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Legalization of recreational cannabis in the U.S. is associated with a rise in hospital admissions for cardiovascular disease, finds an analysis of more than 50 million patient discharge records, published in the open-access journal BMJ Open.

Admissions for atrial fibrillation (abnormal heart rhythm), heart failure and heart attack all rose faster after the law was enacted in the Western region of the U.S. with the policy than in states without it, the analysis shows.

Cannabis use has the potential to affect cardiovascular health through various physiological mechanisms, explain the researchers. And legalization policies have been associated with more widespread use of cannabis products, particularly among older people who are already at heightened risk of cardiovascular problems, they add.

As of June 2025, medicinal cannabis use was legal in 41 U.S. states, while recreational use was legal in 24, they point out.

To gauge the potential impact of recreational cannabis laws on cardiovascular health, the researchers obtained data on hospital discharge diagnoses and patient demographics from the National Inpatient Sample (NIS) for the years 2012–18 inclusive: NIS participating states cover around 97% of the U.S. population.

The researchers focused on the Western region of the U.S. (Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington and Wyoming), because it began legalizing recreational cannabis in January 2014.

This was nearly five years before other regions, so that by 2018, over 98% of people in the Western region lived in, or bordered, a state with legal cannabis sales.

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