cannabis use among U.S. adults and to identify demographic, socioeconomic, and policy correlates of use. A secondary aim is to examine whether distributions in synthetic cannabis use vary by plant-based cannabis use overall and various use modalities, including smoking, vaping, dabbing, ingesting, absorbing sublingually/orally, applying topicals, and taking pills. By providing contemporary national estimates, this work seeks to inform ongoing surveillance efforts, guide prevention strategies, and support regulatory decision-making in an increasingly complex cannabinoid marketplace.
2. Materials and Methods
2.1. Data and Participants
We used imputed data from the adult (≥18 years) sample of the 2022, 2023, and 2024 waves of NSDUH (n = 186,823) [22,23,24]. NSDUH is a nationally representative, cross-sectional survey designed to assess the prevalence and correlates of mental health conditions and substance use among the noninstitutionalized U.S. population. The survey is administered by the Substance Abuse and Mental Health Services Administration (SAMHSA) and has been conducted annually since 1990, with periodic administrations dating back to 1971. NSDUH employs a multistage area probability sampling design and provides survey weights to account for differential probabilities of selection and nonresponse. Detailed information on NSDUH sampling, weighting, and data collection procedures is available elsewhere [22]. Because this study relied on publicly available, deidentified data, it was deemed exempt from review by the University of Kentucky Institutional Review Board.
2.2. Measures
2.2.1. Synthetic Cannabis Use
In each year of the 2022–2024 NSDUH, participants were asked, “The next question is about synthetic marijuana or fake weed, also called K2 or Spice. Have you ever, even once, used synthetic marijuana or fake weed?” We coded lifetime synthetic cannabis use (yes/no) based on endorsement of ever use. Participants who indicated ever use of synthetic cannabis were subsequently asked, “How long has it been since you last used synthetic marijuana or fake weed?” Response options included: (1) “Within the past 30 days—that is, since (DATEFILL)”, (2) “More than 30 days ago but within the past 12 months”, and (3) “More than 12 months ago”. We coded past-year synthetic cannabis use as any use in the past 12 months (yes/no).
2.2.2. Plant-Based Cannabis Use Modalities
Participants reported the recency of plant-based cannabis use, categorized as any past-year use versus no past-year use, and, in separate items, past-year use by specific cannabis use modalities. Use modalities included smoking, vaping, dabbing (waxes, shatter, or concentrates), ingesting (eating or drinking), sublingual/oral absorption (drops, strips, lozenges, or sprays in the mouth), topical application (lotions, creams, or patches to the skin), and taking pills. Each modality was coded as a binary indicator (yes/no) for past-year use.
2.2.3. Covariates
We included the following covariates: survey year (2022, 2023, 2024), age group (18–25, 26–34, 35–49, ≥50 years), sex (male, female), race and ethnicity (Hispanic, non-Hispanic White, non-Hispanic Black, non-Hispanic multiracial, and non-Hispanic other race), educational attainment (high school graduate or less, some college, college graduate or higher), annual household income (≤$49,999; $50,000–$74,999; ≥$75,000), employment status, metropolitan residence (large metropolitan, small metropolitan, non-metropolitan), and state MCL coverage at the time of survey (yes/no). Non-Hispanic other race included respondents who identified as American Indian/Alaska Native, Asian, and Native Hawaiian/other Pacific Islander. Educational attainment, annual household income, and employment status were used as proxies for SES.
2.3. Statistical Analysis
We estimated unweighted counts and weighted prevalences of all study characteristics overall and stratified by lifetime and past-year synthetic cannabis use. Survey-adjusted chi-square tests were used to assess whether the distribution of each characteristic differed by lifetime and past-year synthetic cannabis use status. To estimate associations between covariates of interest and lifetime and past-year synthetic cannabis use, we fit survey-weighted logistic regression models and report adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Finally, as a secondary analysis and to assess whether lifetime and past-year synthetic cannabis use varied by past-year plant-based cannabis use overall and various use modalities, we compared the distribution of each plant-based cannabis use variable across synthetic cannabis use outcomes using chi-square tests of independence. All analyses were conducted using Stata/MP version 19.5 and accounted for the complex survey design and differential probabilities of nonresponse using svy procedures.
3. Results
Table 1 presents the characteristics of the overall analytic sample. The distribution of survey years was relatively even, ranging from 33.0% to 33.8%. Nearly half of respondents were aged 50 years or older (46.2%), followed by those aged 35–49 (24.8%), 26–34 (15.6%), and 18–25 (13.4%); 51.3% were female. A higher proportion of respondents was non-Hispanic White (61.0%), with smaller proportions identifying as Hispanic (17.7%), non-Hispanic Black (12.1%), non-Hispanic other (7.1%), or non-Hispanic multiracial (2.0%). Educational attainment was most commonly high school graduate or less (36.3%), followed by college graduate or higher (33.8%) and some college (29.9%). With respect to annual household income, 44.8% reported incomes ≥ $75,000, 40.0% reported ≤$49,999, and 15.2% reported $50,000–$74,999. Most respondents were employed (58.9%), and over half resided in large metropolitan areas (55.5%), followed by small metropolitan (31.6%) and non-metropolitan (12.9%) areas. Approximately three-quarters of respondents lived in states with MCL coverage (73.7%). Overall, 2.7% (weighted n = 6,929,608) and 0.3% (weighted n = 716,100) of respondents reported lifetime and past-year synthetic cannabis use, respectively.
We display the distribution of each characteristic by lifetime and past-year synthetic cannabis use in Table 2. For lifetime synthetic cannabis use, distributions differed by age (p < 0.001), sex (p < 0.001), race and ethnicity (p < 0.001), educational attainment (p < 0.001), annual household income (p < 0.001), employment status (p < 0.001), metropolitan status (p < 0.001), and state MCL coverage (p = 0.022), but not survey year (p = 0.42). Similarly, past-year synthetic cannabis use varied by age (p < 0.001), sex (p = 0.001), educational attainment (p < 0.001), annual household income (p < 0.001), metropolitan status (p < 0.001), and state MCL coverage (p = 0.002), but not survey year (p = 0.46), race and ethnicity (p = 0.65), and employment status (p = 0.85).
Table 3 presents results from both multivariable logistic regression models estimating adjusted associations between each characteristic and lifetime or past-year synthetic cannabis use. Compared to adults aged 50+ years, adults aged 18–25 (AOR: 1.95, 95% CI: 1.50–2.54), 26–34 (AOR: 8.25, 95% CI: 6.65–10.23), and 35–49 (AOR: 4.32, 95% CI 3.48–5.35) had higher odds of lifetime synthetic cannabis use. Results were similar for past-year cannabis use, though associations for 18–25-year-old adults were stronger (AOR: 4.28, 95% CI: 2.69–6.82) compared to lifetime use, while weaker for 26–34 (AOR: 2.59, 95% CI: 1.51, 4.45) and 35–49 (AOR: 2.39, 95% CI: 1.52–3.76) year olds. Female (vs. male) sex was associated with lower odds of lifetime (AOR: 0.57, 95% CI: 0.51–0.63) and past-year (AOR: 0.63, 95% CI: 0.47–0.84) synthetic cannabis use. Compared to non-Hispanic White respondents, Hispanic (AOR: 0.46, 95% CI: 0.38–0.55), non-Hispanic Black (AOR: 0.42, 95% CI: 0.33–0.52), and non-Hispanic other (AOR: 0.32, 95% CI: 0.23–0.45) respondents had lower odds of lifetime synthetic cannabis use, and only non-Hispanic multiracial respondents had lower odds of past-year synthetic cannabis use (AOR: 0.43, 95% CI: 0.19–0.95).
For SES and geographic characteristics, high school graduate or less (AOR: 2.16, 95% CI: 1.81–2.57) and some college (AOR: 1.92, 95% CI: 1.63, 2.27) (vs. college graduate or higher) educations were associated with higher odds of lifetime synthetic cannabis use, while only high school graduate or less education was associated with higher odds of past-year synthetic cannabis use (AOR: 1.83, 95% CI: 1.003–3.35). Lower annual household income was consistently associated with lifetime and past-year synthetic cannabis use. For example, making ≤$49,999 was associated with higher odds of lifetime (AOR: 1.43, 95% CI: 1.25–1.62) and past-year (AOR: 1.86, 95% CI: 1.13–3.06) synthetic cannabis use. We did not observe any associations for employment status. However, living in small (AOR: 1.18, 95% CI: 1.03–1.34) and non-metropolitan (AOR: 1.35, 95% CI: 1.15–1.59) areas was associated with lifetime synthetic cannabis use, and only non-metropolitan residence (AOR: 1.54, 95% CI: 1.03–2.30) was associated with past-year synthetic cannabis use. Finally, not residing in a state with MCL coverage was associated with past-year synthetic cannabis use (AOR: 1.45, 95% CI: 1.09–1.94).
Distributions of lifetime and past-year synthetic cannabis use by past-year plant-based cannabis use overall and via specific modalities are displayed in Table 4. The prevalence of past-year plant-based cannabis use was 23.1%. For use modalities, smoking was the most common (17.7%) followed by ingesting (11.3%), vaping (8.6%), dabbing (3.7%), applying topicals (2.0%), absorbing sublingually/orally (1.4%), and taking pills (0.6%). Approximately seven in ten adults who reported lifetime synthetic cannabis use also reported past-year plant-based cannabis use (70.0%), with an even higher proportion observed among those reporting past-year synthetic cannabis use (85.2%).
Among adults who ever used synthetic cannabis, the most prevalent past-year plant-based cannabis use modality was smoking (61.7%), followed by vaping (39.2%), ingesting (37.1%), and dabbing (20.9%), with smaller proportions for applying topically (5.9%), absorbing sublingual/oral products (4.6%), and taking pills (2.7%). In addition, among those who did not report lifetime synthetic cannabis use, 16.5% smoked plant-based cannabis and 10.6% ingested it. For adults reporting past-year synthetic cannabis use, plant-based cannabis use was more prevalent via smoking (67.3), vaping (52.5%), ingesting (42.2%), and dabbing (21.1%) in the past year, mimicking patterns observed for lifetime synthetic cannabis use.
4. Discussion
Using pooled, nationally representative data from the 2022–2024 NSDUH, our study contributes updated estimates of lifetime and past-year synthetic cannabis use among U.S. adults, including disparities in and correlates of use patterns. Overall, synthetic cannabis use was uncommon, with fewer than 3% of adults reporting lifetime use and fewer than 1% reporting past-year use. Despite the low prevalence, clear and consistent use disparities emerged by age, sex, SES, place of residence, and state MCL coverage. Furthermore, co-use of synthetic and plant-based cannabis was evident, with higher proportions of adults who reported past-year smoking, vaping, ingesting, and dabbing plant-based cannabis also reporting past-year synthetic cannabis use. Overall, our findings underscore the need for continued public health surveillance of both synthetic and plant-based cannabis products within an evolving cannabinoid marketplace.
Age was a strong correlate of synthetic cannabis use. Compared with adults aged 50 years or older, younger adults—particularly those aged 26–34 and 35–49—had substantially higher odds of lifetime use, while adults aged 18–25 had the highest odds of past-year use. Experimentation with synthetic cannabis may peak in young adulthood, whereas more recent use may be concentrated among the youngest adults. These findings are consistent with a possible cohort effect, in which synthetic cannabis use is concentrated among younger adults in the context of evolving cannabis markets and regulatory landscapes. Our findings align with prior work indicating that synthetic cannabinoids have historically appealed to younger populations, potentially due to perceptions of legality, affordability, or detectability relative to plant-derived cannabis [1,5,25]. These patterns are concerning, given the well-documented toxicity associated with synthetic cannabinoids. Many synthetic cannabinoids act as full agonists at cannabinoid receptors and can be substantially more potent than THC, contributing to unpredictable clinical effects and greater risk of severe intoxication [1,2,3,26,27,28]. Surveillance systems, including poison control center and toxicology registry data, have documented clusters of serious adverse events linked to these products in the United States, highlighting their potential to cause disproportionate harm relative to their prevalence of use [4].
Consistent with prior research on both synthetic and plant-based cannabis [10,19], males had higher odds of lifetime and past-year synthetic cannabis use than females. Sex differences in substance use may reflect a combination of behavioral, social, and structural factors, such as differential risk-taking attitudes and behaviors, peer use and norms, and product availability and access [29,30]. Because co-use of synthetic and plant-based cannabis is common, sex differences observed in plant-based cannabis use—particularly higher prevalence among males—may contribute to similar sex differences observed in synthetic cannabis use [17,20]. Racial and ethnic differences were evident for lifetime use but largely attenuated for past-year use. Hispanic, non-Hispanic Black, and non-Hispanic other adults had lower odds of lifetime synthetic cannabis use, whereas only non-Hispanic multiracial adults had lower odds of past-year use, relative to non-Hispanic White adults. The difference between lifetime and past-year use likely reflects an artifact of statistical power, given the lower prevalence of past-year use. Additional explanations could be shifting exposure over time, true differences in use patterns, or other social or contextual factors differentially shaping substance use behaviors [31,32].
We also observed clear SES disparities. Lower educational attainment and household income were generally associated with higher odds of lifetime synthetic cannabis use, and, to a lesser extent, past-year use, consistent with prior research [10]. These findings substantiate concerns that synthetic cannabinoids disproportionately affect individuals from socioeconomically disadvantaged communities, potentially due to factors such as lower cost, reduced access to regulated cannabis products, or greater exposure to unregulated markets [1,8,11]. Unlike for many other substances, employment status was not associated with either lifetime or past-year synthetic cannabis use, suggesting that economic position, as captured by income and education, may be more salient than labor force participation [33].
Geographic disparities were also evident. Adults residing in small metropolitan and non-metropolitan areas had higher odds of lifetime synthetic cannabis use, and non-metropolitan residence was associated with higher odds of past-year use. These findings point to heightened exposure and risk in less urban areas, where constrained access to regulated cannabis dispensaries may amplify the role of illicit markets [12,13,34,35]. Rural and non-metropolitan communities also face well-documented barriers to healthcare access, substance use treatment, and harm reduction services, which may exacerbate the risks associated with synthetic cannabinoid use or experimentation/initiation [36,37,38]. Further, adults residing in states without MCL coverage had higher odds of past-year synthetic cannabis use, even after adjustment for sociodemographic characteristics. While causal inference is not possible from these data, this finding is consistent with the idea that restricted access to legal, regulated cannabis may increase demand for alternative or unregulated products, including synthetic cannabinoids [1,9,12,13]. No association was observed between MCL coverage and lifetime use, suggesting that policy context may be more relevant for recent patterns of use than for historical experimentation.
Finally, in our secondary analysis, patterns of past-year plant-based cannabis use modalities differed substantially by lifetime and past-year synthetic cannabis use. Among adults who reported lifetime or past-year synthetic cannabis use, smoking and vaping plant-based cannabis were most prevalent, followed by ingestion and dabbing, whereas use of sublingual/oral products, topicals, and pills was uncommon. Notably, plant-based cannabis use, particularly smoking and ingesting, was also reported by a subset of adults who did not report synthetic cannabis use. These results suggest that plant-based cannabis use modalities do not equally translate to synthetic product use. Our findings point to the possibility that synthetic cannabis use may cluster among individuals who engage more intensively with inhaled or higher-potency cannabis modalities, potentially reflecting shared risk environments, product availability, or dose preferences [39,40,41]. This modality-specific patterning highlights the importance of considering how use modalities may intersect with exposure to synthetic cannabinoids in surveillance and prevention efforts.
Limitations
This study has several limitations. First, all data are self-reported and subject to response biases, particularly recall and social desirability. Second, NSDUH is cross-sectional limiting causal inference. Third, the low prevalence of past-year use resulted in wider CIs for some estimates and limited statistical power to detect meaningful differences across certain subgroups. Similarly, due to limited sample sizes, we were unable to examine past-month or current synthetic cannabis use as an indicator for more recent and potentially problematic use. Adults who reported past-year synthetic cannabis use are likely heterogeneous with respect to their substance misuse and other adverse behavioral health outcomes. Finally, NSDUH excludes institutionalized populations, who may be at elevated risk for synthetic cannabinoid exposure.
5. Conclusions
This study, using recent nationally representative data, found that synthetic cannabis use among U.S. adults remains uncommon. However, clear disparities persisted across various sociodemographic and policy characteristics, including age, SES, geographic context, and state cannabis policy environments. Specifically, synthetic cannabis use was more prevalent among younger adults, individuals with lower income and educational attainment, residents of non-metropolitan areas, and those living in states without MCL coverage. In addition, synthetic cannabis use was more common among adults who reported past-year smoking or vaping of plant-based cannabis followed by modes such as ingesting and dabbing. These results suggest that modality-specific patterns of cannabis use may shape exposure to synthetic products. Together, our findings underscore the need for continued surveillance of synthetic cannabinoids within an evolving cannabinoid marketplace to inform prevention and regulatory strategies aimed at mitigating harmful use and reducing inequity associated health outcomes.
Author Contributions
Conceptualization, D.T.M., M.D., O.A. and J.L.H.; methodology, D.T.M.; validation, M.D.; formal analysis, D.T.M.; data curation, D.T.M.; writing—original draft preparation, D.T.M.; writing—review and editing, D.T.M., M.D., O.A. and J.L.H.; visualization, D.T.M., M.D., O.A. and J.L.H.; supervision, J.L.H. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
Not applicable.
Informed Consent Statement
Not applicable.
Data Availability Statement
The data used in this study are publicly available from the Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey on Drug Use and Health (NSDUH) data repository (2022–2024). However, access to these data may be restricted in certain countries due to external website or governmental access limitations. In such cases, data access guidance may be requested from the corresponding author.
Conflicts of Interest
The authors declare no conflicts of interest.
Abbreviations
The following abbreviations are used in this manuscript:
| AOR | Adjusted odds ratio |
| CI | Confidence interval |
| NSDUH | National Survey on Drug Use and Health |
| MCL | Medical cannabis law |
| RCL | Recreational cannabis law |
| SAMHSA | Substance Abuse and Mental Health Services Administration |
| SES | Socioeconomic status |
| THC | Tetrahydrocannabinol |
| U.S. | United States |
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Table 1.
Sample Characteristics of U.S. Adults, the National Survey on Drug Use and Health, 2022–2024 (n = 139,532).
Table 1.
Sample Characteristics of U.S. Adults, the National Survey on Drug Use and Health, 2022–2024 (n = 139,532).
| n (%) | |
|---|---|
| Survey year | |
| 2022 | 47,100 (33.0) |
| 2023 | 45,133 (33.2) |
| 2024 | 47,299 (33.8) |
| Age in years | |
| 18–25 | 42,030 (13.4) |
| 26–34 | 28,437 (15.6) |
| 35–49 | 37,788 (24.8) |
| 50+ | 31,277 (46.2) |
| Sex | |
| Male | 62,262 (48.7) |
| Female | 77,270 (51.3) |
| Race and ethnicity | |
| Hispanic | 26,002 (17.7) |
| Non-Hispanic White | 81,941 (61.0) |
| Non-Hispanic Black | 16,290 (12.1) |
| Non-Hispanic multiracial | 5556 (2.0) |
| Non-Hispanic other a | 9743 (7.1) |
| Educational attainment | |
| High school graduate or less | 51,789 (36.3) |
| Some college | 40,469 (29.9) |
| College graduate or higher | 47,274 (33.8) |
| Annual household income | |
| ≤$49,999 | 60,398 (40.0) |
| $50,000–$74,999 | 20,740 (15.2) |
| ≥$75,000 | 58,394 (44.8) |
| Employment status | |
| Employed | 89,545 (58.9) |
| Unemployed | 49,987 (41.1) |
| Metropolitan status | |
| Large metropolitan | 63,108 (55.5) |
| Small metropolitan | 54,484 (31.6) |
| Non-metropolitan | 21,940 (12.9) |
| State medical cannabis law coverage | |
| No | 31,476 (26.3) |
| Yes | 108,056 (73.7) |
| Lifetime synthetic cannabis use | |
| No | 135,089 (97.3) |
| Yes | 4443 (2.7) |
| Past-year synthetic cannabis use | |
| No | 139,072 (99.7) |
| Yes | 460 (0.3) |
a Non-Hispanic other included non-Hispanic Native American/Alaska Native, Native Hawaiian/other Pacific Islander, or Asian respondents.
Table 2.
Sample Characteristics of U.S. Adults by Lifetime and Past-Year Synthetic Cannabis Use (n = 139,532).
Table 2.
Sample Characteristics of U.S. Adults by Lifetime and Past-Year Synthetic Cannabis Use (n = 139,532).
| Lifetime Synthetic Cannabis Use | Past-Year Synthetic Cannabis Use | |||||
|---|---|---|---|---|---|---|
| No | Yes | p | No | Yes | p | |
| Survey year | 0.42 | 0.46 | ||||
| 2022 | 45,531 (33.0) | 1569 (33.4) | 46,953 (33.0) | 147 (35.2) | ||
| 2023 | 43,739 (33.2) | 1394 (31.4) | 44,981 (33.2) | 152 (28.3) | ||
| 2024 | 45,819 (33.8) | 1480 (35.2) | 47,138 (33.8) | 161 (36.4) | ||
| Age in years | <0.001 | <0.001 | ||||
| 18–25 | 41,110 (13.5) | 920 (10.0) | 41,784 (13.3) | 246 (30.5) | ||
| 26–34 | 26,551 (15.0) | 1886 (39.0) | 28,365 (15.6) | 72 (18.5) | ||
| 35–49 | 36,434 (24.5) | 1354 (33.7) | 37,683 (24.8) | 105 (26.5) | ||
| 50+ | 30,994 (47.0) | 283 (17.3) | 31,240 (46.3) | 37 (24.5) | ||
| Sex | <0.001 | 0.001 | ||||
| Male | 59,792 (48.3) | 2470 (63.3) | 62,015 (48.7) | 247 (60.5) | ||
| Female | 75,297 (51.7) | 1973 (36.7) | 77,057 (51.3) | 213 (39.5) | ||
| Race and ethnicity | <0.001 | 0.65 | ||||
| Hispanic | 25,341 (17.8) | 661 (13.8) | 25,915 (17.7) | 87 (15.5) | ||
| Non-Hispanic White | 78,891 (60.7) | 3050 (72.2) | 81,671 (61.0) | 270 (61.9) | ||
| Non-Hispanic Black | 15,990 (12.2) | 300 (8.0) | 16,235 (12.1) | 55 (15.0) | ||
| Non-Hispanic multiracial | 5284 (2.0) | 272 (3.1) | 5535 (2.0) | 21 (1.1) | ||
| Non-Hispanic other a | 9583 (7.3) | 160 (2.8) | 9716 (7.2) | 27 (6.5) | ||
| Educational attainment | <0.001 | <0.001 | ||||
| High school graduate or less | 49,812 (36.1) | 1977 (44.2) | 51,548 (36.3) | 241 (50.3) | ||
| Some college | 38,985 (29.7) | 1484 (34.5) | 40,322 (29.8) | 147 (31.5) | ||
| College graduate or higher | 46,292 (34.2) | 982 (21.3) | 47,202 (33.9) | 72 (18.2) | ||
| Annual household income | <0.001 | <0.001 | ||||
| ≤$49,999 | 58,164 (39.8) | 2234 (46.0) | 60,114 (39.9) | 284 (58.4) | ||
| $50,000–$74,999 | 20,030 (15.2) | 710 (17.6) | 20,689 (15.2) | 51 (12.7) | ||
| ≥$75,000 | 56,895 (45.0) | 1499 (36.4) | 58,269 (44.8) | 125 (28.9) | ||
| Employment status | <0.001 | 0.85 | ||||
| Employed | 86,450 (58.7) | 3095 (68.6) | 89,261 (58.9) | 284 (58.1) | ||
| Unemployed | 48,639 (41.3) | 1348 (31.4) | 49,811 (41.1) | 176 (41.9) | ||
| Metropolitan status | <0.001 | <0.001 | ||||
| Large metropolitan | 61,477 (55.7) | 1631 (45.8) | 62,925 (55.5) | 183 (50.1) | ||
| Small metropolitan | 52,585 (31.5) | 1899 (35.9) | 54,305 (31.6) | 179 (26.8) | ||
| Non-metropolitan | 21,027 (12.7) | 913 (18.3) | 21,842 (12.9) | 98 (23.1) | ||
| State medical cannabis law coverage | 0.022 | 0.002 | ||||
| No | 30,391 (26.2) | 1085 (29.5) | 31,325 (26.2) | 151 (36.3) | ||
| Yes | 104,698 (73.8) | 3358 (70.5) | 107,747 (73.8) | 309 (63.7) | ||
Bolded estimates are statistically significant (two-tailed p-value < 0.05); a Non-Hispanic other included non-Hispanic Native American/Alaska Native, Native Hawaiian/other Pacific Islander, or Asian respondents.
Table 3.
Adjusted Associations Between Sample Characteristics and Lifetime and Past-Year Synthetic Cannabis Use Among U.S. Adults (n = 139,532).
Table 3.
Adjusted Associations Between Sample Characteristics and Lifetime and Past-Year Synthetic Cannabis Use Among U.S. Adults (n = 139,532).
| Lifetime Synthetic Cannabis Use | Past-Year Synthetic Cannabis Use | |
|---|---|---|
| AOR (95% CI) a | AOR (95% CI) a | |
| Survey year (continuous) | 1.03 (0.97, 1.10) | 1.03 (0.81, 1.31) |
| Age | ||
| 18–25 | 1.95 (1.50, 2.54) | 4.28 (2.69, 6.82) |
| 26–34 | 8.25 (6.65, 10.23) | 2.59 (1.51, 4.45) |
| 35–49 | 4.32 (3.48, 5.35) | 2.39 (1.52, 3.76) |
| 50+ | REF | REF |
| Sex | ||
| Male | REF | REF |
| Female | 0.57 (0.51, 0.63) | 0.63 (0.47, 0.84) |
| Race and ethnicity | ||
| Hispanic | 0.46 (0.38, 0.55) | 0.63 (0.38, 1.05) |
| Non-Hispanic White | REF | REF |
| Non-Hispanic Black | 0.42 (0.33, 0.52) | 0.92 (0.59, 1.45) |
| Non-Hispanic multiracial | 0.95 (0.76, 1.20) | 0.43 (0.19, 0.95) |
| Non-Hispanic other b | 0.32 (0.23, 0.45) | 0.91 (0.32, 2.58) |
| Educational attainment | ||
| High school graduate or less | 2.16 (1.81, 2.57) | 1.83 (1.003, 3.35) |
| Some college | 1.92 (1.63, 2.27) | 1.15 (0.80, 2.83) |
| College graduate or higher | REF | REF |
| Annual household income | ||
| ≤$49,999 | 1.43 (1.25, 1.62) | 1.86 (1.13, 3.06) |
| $50,000–$74,999 | 1.32 (1.12, 1.55) | 1.15 (0.64, 2.04) |
| ≥$75,000 | REF | REF |
| Employment status | ||
| Employed | REF | REF |
| Unemployed | 0.89 (0.79, 1.01) | 1.08 (0.71, 1.63) |
| Metropolitan status | ||
| Large metropolitan | REF | REF |
| Small metropolitan | 1.18 (1.03, 1.34) | 0.79 (0.53, 1.19) |
| Non-metropolitan | 1.35 (1.15, 1.59) | 1.54 (1.03, 2.30) |
| State medical cannabis law coverage | ||
| No | 1.07 (0.93, 1.24) | 1.45 (1.09, 1.94) |
| Yes | REF | REF |
Bolded estimates are statistically significant (two-tailed p-value < 0.05); columns represent separate adjusted survey-weighted logistic regression models. a Adjusted odds ratios and 95% confidence intervals. b Non-Hispanic other included non-Hispanic Native American/Alaska Native, Native Hawaiian/other Pacific Islander, or Asian respondents.
Table 4.
Lifetime and Past-Year Synthetic Cannabis Use by Past-Year Plant-based Cannabis Use and Use Modalities (n = 139,532).
Table 4.
Lifetime and Past-Year Synthetic Cannabis Use by Past-Year Plant-based Cannabis Use and Use Modalities (n = 139,532).
| Lifetime Synthetic Cannabis Use | Past-Year Synthetic Cannabis Use | ||||||
|---|---|---|---|---|---|---|---|
| Overall | No | Yes | p | No | Yes | p | |
| Any plant-based cannabis use | <0.001 | <0.001 | |||||
| No | 100,657 (76.9) | 99,363 (78.2) | 1294 (30.0) | 100,573 (77.1) | 84 (14.8) | ||
| Yes | 38,875 (23.1) | 35,726 (21.8) | 3149 (70.0) | 38,499 (22.9) | 376 (85.2) | ||
| Smoking cannabis | <0.001 | <0.001 | |||||
| No | 109,129 (82.3) | 107,523 (83.5) | 1606 (38.3) | 108,992 (82.4) | 137 (32.7) | ||
| Yes | 30,403 (17.7) | 27,566 (16.5) | 2837 (61.7) | 30,080 (17.6) | 323 (67.3) | ||
| Vaping cannabis | <0.001 | <0.001 | |||||
| No | 123,186 (91.4) | 120,547 (92.2) | 2639 (60.8) | 122,950 (91.5) | 236 (47.5) | ||
| Yes | 16,346 (8.6) | 14,542 (7.8) | 1804 (39.2) | 16,122 (8.5) | 224 (52.5) | ||
| Dabbing cannabis | <0.001 | <0.001 | |||||
| No | 131,613 (96.3) | 128,260 (96.8) | 3353 (79.1) | 131,279 (96.4) | 334 (78.9) | ||
| Yes | 7919 (3.7) | 6829 (3.2) | 1090 (20.9) | 7793 (3.6) | 126 (21.1) | ||
| Ingesting cannabis | <0.001 | <0.001 | |||||
| No | 119,606 (88.7) | 116,868 (89.4) | 2738 (62.9) | 119,328 (88.8) | 278 (57.8) | ||
| Yes | 19,926 (11.3) | 18,221 (10.6) | 1705 (37.1) | 19,744 (11.2) | 182 (42.2) | ||
| Absorbing cannabis sublingually/orally a | <0.001 | <0.001 | |||||
| No | 137,201 (98.6) | 133,010 (98.7) | 4191 (95.4) | 136,769 (98.6) | 432 (95.5) | ||
| Yes | 2331 (1.4) | 2079 (1.3) | 252 (4.6) | 2303 (1.4) | 28 (4.5) | ||
| Applying cannabis topicals b | <0.001 | <0.001 | |||||
| No | 136,184 (98.0) | 132,075 (98.1) | 4109 (94.1) | 135,761 (98.0) | 423 (93.6) | ||
| Yes | 3348 (2.0) | 3014 (1.9) | 334 (5.9) | 3311 (2.0) | 37 (6.4) | ||
| Taking cannabis pills | <0.001 | <0.001 | |||||
| No | 138,466 (99.4) | 134,153 (99.4) | 4313 (97.3) | 138,021 (99.4) | 445 (97.0) | ||
| Yes | 1066 (0.6) | 936 (0.6) | 130 (2.7) | 1051 (0.6) | 15 (3.0) | ||
Bolded estimates are statistically significant (two-tailed p-value < 0.05); a Includes the use of cannabis drops, strips, lozenges, or sprays; b includes lotions, creams, or skin patches.
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MDPI and ACS Style
Mattingly, D.T.; Diaby, M.; Agbonlahor, O.; Hart, J.L. Disparities in Synthetic Cannabis Use Among U.S. Adults, 2022–2024. Psychoactives 2026, 5, 9. https://doi.org/10.3390/psychoactives5020009
AMA Style
Mattingly DT, Diaby M, Agbonlahor O, Hart JL. Disparities in Synthetic Cannabis Use Among U.S. Adults, 2022–2024. Psychoactives. 2026; 5(2):9. https://doi.org/10.3390/psychoactives5020009
Chicago/Turabian StyleMattingly, Delvon T., Meman Diaby, Osayande Agbonlahor, and Joy L. Hart. 2026. "Disparities in Synthetic Cannabis Use Among U.S. Adults, 2022–2024" Psychoactives 5, no. 2: 9. https://doi.org/10.3390/psychoactives5020009
APA StyleMattingly, D. T., Diaby, M., Agbonlahor, O., & Hart, J. L. (2026). Disparities in Synthetic Cannabis Use Among U.S. Adults, 2022–2024. Psychoactives, 5(2), 9. https://doi.org/10.3390/psychoactives5020009
