In this study from Lebanon, we examine young adults’ attitudes towards the legalization of cannabis for medicinal and/or recreational purposes and describe the socio-demographic and other characteristics differentiating those who oppose from those who support legalization. The significance of the country is in its positioning both as a prominent producer, so far illicitly, of cannabis and a consumer of the substance for recreational purposes. Besides Iran, Lebanon is also one of the few countries with a significant Muslim population and a fragile geopolitical context where this subject has been studied. A review of the attitudes of youth towards substance use in this part of the world suggest a role, amongst others, for religious dogma that may be absent in western societies (Khoury et al. 2019). In our sample around 60% were supportive of recreational cannabis legalization, in line with the percentage of supportive youth in Australia and the US, despite methodological differences (Ghandour et al. 2024, Khoury et al. 2019). We observed important variations, particularly that young adults who were male, non-students, working and of a higher perceived socioeconomic status were the ones most likely to be supportive of cannabis legalization for medicinal and recreational use. The profile of cannabis legalization supporters seems to vary between countries. A survey of young people from Finland suggests that females are more likely to support legalization for medical purposes (Rudy et al. 2021), while an Australian study found older females to be the most liberal on cannabis legalization. These differences could also reflect different gender dynamics influenced by the social, cultural and religious context of Lebanon. The social structure in Lebanon remains highly patriarchal, with males being significantly more likely to voice controversial opinions or act on the fringe of lawful boundaries. This is particularly the case within low SES circles where the influence of tradition and religious conservatism is stronger.

Another interesting finding is the association between wealth perception and support for legalization; young adults in our sample who perceived themselves to be wealthier were more supportive of the legalization of cannabis (both for recreational and medicinal purposes). It is established that individuals with higher socioeconomic status usually experience fewer legal or financial consequences related to cannabis use, paving the way for more liberal attitudes on legalization (Chiu et al. 2022). Additionally, some studies argue that wealthier individuals might be more involved in communities that advocate for reform, influencing their attitudes through more liberal social networks (Hupli et al. 2024). As highlighted by studies on drug policy attitudes, higher socioeconomic groups often have more exposure to discussions around cannabis and its benefits, which can further shape their perceptions more positively (Shover and Humphreys 2019). The intersection between socioeconomic status and perception towards cannabis legislation is multifaceted, involving personal experience, community affluence, and societal trends. This complex relation can vary from one country to another as it integrates the sociocultural and religious context.

Expectedly, the perception of cannabis harm was highest for daily use and lowest for trying once or twice, and this was true regardless of attitude towards legalization. Quite interestingly, the perception of harm was always higher in the oppositional rather than supportive groups (the latter more likely to perceive cannabis as less harmful). This is in line with ongoing social debates about the risks versus the benefits of cannabis, with potential implications for health campaigns aimed at educating the public about safe use practices (Pacula and Smart 2017). From global experience, this debate does not end when cannabis is legalized. Even in countries with progressive cannabis laws, scepticism about its widespread use is prevalent (Stephenson et al. 2023).

In terms of actual consumption, our study revealed some meaningful behavioural trends in cannabis use. Over 40% of respondents reported using cannabis in conjunction with alcohol or other drugs. Nearly one-third reported driving under the influence of cannabis. International experience so far suggests that legalization does not improve this particular risky behaviour. While more research is needed, impaired driving under the influence has been highlighted as a public health issue where cannabis has been legalized (Hall and Weier 2015). Our survey further highlighted that the percentage of young adults driving under the influence of cannabis was highest in those supportive of legalization and lowest in those who were oppositional. A 2022 scoping review found, among other factors, that having a reduced perception of danger was linked to a higher likelihood of driving under the influence of cannabis (DUIC); reduced perception of cannabis harm in our study was indeed linked to more lenient attitudes towards legalization and the latter was linked to a higher likelihood of DUIC (Lopez-Quintero et al. 2011). If indeed easier access to cannabis legally means more young people driving under its influence, there is a need for clear regulations and educational interventions to prevent this and other dangerous behaviours associated with cannabis use. A major challenge for a fragile country such as Lebanon is the weakness of the central state authority and the inability of law enforcement agencies to effectively police a surge in antisocial behaviour involving cannabis directly or indirectly.

There are limitations to the study. First, given the sampling methodology adopted, selection bias cannot be ruled out, and the young adult sample is likely not representative of Lebanon’s young adult population. The survey was released within months of the news of cannabis legalization for therapeutic use, a period that coincided with the COVID-19 pandemic and the national lockdowns. An online survey was the only viable choice, and therefore the convenience sampling adopted to recruit young adults aged 18 to 24 is likely to have resulted in selection bias. In fact, when comparing our estimates to the statistics made available by CAS/ILO, our sample appears to be skewed toward certain subgroups of Lebanese young adults (ILO 2018). In particular, it over-represents males, university students, and Bachelors’ degree holders, while under-representing less-educated or non-student youth. The proportion reporting unemployment (68%) is higher than official youth unemployment estimates (~ 48%), likely reflecting differences in definition and a student-heavy sample. Socioeconomic self-perceptions in our sample also suggest relatively better-off participants than expected in the broader population. Overall, our sample provides insight into digitally connected and educated young Lebanese, and is not fully representative of the national 18–24 cohort. Another limitation is inherent to the cross-sectional nature of the study, which precludes causal inference regarding risky behaviours, perceptions of harm and legalization attitudes. While causality or bidirectionality cannot be established in a cross-sectional design, the observed associations remain valuable in highlighting potential prevention and intervention pathways. These insights, however, should be interpreted with caution, as our sample—being more male, more highly educated, and more student-oriented than the broader Lebanese youth population—reflects a particular youth profile. Accordingly, prevention approaches informed by these findings may be most relevant to similarly profiled subgroups of young adults.