Associations of delta-9-tetrahydrocannabinol quantity and Cannabis use frequency with Cannabis use disorder among adults who use Cannabis in the United States.

Borodovsky J.; Wall M.; Struble C.; Liu J.; Budney A.; Hasin D. · Preventive medicine · 2026

**Background & Methods** This cross-sectional survey examined relationships between delta-9-tetrahydrocannabinol (THC) quantity and cannabis use frequency with cannabis use disorder (CUD) among 3,303 past-month cannabis users in the United States. Participants completed the Cannabis Exposure Index online survey from August 2024 to January 2025, with logistic and linear regression analyses examining three CUD outcomes: diagnosis, individual criterion endorsement, and total criteria count, adjusted for sociodemographics. **Key Findings** • Higher milligrams of THC per using day significantly predicted greater odds of CUD diagnosis (OR = 1.28, 95% CI: 1.20–1.37) and greater total criteria count (β = 0.84, 95% CI: 0.61–1.07), demonstrating a dose-response relationship. • Cannabis users on 1–10 days per month had substantially lower CUD odds compared to daily users (OR = 0.28, 95% CI: 0.20–0.40), indicating frequency is an independent risk factor. • THC quantity was a stronger predictor of CUD among lower-frequency users than higher-frequency users (interaction p = 0.030), and higher THC was most strongly associated with time spent using, tolerance development, and hazardous use criteria. **Dosage & Administration** The study measured THC exposure as milligrams of THC per using day but did not specify absolute dose ranges or administration routes. **Safety & Adverse Effects** Not reported. The study focused on associations with CUD diagnostic criteria rather than acute adverse effects. **Evidence Quality** This study has moderate limitations: it is cross-sectional, preventing causal inference; relies on self-reported data; involves a convenience sample from an online survey, potentially introducing selection bias; and was conducted in the United States, limiting generalizability. The study provides observational evidence (Level 3) suggesting both THC potency and use frequency independently contribute to CUD risk. A key strength is the large sample size (N = 3,303) and examination of dose-response relationships with specific CUD criteria. The authors appropriately conclude that cannabis exposure should be characterized by both frequency and THC content, rather than either factor alone.

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