This study examined the profile of people who use medicinal cannabis in California, delving into usage patterns, cannabis sources, guidance sources, patient-provider relationships, and driving behavior. Sixty percent of current cannabis users in California reported medicinal use of cannabis, with or without concomitant recreational use. This increase aligns with evolving societal attitudes and the California Department of Health's observations of increased cannabis use since 2012 (Ryan-Ibarra et al. 2015; California Department of Public Health 2020). Compared to national data, in 2018, California's estimated cannabis use stands at 17.7% versus the national average of 10.5% (California Department of Public Health 2020). Earlier studies likely represent underreporting due to lower social acceptance, making our current insights critical for further research in this evolving landscape.

In this environment of increasing cannabis use, including for medicinal reasons, our study examined where Californian medicinal users look for guidance on their use. Clinicians and medical providers are not the primary sources regarding products and dosing; participants were more likely to seek guidance from sources like the internet, friends and family, and budtenders. This can be especially true of individuals with higher educational levels (who may feel in a position to better interpret online information) (Pew Research Center 2014) or are either Hispanic and/or Black non-Hispanic (who may have larger communities to share information with) (USAFacts 2025). To our knowledge, there are limited studies that describe the demographic analysis of those going to dispensaries, especially in California (Kaufmann et al. 2022; Rosenthal and Pipitone 2021). Instead, individuals may discuss use with budtenders, who come with more “lived” experience with cannabis, may bring personal biases, often have limited in-depth cannabis knowledge, and are also tasked with promoting sales (Slawek et al. 2023). For example, one study found that over 65% of surveyed budtenders recommended cannabis use during the first trimester of pregnancy, despite limited or concerning evidence regarding this practice (Merlin et al. 2021).

Despite reported concerns of fear of stigma from providers, the majority of participants viewed their primary care doctors and health groups as more accepting of cannabis and reported openly discussing their medicinal cannabis use with primary doctor. A 2022 qualitative survey showed that medicinal cannabis users perceive stigma from their providers, even when they feel comfortable disclosing use (Crapanzano et al. 2018). Yet, several studies of physicians have found in knowledge gaps, mixed attitudes, and inconsistent recommendations for medicinal cannabis use (Kruger et al. 2023; Adler et al. 2022). One health system study found that just 10% of physicians in USA had ever authorized medical cannabis, with low self-perceived knowledge and competency. Their knowledge is primarily focused on the risks of use, but providers feel ill-equipped to discuss aspects of medicinal use such as dosing and harm-reduction strategies. Medical school curricula do not equip providers with the knowledge and skills to discuss medicinal cannabis with patients (Zolotov et al. 2021). In addition, little guidance or support is provided by medical societies and physicians may fear losing their medical license due to its federal Schedule I status (Drug Enforcement Administration 2025; Rønne et al. 2021). Further research into providers' knowledge and attitudes regarding cannabis/cannabinoids, along with expanded training, would be an important future step; greater knowledge and awareness would empower providers to discuss medicinal cannabis use without bias, allowing them to address benefits, risks, and guidance effectively.

Participants in both groups primarily sought pain management, with the M + R group also emphasizing stress and anxiety relief. Despite limited evidence and particularly randomized clinical trials on cannabis benefits for mental health issues such as anxiety, depression, and attention deficit hyperactivity disorder (ADHD) (National Academies of Sciences, Engineering, and Medicine 2017; Francisco et al. 2023; Schlienz et al. 2021), both groups reported mental health benefits, including improved focus and mental clarity (Schlienz et al. 2021). Self-medication is likely, as about 60% in both groups of participants reported replacing prescription medications with cannabis. This is similar to the findings of 2022 survey, where participants cited multiple reasons for substituting cannabis for medication, including perceived treatment inefficacy, negative side effects from traditional pharmaceuticals or expressed a preference for a natural approach (Garcia-Romeu et al. 2022). Other studies have demonstrated that people view cannabis as a safer alternative to prescription opioids (Mattson et al. 2021). The M + R group reported more negative effects; this may be associated with the use of higher doses and higher potency products among recreational users (Urits et al. 2021), though that was not explored in this study. Given the known gaps in accessing mental health and substance use treatment, along with the opioid crisis, it is important that patients have access to safe cannabis use education, patient risk screening, and are supported medically so they do not resort to self-medication (Francisco et al. 2023; Mattson et al. 2021; Buttorff et al. 2023; Kohn et al. 2018).

This study additionally found that medicinal-only users were more likely to report occasional cannabis use (1–3 times per week or less), while the M + R group were more likely to report very frequent (multiple times a day) use. This differs from a 2023 study of recreational and medicinal cannabis users, which showed a similar frequency of use between groups, although problematic use was more common in recreational users (Ataiants et al. 2024). Medicinal-only users also reported a longer wait time before they felt safe to drive after using cannabis; future research should explore this difference, which could be associated with the demographics of medicinal-only users (e.g., female, older), or their use patterns (e.g., occasional use, use for sleep). While the decision to drive after cannabis use is multifactorial, recognizing the differences between medicinal-only and M + R users may help guide outreach toward the higher risk group.

There were some notable differences between groups about how cannabis is obtained and used. Our study found that about 60% of medicinal-only users obtained cannabis from dispensaries and delivery services, with fewer medicinal-only users acquiring it from friends and family than the M + R group; this is a similar finding to a post-Prop 64 survey of young adults in Los Angeles County (D’Amico et al. 2020). This also aligns with medicinal users prioritizing treatment over social or recreational use; dispensaries may be perceived as more reliable, regulated, and safer, and provide a higher variety of products to appeal to medicinal users (e.g., tinctures, salves). Although almost all participants in our study used cannabis at their own homes, the M + R group was more likely to also use cannabis in other, more public, locations. Similar to other studies (Subbaraman and Kerr 2018), the medicinal-only group also reported less concurrent alcohol use than the M + R group. Our study did not investigate cannabis product storage or child access (i.e., to what degree do users ensure restricted access to children), which is an important area for further research.

Medicinal-only users in our study were more likely to be female, consistent with previous findings (Jeffers et al. 2021). This pattern may reflect a greater tendency among females to seek medical care and a preference for more traditional and natural products (Bertakis et al. 2000). Medicinal-only users also initiated cannabis use later in life, possibly due to development of specific medical conditions. In contrast, combined M + R users were more likely to be male and initiate cannabis use at a younger age; these trends are in line with previous research comparing medicinal to recreational use (Goulet-Stock et al. 2017) and further demonstrates that medicinal use type should be considered. For example, studies have shown that early initiation of substance use during brain development is known to have associated risks including the risk for cannabis use disorder (CUD) (Urits et al. 2021; Narouze et al. 2024). Education and prevention efforts may be more effective when the target population’s medicinal cannabis use pattern is considered (Goulet-Stock et al. 2017).

This study’s strengths include the substantial sample size of 4,020 current users, closely matching California's demographic distribution. It incorporated algorithmic technology for efficient interaction in open-ended queries and benefited from guidance from SME interviews and the exploratory questionnaire. However, the study does have limitations. The study was confined to California, limiting its generalizability to states where cannabis use remains illegal, access to products is likely more limited, and attitudes towards use may differ. Since we were limited to querying individuals 21 years of age and older, the study does not provide insights into use by younger individuals. The online questionnaire required access to phones or the internet, potentially excluding marginalized groups, though the degree to which that limits participation has declined significantly over the past decade (Subbaraman and Kerr 2018).