Highlights:
- Less than a third of youth maintained a single mode of cannabis use across legalization.
- More than three times as many participants expanded their use modes as reduced them.
- Maintenance of multiple modes was associated with other substance use and depressive symptoms
- Using cannabis in multiple ways linked to binge drinking and depressive symptoms
Conclusions: Multi-modal cannabis use increased among Canadian youth in our sample. Its association with other substance use and depressive symptoms may indicate clustering of additional harms. Screening for this use pattern may assist in identifying high-risk substance use and should be considered in the design of harm reduction programming.