The increasingly permissive global attitude towards cannabis use has been met with a sharp, cautionary flag from the medical research community. A striking new analysis, presented this month at the Annual Meeting of The European Association for the Study of Diabetes (EASD) 2025 in Vienna, Austria (September 15-19), has unveiled a powerful statistical link: people who use cannabis are four times more likely to develop Type 2 diabetes compared to non-users.
This revelation lands squarely in the middle of a complex global debate, forcing policymakers, medical practitioners, and the public to weigh the reported therapeutic benefits of cannabis against a potentially grave, non-communicable disease risk. The implications are particularly acute in countries like Nigeria, where the substance remains strictly prohibited on public health and legal grounds.
The research, led by Dr. Ibrahim Kamel and a team from Boston Medical Center in Massachusetts, is the result of a vast, retrospective study that meticulously compared the medical data of well over 4 million people—a scale that lends significant weight to its findings, even prior to formal publication in a peer-reviewed journal.
The objective was to compare the incidence of Type 2 diabetes between a cohort of cannabis users and a much larger control group of non-users over a five-year period.
Study Size: Researchers identified 96,795 patients from 54 healthcare organizations across the United States and Europe with a documented history of cannabis use.
Control Group: This group was matched against a massive control group of 4,160,998 people with no recorded cannabis use.
Incidence Rate: The analysis revealed that the incidence of diabetes in the cannabis-using group was 2.2%, significantly higher than the 0.6% recorded in the non-user group.
Risk Calculation: After accounting for other significant confounding variables—including uncontrolled high blood pressure, cocaine and alcohol use, other lifestyle risk factors, and atherosclerotic cardiac disease—the four-fold increased risk became apparent.
As Dr. Kamel himself noted to Medical News Today, the magnitude of the finding was surprising: “The association was surprising, as we are still not sure of the mechanism, and it isn’t that obvious.”
An Association, Not Definitive Causation: The Scientific Caveat
Crucially, the study’s authors and attending experts were careful to apply the appropriate scientific caution. As a retrospective study, the research could only describe a strong association between cannabis use and Type 2 diabetes; establishing a direct, causal connection was beyond its scope. The data demonstrates correspondence, not definitive proof that cannabis causes the disease.
Despite this necessary caveat, the association is robust enough to demand deeper investigation into the underlying biological and behavioural mechanisms.
Dr. Jason Ng, a clinical associate professor of medicine specializing in endocrinology and metabolism at the University of Pittsburgh (who was not involved in the research), highlighted the complexity of the existing literature. “Studies regarding cannabis use and diabetes are limited, with some studies suggesting benefits and others showing worsening of sugar control. So this association is not necessarily surprising, given the lack of data across the board.”
This mixed literature underscores the need for clarity, yet the new study strongly shifts the balance towards caution.
The researchers propose two primary, interconnected pathways through which cannabis use might be fueling this heightened diabetes risk, both of which relate to the body's delicate balance of glucose and metabolism.
1. Disrupting Insulin Sensitivity via the Endocannabinoid System
The first proposed mechanism is deeply biological, focusing on how cannabis compounds interact with the body’s own regulatory systems.
Dr. Kamel explained that cannabis may contribute to Type 2 diabetes through "endocannabinoid system overstimulation, particularly CB1 receptor activation." This receptor activation, he contends, is known to be metabolically destabilizing, promoting:
Visceral Adiposity: The accumulation of harmful fat around internal organs.
Hepatic Fat Accumulation: The buildup of fat in the liver.
Insulin Resistance: A key characteristic of Type 2 diabetes, where cells stop responding effectively to the insulin hormone, forcing the pancreas to overproduce it until it fails.
Furthermore, Dr. Kamel cited broader physiological impacts, including "low-grade inflammation, oxidative stress, and potential beta-cell dysfunction, all of which impair glucose homeostasis." He also factored in associated lifestyle elements, such as "reduced physical activity and co-use of alcohol or nicotine," which could collectively amplify the risk.
However, Dr. Ng provided a necessary counterbalance, referencing the mixed findings that currently exist: “There is mixed literature currently, with some studies even showing a stable weight to weight loss and increased insulin sensitivity, which is paradoxical to this study’s findings. [This illustrates] how the interactions are likely complex and not understood completely between cannabis and development of [Type 2 diabetes].”
2. The Behavioural Pathway: The 'Munchies' and Poor Eating
The second, more readily observable pathway is behavioural, linking cannabis use to potentially catastrophic changes in dietary habits.
It is a well-known phenomenon that cannabis use induces powerful cravings—colloquially termed the "munchies." According to Dr. Kamel, “Experimental and epidemiologic data suggest that cannabis use can increase both the quantity and type of food consumed.”
The underlying cause is neurological: "The mechanistic evidence is that CB1 receptor activation heightens the reward value of palatable foods," he stated. This shift towards excess caloric load, often in the form of high-sugar or high-fat snacks, promotes central adiposity (fat around the waistline) and "glycemic stress," which in turn are major, preventable risk factors for Type 2 diabetes.
With 90% of global diabetes cases being Type 2, and often a byproduct of preventable risk factors, this behavioural mechanism may be a critically important—and actionable—component of the observed association.
This research emerges at a time when the global landscape regarding cannabis is undergoing rapid transformation.
The Centers for Disease Control and Prevention (CDC) notes that, despite its continued illegality at the federal level, cannabis is the most commonly used federally illegal drug in the U.S. Roughly 52.5 million people, or about 19% of U.S. residents, have used it at least once since 2021. As of this writing, 24 U.S. states have legalized its recreational use to some degree.
This relaxing of restrictions provides an urgent context for the study’s findings. The U.S. already grapples with a Type 2 diabetes crisis, affecting 38.4 million people of all ages, or 11.6% of the nation’s population, with 1.2 million people newly diagnosed every year.
When asked about the future of cannabis policy in light of the risks, Dr. Kamel struck a pragmatic tone: “while more evidence is growing regarding the use of cannabis (largely due to legalization), I personally do not think it will be reversed, as many other substances with established risks still remain accessible.”
His core purpose, he concluded, is clinical: “The purpose of this study is to help physicians risk-stratify patients and provide the best support for them.”
Dr. Ng echoed this focus on public health dialogue: “if this association is confirmed and a causative relationship found, this would be part of the public discussion on the pros and cons of cannabis use and may given some people in the public pause before pursuing [the use of cannabis] depending upon their specific circumstances.”
While the discussion in Vienna focused on markets with relaxing attitudes, the new evidence carries particular weight in nations maintaining a zero-tolerance policy, such as Nigeria.
The African giant is estimated by the World Health Organization (WHO) to have about 147 million people, or 2.5% of the global population, using cannabis, and Nigeria itself is consistently ranked as one of the world's highest consumers and cultivators of the substance in West Africa.
This high prevalence exists despite the incredibly strict and punitive legal framework. In Nigeria, the Federal Ministry of Health and Social Welfare operates within a legal environment defined by the National Drug Law Enforcement Agency (NDLEA) Act and the Indian Hemp Act. Under these statutes:
Cannabis is strictly illegal for both recreational and medicinal use. The NDLEA and the Ministry of Health have consistently maintained a stance of prohibition, citing the profound negative health, mental, and social consequences of drug abuse, particularly among the youth.
Severe Penalties: The law prescribes heavy custodial sentences for the possession, sale, or cultivation of cannabis, with the penalty for possession alone being not less than 15 years imprisonment under the NDLEA Act. Cultivation can carry sentences as severe as 21 years imprisonment or even the death penalty under the old Indian Hemp Act, which remains in force.
Public Health Mandate: The NDLEA's mandate, which aligns with the Ministry of Health's objective to promote public health, includes the "elimination of illicit demand for narcotic drugs and psychotropic substances" with a view to "reducing human suffering." The official stance is that the potential for widespread abuse and the overwhelming challenge of regulation in the Nigerian context outweigh any purported medical benefits, leading to a firm opposition to its legalization in any form.
The new research from the EASD meeting—which links cannabis to a fourfold increase in a major public health crisis like Type 2 diabetes—provides powerful additional scientific evidence to support the cautionary position held by Nigerian authorities. It reinforces the official argument that, regardless of trends in the U.S. or Europe, a substance carrying such a strong, documented health risk should not be liberalized.
Globally, the scientific landscape surrounding cannabis is becoming more complex, moving past simple narratives of harm reduction versus prohibition. The new EASD analysis, while yet to appear in a peer-reviewed journal, has thrown a significant complication into the debate, pointing to an alarming potential correlation between the use of popular cannabis products (including smokable cannabis in various forms, edibles, oils, and tinctures) and the development of Type 2 diabetes.
With approximately 589 million adults between the ages of 20 and 79 currently living with diabetes worldwide, and the WHO reporting that cannabis use is increasing more rapidly than other recreational substances, the necessity for fully informed public policy has never been more critical.
The ultimate takeaway from this research is not a declaration of outright cause, but a clear, urgent call to caution. It serves as a stark warning to users and a necessary tool for physicians globally, empowering them to properly risk-stratify patients. For nations like Nigeria, where the law already maintains a strict guard against the substance, the study provides fresh scientific validation for the prevailing policy of prohibition based on the protection of public health.
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