Cannabis use in Germany increased slightly but not significantly in the immediate period following partial legalization, according to an analysis by Eva Hoch, MD, from the Department of Psychiatry and Psychotherapy, Cannabinoids Research Group, University Hospital of Munich, Ludwig Maximilian University of Munich, Munich, Germany, and her colleagues, published in Deutsches Ärzteblatt International. These findings provide the first comprehensive national data since the Cannabis Act came into effect on April 1, 2024.

Hoch and her team analyzed data from the Epidemiological Survey of Substance Use Disorders (ESA), a national survey of German-speaking adults conducted every 3 years. Data come from the survey waves of 2012 (n = 9084), 2015 (n = 9204), 2018 (n = 9267), 2021 (n = 9046), and 2024 (n = 7534).

Researchers have shown that the 12-month prevalence of cannabis use increased continuously from 4.6% in 2012 to 8.8% in 2021.

A further increase to 9.8% was observed in 2024 compared with 2021, although this was not statistically significant.

This increase was predicted independently of legal changes and aligned with the steady increase from 2012 to 2021.

The analysis showed that the majority of the participants used marijuana (92.3%) and mainly smoked joints (88.6%). About 1 in 4 (25.7%) participants were members of a cannabis social club. The most frequent reasons for use were “to get high or have fun” (66.8%) and “to relieve stress or relax” (61.3%). Users were more likely to be men (65.6%) with a mean age of 34 years.

The Study

According to the study authors, it remains too early to see the clear effects of legal change. “The 12-month prevalence of cannabis use increased steadily from 4.6% in 2012 to 8.8% in 2021. A further increase of 9.8% was observed in 2024 compared to 2021, although this was not statistically significant,” wrote the authors.

The effects may need time to emerge because the data were collected 5-10 months after the law took effect.

Home cultivation was permitted only from April 2024, which may have delayed visible changes. Few cultivation permits were granted in 2024. The latest ESA wave occurred during the COVID pandemic, when previous studies reported an increased use. The prevalence in 2021 may have increased due to the pandemic.

Professor Benedikt Fischer, PhD, from the Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada, described the ESA as an “important addiction survey” providing insight into cannabis use trends.

Jakob Manthey, PhD from the Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany, confirmed the results align with assumptions that legalization has no short-term impact. He does not believe that legalization significantly changed the response behavior.

Daniel Kotz, PhD, professor and head, Addiction Research and Clinical Epidemiology Unit at Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Düsseldorf, Germany, stated that according to the 2025 Drug Affinity Study by the Federal Institute for Public Health, cannabis prevalence among 12- to 17-year-olds has not changed post-legalization. Kotz said, “It has increased among 18- to 25-year-old men but not among women.”

According to Fischer, the ESA data suggest that Germany should avoid commercializing cannabis production and distribution “as this is associated with an increase in consumption and health problems. Germany has a unique opportunity in the current situation to avoid these negative consequences.”

Manthey pointed out that the EKOCAN report combined eight surveys, providing information on consumption patterns after partial legalization. This includes data on the development of acute and chronic health problems, for example, from hospitals, as well as the prevalence of road traffic accidents involving cannabis use.

This short report offers preliminary insights into a potentially harmful development. “However, it is too early for a comprehensive scientific evaluation of the law and the derivation of robust recommendations for action,” Manthey emphasized. 

Kotz also pointed out that the law had only recently come into effect, and its full impact had likely not yet been fully realized. Kotz emphasized, “Further close scientific monitoring of cannabis use in Germany will be necessary in the coming years.”

This story was translated from Medscape’s German edition.