Economic burden of eosinophilic esophagitis in the first year after diagnosis in Spain: A direct medical cost analysis.

Cannabis is the most widely used illicit substance among adolescents and young adults (AYAs) in the U.S. [, , , ]. While federally illegal, the legal landscape of cannabis at the state and local levels has undergone significant transformation. As of April 2025, cannabis for medical use is legal in 38 U.S. states, with 24 states and the District of Columbia (DC) having additionally legalized recreational cannabis, up from only two states a decade earlier []. Other than DC and Virginia, states that have legalized recreational cannabis use have further established retail cannabis markets or have retail markets pending, making cannabis easily accessible to a majority of the U.S. population [, , , , ]. All the states with retail cannabis further impose excise taxes on these products, with the expectation that these taxes will reduce harmful cannabis use while generating tax revenues []. Unlike adult use of cannabis, which could have potential benefits in pain management, cannabis use at a young age can harm the developing brain and lead to lifelong addiction and adverse consequences (e.g., psychosis) []. While there is mixed evidence on whether cannabis legalization is associated with increased cannabis use among youth, concerns persist over the potential long-term impacts of cannabis access and use on adolescent health [, , ]. Studies have demonstrated that while recreational cannabis sales are restricted for AYAs younger than 21, a majority of AYA users reported buying cannabis from dispensaries or friends and family who have access to dispensaries [, ]. Since excise taxes are the most adopted policy to regulate retail cannabis, whether these taxes prevent the initiation and escalations of cannabis use among AYAs is of particular interest for policymakers and is the primary public health justification for taxing cannabis [, , , , , , , , ]. Economic theory further predicts that younger consumers who have limited budgets are more sensitive to cannabis price and taxes than older adults, making cannabis taxation a potentially powerful tool for use prevention. Using Monitoring the Future surveys, two studies estimated that a 10% increase in cannabis prices is associated with about 3% less cannabis use among youth [, ]. Additional research using observational surveys and behavioral purchasing experiments similarly shows that higher cannabis prices are associated with reduced AYA cannabis use [, , , , , ], with participation elasticities in the range of -0.2 to -0.3 [, , ]. However, many of these studies have limitations such as focusing on associations instead of causation or reliance on historical price and behavioral data collected when cannabis products were largely illegal [, , , , ]. As legal and illegal cannabis products, and as a result, taxed and untaxed products, increasingly co-exist in the US, how AYA consumers respond to changes in cannabis prices and taxes merits additional investigation.