Sexual and gender minority (SGM) youth have significantly higher rates of cannabis use and misuse than heterosexual and cisgender youth. This is one of multiple health disparities experienced by this population including greater rates of cardiac disease, obesity, cancer, substance misuse, mood disorders, and suicidality. SGM youth experience significantly higher rates of youth homelessness as well. SGM experience greater barriers to accessing physical and mental healthcare, including substance abuse treatment due to stigma, lack of cultural competence among treatment providers, and low rates of health insurance coverage for these youth. Minority stress and stigma-based social isolation also influence health disparities for these youth. This chapter reviews the current state of knowledge related to rates of cannabis use and misuse among SGM youth, developmental tasks associated with middle adolescence and emerging adulthood, the impact of minority stress on neurobiological functioning, and risk factors for cannabis misuse among this population. This chapter reviews evidence-based interventions and validated assessment measures for youth who misuse cannabis. Finally, this chapter offers a review of treatment processes that are affirming of individuals with sexual and gender minoritized identities with suggestions for the integration of these practices into current evidence-based interventions.