Characterization of Cannabis Products Purchased for Medical Use in New York State

Authors: Alexandra F. Kritikos, Rosalie Liccardo Pacula

Affiliations: Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts; Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles; USC Institute for Addiction Sciences, University of Southern California, Los Angeles; Sol Price School of Public Policy, University of Southern California, Los Angeles; National Bureau of Economic Research, Cambridge, Massachusetts

License: Copyright 2022 Kritikos AF et al. JAMA Network Open. CC BY 4.0 This is an open access article distributed under the terms of the CC-BY License.

Article links: DOI: 10.1001/jamanetworkopen.2022.27735  |  PubMed: 35984662  |  PMC: PMC9391960

Relevance: Moderate: mentioned 3+ times in text

Introduction

Although the number of registered medical cannabis patients has grown,¹ evidence regarding effective medical cannabis products and appropriate dosing by condition remains elusive.^2,3 What little is known comes largely from self-reports,^4,5 which presumes patient knowledge of products and specific cannabinoids, particularly delta-9 tetrahydrocannabinol (THC) and cannabidiol (CBD). In this study, we examined cannabis purchases made by registered patients in a large medical cannabis state in the US and provide new evidence regarding cannabis products.

Methods

This cross-sectional study examined purchases of cannabis products by registered patients that were made in New York State from dispensaries operated by a single integrated manufacturer and retail company licensed within the state. New York requires dispensaries to report all patient purchases to the Department of Health with patient ID, qualifying conditions, age, and sex. These details, which are retained in the company’s data system, were provided under a Data Use Agreement to Brandeis University for the period January 2, 2016, through August 15, 2019. Institutional review board approval and informed consent were waived by Brandeis University’s Human Subjects Committee owing to deidentified data.

During this period, 27 349 patients purchased 79 885 products. To reduce noise from infrequent customers, we restricted our sample to 16 727 patients who made 2 or more visits (n = 16 727) and assessed the comparability of our sample with all registered patients in New York (Table 1). We then examined purchases by product type, cannabinoid formulation ratios, and labeled THC and CBD doses overall and by patient characteristics. Products included vaporizers, tinctures, tablets, and “other” (ie, lotions and suppositories); cannabis flower was excluded because its sale was prohibited in New York during the study period. Descriptive statistics were calculated using Stata version 16.0 (StataCorp LLC). This study followed the STROBE reporting guideline.

Results

Of the 16 727 patients in our sample, 52.6% were female and most (61.2%) were older than 50 years. The top 3 conditions or symptoms were severe pain (82.0%), chronic pain (51.9%), and neuropathy (22.1%), which is consistent with registered patients in New York overall (Table 1). Single-purchase patients were younger (18-30 years) and were less likely to have cancer and chronic pain.

Vaporizers were the most common product purchased (39.5%), as were products with a ratio of high THC to low CBD (52.4%) (Table 2). High-THC vaporizers, the most commonly purchased product overall, provide 2 mg THC per dose, whereas high-THC tinctures and tablets offer 10 mg THC per dose; the CBD dose in both products is 0.5 mg.

Men were more likely to purchase vaporizers (43.1%), whereas women more frequently purchased tinctures (41.7%) (Table 2). High-THC products were purchased predominantly by both men and women. Patients older than 65 years and less than 21 years were more likely to purchase tinctures (44.9% and 42.0%, respectively) (Table 2). Patients in other age groups generally purchased vaporizers. Patients in all age groups except those less than 21 years preferred high-THC products, particularly patients with cancer (55.3%), HIV/AIDS (66.5%), spinal cord injury (50.9%), neuropathy (48.0%), posttraumatic stress disorder (58.4%), chronic pain (56.2%), and opioid replacement (55.2%) (Table 2). Patients with seizures and epilepsy were more likely to purchase high-CBD products (55.1% and 56.4%, respectively) (Table 2).

Discussion

Our findings are consistent with those from self-reports^4,5 but reveal some new insights. First, there was considerable variability in preferred product form—and hence cannabinoid mix—across most conditions. Second, the THC dose of high-THC products varied considerably (2 mg vs 10 mg). Third, although patients with epilepsy and seizures purchase high-CBD products in this market, these products also contain THC—unlike Epidiolex, the only US Food and Drug Administration–approved cannabinoid for seizures.⁶ Clinicians should understand how doses vary by product when discussing cannabis use with patients.

This study has some limitations. Our analysis only considered purchases from a single company in 1 US state and did not include cannabis flower. Purchases in other US states or from other sources could differ. Nonetheless, these data may provide a useful starting point for clinicians when discussing medical cannabis use with their patients.

References

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