Abstract
BACKGROUND: Cannabis is the third most consumed drug worldwide, with its use linked to a high number of substance use disorders, particularly among young men. Associated mortality causes include traffic accidents and cardiovascular diseases. The global expansion of cannabis legalization has sparked debates about its impact on risk perception, with risk perception decreasing in countries with permissive laws. Social media analysis, such as on Twitter (subsequently rebranded as X), is a useful tool for studying these perceptions and their variation by geographic region. OBJECTIVE: This study aims to analyze Twitter users' perceptions of cannabis use and legalization, taking into account the geographic location of the tweets. METHODS: A mixed methods approach was used to analyze cannabis-related tweets on Twitter, using keywords such as "cannabis," "marijuana," and "hashish." Tweets were collected from January 1, 2018, to April 30, 2022, in English and Spanish, and only those with at least 10 retweets were included. The content analysis involved an inductive-deductive approach, resulting in the classification of tweets into thematic categories, including discussions on legalization. RESULTS: The tweet analysis showed that in America, Europe, and Asia, political discussions about cannabis were the most common topic, while personal testimonies dominated in Oceania and Africa. In all continents, personal experiences with cannabis use were mostly positive, with Oceania recording the highest percentage (1642/2695, 60.93%). Regarding legalization, Oceania also led with the highest percentage of tweets in favor (1836/2695, 68.13%), followed by America and Africa, while support in Europe and Asia was slightly lower, with about half of the tweets in favor. CONCLUSIONS: The political debate has been the most frequently mentioned topic, reflecting the current situation in which legislative changes are being discussed in many countries. The predominance of opinions in favor of legalization, combined with the prevalence of positive experiences expressed about cannabis, suggests that the health risks associated with cannabis use are being underestimated in the public debate.