Comparing medical cannabis use in 5 US states: a retrospective database study
Abstract
Background:
US states have been adopting their own medical cannabis laws since 1996. There is substantial variability in the medical cannabis programs between states, and these differences have not been thoroughly investigated in the literature. The objective of the study was to compare medical cannabis patient characteristics across five states to identify differences potentially caused by differing policies surrounding condition eligibility.
Methods:
We conducted secondary analyses following a retrospective study of a registry database with data from 33 medical cannabis evaluation clinics in the US, owned and operated by CB2 Insights. This study narrowed the dataset to include patients from five states with the largest samples: Massachusetts (n = 27,892), Colorado (n = 16,434), Maine (n = 4591), Connecticut (n = 2643), and Maryland (n = 2403) to conduct an in-depth study of the characteristics of patients accessing medical cannabis in these states, including analysis of variance to compare average ages and number of conditions and chi-squared tests to compare proportions of patient characteristics between states.
Results:
Average ages varied between the states, with the youngest average in Connecticut (42.2) and the oldest in Massachusetts (47.0). Males represented approximately 60% of the patients with data on gender in each state. The majority of patients in each state had cannabis experience prior to seeking medical certification. Primary medical conditions varied for each state, with chronic pain, anxiety, and back and neck problems topping the list in varying orders for Massachusetts, Maine, and Maryland. Colorado had 78.7% of patients report chronic pain as their primary condition, and 70.4% of patients in Connecticut reported post-traumatic stress disorder as their primary medical condition.
Conclusion:
This study demonstrated the significant impact that policy has on patients’ access to medical cannabis in Massachusetts, Colorado, Maine, Connecticut, and Maryland utilizing real-world data. It highlights how qualifications differ between the five states and brings into question the routes through which patients in states with stricter regulations surrounding eligible conditions choose to seek treatment with cannabis. These patients may turn to alternative treatments, or to the illicit or recreational cannabis markets, where permitted.
Supplementary Information:
The online version contains supplementary material available at 10.1186/s42238-021-00075-z.
Article type: Research Article
Keywords: Medical cannabis regulations, Laws, Chronic pain, Anxiety, Post-traumatic stress disorder, State differences
Affiliations: CB2 Insights, 5045 Orbitor Dr, Building 11, Suite 300, Mississauga, ON L4W 4Y4 Canada
License: © The Author(s) 2021 CC BY 4.0 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Article links: DOI: 10.1186/s42238-021-00075-z | PubMed: 34044878 | PMC: PMC8161659
Relevance: Moderate: mentioned 3+ times in text
Full text: PDF (697 KB)
References
- 128th Maine Legislature. An act to amend Maine’s medical marijuana law. http://legislature.maine.gov/legis/bills/getPDF.asp?paper=HP1060&item=1&snum=128. Accessed 11 Aug 2020.
- 2018 NSDUH Detailed Tables | CBHSQ Data. https://www.samhsa.gov/data/report/2018-nsduh-detailed-tables. Accessed 27 Mar 2020.
- Alsherbiny MA, Li CG. Medicinal cannabis-potential drug interactions. Med (Basel, Switzerland). 2018;6(1). 10.3390/medicines6010003.
- KF Boehnke, S Gangopadhyay, DJ Clauw, RL Haffajee. Qualifying conditions of medical cannabis license holders in the United States. Health Aff, 2019. [DOI]
- KF Boehnke, E Litinas, DJ Clauw. Medical cannabis use is associated with decreased opiate medication use in a retrospective cross-sectional survey of patients with chronic pain. J Pain, 2016. [DOI | PubMed]
- KF Boehnke, JR Scott, E Litinas, S Sisley, DA Williams, DJ Clauw. Pills to pot: observational analyses of cannabis substitution among medical cannabis users with chronic pain. J Pain, 2019. [DOI | PubMed]
- KM Bohnert, BE Perron, L Ashrafioun, F Kleinberg, M Jannausch, MA Ilgen. Positive posttraumatic stress disorder screens among first-time medical cannabis patients: prevalence and association with other substance use. Addict Behav, 2014. [DOI | PubMed]
- Bureau UC. U.S. Median Household Income Up in 2018 From 2017. https://www.census.gov/library/stories/2019/09/us-median-household-income-up-in-2018-from-2017.html. Accessed 25 Mar 2020.
- C Cambron, K Guttmannova, CB Fleming. State and national contexts in evaluating cannabis laws: a case study of Washington state. J Drug Issues, 2017. [DOI | PubMed]
- H Carliner, QL Brown, AL Sarvet, DS Hasin. Cannabis use, attitudes, and legal status in the U.S.: a review. Prev Med (Baltim), 2017. [DOI]
- M Cerdá, C Mauro, A Hamilton, NS Levy, J Santaella-Tenorio, D Hasin. Association between recreational marijuana legalization in the United States and changes in marijuana use and cannabis use disorder from 2008 to 2016. JAMA Psychiatry, 2020. [DOI | PubMed]
- M Cerdá, M Wall, T Feng, KM Keyes, A Sarvet, J Schulenberg. Association of state recreational marijuana laws with adolescent marijuana use. JAMA Pediatr, 2017. [DOI | PubMed]
- M Cerdá, M Wall, KM Keyes, S Galea, D Hasin. Medical marijuana laws in 50 states: investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence. Drug Alcohol Depend, 2011. [DOI | PubMed]
- Colorado – Official State Web Portal. Qualifying medical conditions Medical Marijuana Registry. https://cdphe.colorado.gov/apply-colorado-medical-marijuana-card. Published 2019. Accessed 11 Aug 2020.
- Connecticut State Department of Consumer Protection. Qualification Requirements. https://portal.ct.gov/DCP/Medical-Marijuana-Program/Qualification-Requirements. Published 2020. Accessed 11 Aug 2020.
- DISA Global Solutions. Map of marijuana legality by state. Retrieved from URL https://disa.com/map-of-marijuana-legality-by-state. 2019.
- DT Eurich, JG Hanlon, JJ Boisvenue, H Meng, JRB Dyck. A description of the medical cannabis use in Ontario, Canada. Cannabis Cannabinoid Res, 2019. [DOI]
- BJ Fairman. Trends in registered medical marijuana participation across 13 US states and District of Columbia. Drug Alcohol Depend, 2016. [DOI | PubMed]
- FDA Regulation of Cannabis and Cannabis-Derived Products, Including Cannabidiol (CBD). U.S. Food and Drug Administration. https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd. Accessed 1 Feb 2020.
- Ghaffarzadegan N, Ebrahimvandi A, Jalali MS. A dynamic model of post-traumatic stress disorder for military personnel and veterans. 2016;11(10):e0161405. 10.1371/journal.pone.0161405.
- DM Gorman, JC Huber. Do medical cannabis laws encourage cannabis use?. Int J Drug Policy, 2007. [DOI | PubMed]
- Guzman GG. American Community Survey Briefs. www.census.gov/programs. Accessed 6 Apr 2020.
- Legislatures NC of S. State medical marijuana laws. https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx. 2020.
- M Leyton. Cannabis legalization: did we make a mistake? Update 2019. J Psychiatry Neurosci, 2019. [DOI | PubMed]
- P Lucas, EP Baron, N Jikomes. Medical cannabis patterns of use and substitution for opioids & other pharmaceutical drugs, alcohol, tobacco, and illicit substances; results from a cross-sectional survey of authorized patients. Harm Reduct J, 2019. [DOI | PubMed]
- VK Mahabir, JJ Merchant, C Smith, A Garibaldi. Medical cannabis use in the United States: a retrospective database study. J Cannabis Res, 2020. [DOI | PubMed]
- Marijuana Decriminalization & Its Impact on Use – NORML – Working to Reform Marijuana Laws. https://norml.org/aboutmarijuana/item/marijuana-decriminalization-its-impact-on-use-2. Accessed 9 Apr 2020.
- A Mead. The legal status of cannabis (marijuana) and cannabidiol (CBD) under U.S. law. Epilepsy Behav, 2017. [DOI | PubMed]
- Medical Marijuana Patient Numbers. https://www.mpp.org/issues/medical-marijuana/state-by-state-medical-marijuana-laws/medical-marijuana-patient-numbers/. Accessed 5 Jan 2021.
- Natalie M. LaPride – Maryland Medical Cannabis Commission. Patients – who is eligible to register as a patient. https://mmcc.maryland.gov/pages/patients.aspx. Accessed 11 Aug 2020.
- RL Pacula, R Smart. Medical marijuana and marijuana legalization. Annu Rev Clin Psychol, 2017. [DOI | PubMed]
- RG Pertwee. Pharmacology of cannabinoid CB1 and CB2 receptors. Pharmacol Ther, 1997. [DOI | PubMed]
- RG Pertwee, AC Howlett, ME Abood, SPH Alexander, V di Marzo, MR Elphick. International Union of Basic and Clinical Pharmacology. LXXIX. Cannabinoid receptors and their ligands: beyond CB(1) and CB(2). Pharmacol Rev, 2010. [DOI | PubMed]
- BJ Piper, ML Beals, AT Abess. Chronic pain patients’ perspectives of medical cannabis, 2017
- BJ Piper, RM Dekeuster, ML Beals. Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep. J Psychopharmacol, 2017. [DOI | PubMed]
- A Reiman. Medical cannabis patients: patient profiles and health care utilization patterns. Complement Health Pract Rev, 2007. [DOI]
- M Sexton, C Cuttler, JS Finnell, LK Mischley. A cross-sectional survey of medical cannabis users: patterns of use and perceived efficacy. Cannabis Cannabinoid Res, 2016. [DOI | PubMed]
- Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in anxiety and sleep: a large case series. Perm J. 2019;23(18-041). 10.7812/TPP/18-041.
- The 191st General Court of The Commonwealth of Massachusetts. Chapter 369 – An act for the humanitarian medical use of marijuana. https://malegislature.gov/Laws/SessionLaws/Acts/2012/Chapter369. Published 2012. Accessed 11 Aug 2020.
- U.S. Census Bureau QuickFacts: United States. https://www.census.gov/quickfacts/fact/table/CT,CO,MD,ME,MA,US/PST045218. Accessed 9 Apr 2020.
- US Income Statistics – Current Census Data for Zip Codes. https://www.incomebyzipcode.com/. Accessed 27 Mar 2020.
- VA and Marijuana – what veterans need to know – Public Health. https://www.publichealth.va.gov/marijuana.asp. Accessed 22 Apr 2020.
