When New York legalised recreational marijuana in March 2021, policymakers promised that regulation would improve public safety, reduce crime, and protect vulnerable populations through proper oversight. More than four years later, data reveals a complex picture of how legal marijuana in New York has affected usage patterns and public health.

Rising Usage Patterns Across Demographics

According to New York’s Behavioural Risk Factor Surveillance System, past-month marijuana use amongst adults increased from 12.6% in 2021 to 14.7% in 2023. More concerning is the trend amongst the heaviest users: daily or near-daily cannabis consumption rose from 5.9% to 6.7% during the same period.

The National Survey on Drug Use and Health reported that marijuana use disorder amongst New Yorkers aged 21 or older increased from 5.1% in 2021–2022 to 6.1% in 2022–2023. These figures suggest that legal marijuana in New York has coincided with measurable increases in both frequency and problematic use patterns.

Youth Cannabis Consumption Trends

Whilst youth use had been declining prior to legalisation, early evidence indicates a reversal of this positive trend. Amongst adolescents aged 12–20, past-year marijuana use increased from 18.5% to 19.2% between 2021–2022 and 2022–2023.

The CDC’s Youth Risk Behaviour Survey provides additional insight: amongst New York City high school students, current cannabis use increased from 11.7% in 2021 to 13.0% in 2023. Perhaps most troubling, the percentage of students who tried cannabis before age 13 rose from 4.5% to 5.2% during this period.

Emergency Department Visits and Poison Control Cases

Healthcare facilities across New York State have documented a dramatic increase in cannabis-related emergencies. Marijuana-related emergency department visits increased by 131% from 58,578 in 2019 to 135,300 in 2023, according to data obtained by the USA Today Network.

Poison control data reveals particular concerns regarding accidental exposure. Cannabis-related exposure cases statewide increased from 1,045 in 2021 to 1,498 in 2023. Within this trend, cases involving individuals under age 19 increased from 649 to 1,014, whilst edible-related cases rose from 528 to 960.

Dr Vince Calleo, medical director of the Upstate New York Poison Centre, warned that cannabis edibles often resemble everyday snacks, making them especially dangerous to young children. The centre handled more than 500 cannabis-related calls in 2024, with more than half involving children under six years old.

Legal Marijuana in New York and Vulnerable Populations

Pregnant women represent another vulnerable group showing increased consumption since the implementation of legal marijuana in New York. The Pregnancy Risk Assessment Monitoring System found that pregnant women reporting marijuana use during pregnancy increased from 4.2% in 2017–2018 to 5.1% in 2021–2022—a 21% increase.

Usage during the three months after pregnancy showed even steeper growth, rising from 4.9% to 8.5% during the same timeframe. This trend raises significant concerns given emerging research about potential impacts on foetal development and early childhood.

Health Disparities and Equity Concerns

Whilst arrest disparities for marijuana possession have decreased—with Black New Yorkers’ representation declining from 48% of possession arrests in early 2021 to 25% in early 2025—troubling health equity patterns have emerged.

Daily or near-daily cannabis use amongst non-Hispanic Black adults reached 10.2% in 2023, compared with 6.5% amongst non-Hispanic white adults. Between 2021 and 2023, this daily usage rate amongst Black New Yorkers increased from 8.5% to 10.2%, whilst remaining relatively stable amongst white residents.

These disparities translate into treatment needs: Black New Yorkers accounted for 38% of treatment admissions for marijuana in 2024, despite representing approximately 18% of the state’s population.

The Illicit Market Reality

Contrary to predictions that legalisation would eliminate illegal sales, New York has experienced a proliferation of unlicensed dispensaries. The New York Times reported nearly 3,000 unlicensed cannabis shops opened across New York City since 2021, compared with only 62 licensed dispensaries in the city.

Various estimates place the number of illicit shops even higher. Governor Kathy Hochul estimated 2,500 unlicensed marijuana shops in New York City alone, whilst the New York City Council estimated almost 8,000.

Attempts to address this issue have faced obstacles. After the state closed more than 1,000 unlicensed dispensaries through “Operation Padlock” in October 2024, a Queens judge ruled the action unconstitutional.

Cardiovascular and Metabolic Health Concerns

Recent medical research has identified serious health risks associated with regular cannabis consumption. A June 2025 meta-analysis published in BMJ Heart found that marijuana users face twice the risk of cardiovascular death and highly elevated risk of major adverse cardiac events.

A March 2025 meta-analysis from the Journal of the American College of Cardiology found that cannabis users have 51% higher odds of experiencing a heart attack compared with non-users. A large European study from September 2025 identified a fourfold increased risk of developing diabetes amongst marijuana users.

Mental Health and Cognitive Implications

The mental health implications of regular cannabis use are equally concerning. An April 2025 study from Canadian researchers found that individuals receiving emergency care for cannabis-related issues had a 1.5 times increased risk of developing dementia within five years compared with all acute-care recipients, and almost four times the risk compared with the general population.

A substantial Danish study from 2023 found that as many as 30% of schizophrenia cases in younger men are linked to marijuana use disorder. This finding underscores the serious psychiatric risks associated with regular consumption, particularly amongst young people whose brains are still developing.

Source: Learn About SAM