New York's Cannabis Treatment System Is Collapsing Just as Youth Need It Most
Treatment admissions for cannabis use disorder in NY have dropped 50% while emergency room visits climb. Young people face a system that wasn't built for them—and isn't adapting fast enough.
Cannabis treatment admissions in New York have dropped by half over the past eight years. Emergency departments across the state are seeing more young people arrive in distress from high-potency marijuana, but most walk out without a referral to care. Pediatricians say they lack the training to identify cannabis use disorder in adolescents. And the state's primary addiction agency is only now planning its first statewide survey to understand what's actually happening.
This is the paradox of New York's legalization era: as adult cannabis use becomes normalized and widely available, the infrastructure to help young people struggling with it is quietly disappearing.
The Numbers Don't Add Up
Between 2015 and 2023, treatment admissions for cannabis use disorder in New York fell from roughly 20,000 to fewer than 10,000—a 50% decline, according to state data reviewed by the Times Union. Over the same period, emergency department visits related to cannabis increased, particularly among adolescents and young adults.
Dr. Madeline Renny, an assistant professor of emergency medicine and pediatrics at Mount Sinai, has spent the past two years trying to bridge that gap. Her research focuses on how emergency departments can better connect young cannabis users to treatment after a crisis visit.
"Kids less than 18 have fewer resources for substance use than adults," Renny told the Times Union, "and very few youth with substance use disorders are linked to care."
The problem isn't a lack of need. National data from SAMHSA shows that about 3.8% of youth and 15.3% of young adults require substance use treatment in any given year. But only 0.6% of youth and 1.6% of young adults actually receive it. For cannabis specifically, that gap is even wider—because the system was built around opioids, alcohol, and stimulants, not marijuana.
Why the Drop?
Several forces are colliding. First, legalization has reduced stigma around cannabis use, which sounds positive—until you realize it also reduces the perceived urgency of seeking help. Parents who once might have intervened when they found marijuana in their teenager's room now shrug it off as "just weed."
Second, the treatment system itself deprioritized cannabis. As opioid overdoses climbed and fentanyl flooded communities, state and federal resources shifted toward medications for opioid use disorder—buprenorphine, methadone, naloxone. Cannabis treatment became an afterthought.
Third, there's a mismatch in how young people access care. Adults with substance use disorders often enter treatment through the criminal justice system, employee assistance programs, or their own recognition that something is wrong. Adolescents rarely have those pathways. They depend on parents, schools, and pediatricians to notice the problem. And right now, none of those systems are equipped.
A 2025 study published in the journal Addictions analyzed who seeks cannabis use disorder treatment in New York. Researchers found that adolescents, pregnant women, and people with co-occurring mental health disorders were significantly underrepresented in treatment settings—despite being at higher risk for severe outcomes. The study called for "enhanced availability of treatment services for vulnerable populations" and recommended that emergency care providers begin screening for cannabis use disorder.
But most emergency departments don't do that. They stabilize the patient and send them home.
What Emergency Departments Are Missing
Renny's research at Mount Sinai began with a simple observation: teenagers were showing up to the ER with severe anxiety, paranoia, and hyperemesis syndrome (a condition where chronic cannabis use causes repeated vomiting). The ED would treat the symptoms, discharge the patient, and move on.
No one asked about long-term use. No one offered a referral to outpatient counseling. No one connected the patient to resources that could actually address the underlying problem.
"Very few youth with substance use disorders are linked to care," Renny said. Her current work aims to change that by developing protocols that emergency departments can use to screen young cannabis users and connect them to follow-up treatment within 48 hours.
The challenge is that cannabis use disorder doesn't present like opioid use disorder. There's no overdose antidote, no medication-assisted treatment, no clear medical emergency that forces intervention. Instead, it's a slow escalation—higher doses, more frequent use, withdrawal symptoms when stopping, academic decline, social isolation—that families often don't recognize until it's entrenched.
And by the time a young person ends up in the ER, they've usually been struggling for months or years.
Pediatricians Aren't Trained for This
Primary care should be the first line of defense. But pediatricians report feeling underprepared to screen for cannabis use disorder or counsel families about it.
Part of the problem is that cannabis has been reclassified in the public mind as "safe" or "medicinal." Parents are more likely to ask about vaping nicotine than marijuana. And when doctors do bring it up, they lack the tools to distinguish between occasional adolescent experimentation and a developing addiction.
The DSM-5 criteria for cannabis use disorder include symptoms like using more than intended, unsuccessful attempts to quit, cravings, continued use despite social or interpersonal problems, and tolerance. But those signs are subtle in teenagers, who are already navigating identity formation, peer pressure, and academic stress.
Dr. June Chin, chief medical officer of the Office of Cannabis Management in New York, acknowledged the gap in a recent interview. "We need better training for healthcare providers," she said, "so they can identify when cannabis use crosses the line from recreational to problematic."
OASAS, the state's addiction services agency, funds treatment and prevention providers across New York, including in rural counties where access is especially limited. But the agency's website notes that only about 900 programs statewide offer specialized care for substance use disorders—and not all of them have the capacity to treat adolescents or cannabis-specific issues.
Commissioner Arlene Cunningham told the Times Union that OASAS is planning a statewide survey to understand young people's perceptions of cannabis, their attitudes, and their usage patterns. That data will inform future prevention and treatment strategies. But the survey hasn't launched yet, and it will take months to analyze the results once it does.
In the meantime, the gap is widening.
Where Do Young People Go for Help?
For adults struggling with cannabis addiction, Marijuana Anonymous meetings offer peer support and a 12-step framework. But those meetings are sparse in New York, and even more so in rural areas. One user profiled in the Times Union article said he couldn't find a meeting within an hour of his upstate New York home. He eventually found a group after moving to Washington, D.C., where meetings were a 25-minute train ride away. The first time he walked in, he was high. The group clapped and hugged him.
That kind of support is critical—but it's not treatment. Cognitive behavioral therapy (CBT), motivational enhancement therapy (MET), and family-based therapy have the strongest evidence for treating cannabis use disorder in adolescents, according to NCBI research. But accessing those services requires insurance, transportation, parental involvement, and a provider who specializes in adolescent substance use. In many parts of New York, at least one of those pieces is missing.
Columbia University's Substance Treatment and Research Service (STARS) offers one-on-one therapy and computer-assisted behavioral therapy for cannabis use disorder, but it's one of only a handful of specialized programs in the state. Most outpatient clinics that treat adults don't have the staff or expertise to work with teenagers.
OASAS does fund youth-specific programs, and New York's Marijuana Regulation and Taxation Act (MRTA)—the law that legalized adult use—earmarked tax revenue for the Drug Treatment and Public Education Fund. That fund requires the Department of Health and OASAS to establish substance use disorder treatment programs for youth and adults. But the rollout has been slow, and advocates say the infrastructure isn't keeping pace with the need.
What Needs to Change
The Times Union article, OASAS data, and public health researchers all point to the same gaps:
Screening in emergency departments. Every adolescent who presents with cannabis-related symptoms should be screened for cannabis use disorder and offered a warm handoff to outpatient care within 48 hours.
Training for pediatricians. Medical schools and residency programs need to teach primary care providers how to identify problematic cannabis use in adolescents and how to have evidence-based conversations with families.
Specialized treatment capacity. New York needs more outpatient programs with the expertise to treat cannabis use disorder in teenagers—not just adults. That includes CBT, MET, and family therapy delivered by clinicians who understand adolescent development.
Public education. Legalization brought cannabis out of the shadows, but it also created confusion about risk. Parents need clear, accurate information about the difference between adult use and adolescent harm.
OASAS's planned statewide survey is a start. But surveys take time, and young people are struggling now. Renny's work at Mount Sinai offers a more immediate path: equip emergency departments with the tools to intervene at the moment of crisis, when families are most open to help.
The Timing Matters
New York legalized adult cannabis use in 2021. Five years later, the state is still figuring out how to regulate dispensaries, tax products, and prevent illicit sales. The public health side of legalization—treatment, prevention, education—has lagged behind.
Other states have faced similar challenges. Colorado, which legalized recreational cannabis in 2012, saw a surge in emergency department visits related to high-potency edibles and concentrates. It took years for the state to implement packaging regulations, potency limits, and public health campaigns. By the time those measures were in place, thousands of adolescents had already developed cannabis use disorder.
New York has the advantage of hindsight. The state can learn from Colorado, Washington, and other early adopters. But so far, that hasn't translated into a coordinated response. The gap between legalization policy and treatment infrastructure keeps growing.
Renny put it simply: "We need to meet young people where they are—and that's often the emergency department. If we can't connect them to care in that moment, we've lost the opportunity."
For the 10,000 fewer New Yorkers who sought cannabis treatment last year compared to 2015, that opportunity may already be gone.
Written by
MTNYC Editorial TeamThe MTNYC Editorial Team is a group of healthcare writers, researchers, and addiction specialists dedicated to providing accurate, compassionate, and evidence-based information about addiction treatment and recovery resources in New York State.
