Authors of a new study in Journal of the American Medical Association (JAMA) that looked at survey responses from more than 175,000 people say the typical medical–recreational binary may not adequately capture how people say they use marijuana, noting that “while most patients (76.1%) reported using cannabis to manage a health symptom, very few patients identified as medical cannabis users.”
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Among people who used marijuana, for instance, 15.6 percent said their use was for strictly medical reasons, while less than a third (31.1 percent) said their use was for both nonmedical and medical purposes. But more than three quarters of users “reported using cannabis to manage a range of symptoms” like pain, stress and sleep issues, the study found.
“Less than half the patients who used cannabis reported using it for medical reasons, even though the majority of patients reported cannabis use to manage a health-related symptom,”
authors wrote. “Given these discrepant findings, it may be more useful for clinicians to ask patients what symptoms they are using cannabis for rather than relying on patient self-identification as a recreational or medical cannabis user.”
“This aligns with another study that found that this type of cannabis use is clinically underrecognized,” they added, “and without specifically screening for medical cannabis use, clinicians may not ask and patients often do not disclose their use.”
The University of California, Los Angeles-based research team looked at records from “a large, university-based [healthcare] system in Los Angeles, California, and encompasses a geographically diverse area” that surveyed its patients during annual wellness visits between January 2021 and May 2023. Of the 175,734 patients screened, 25,278 (17.0 percent) reported using marijuana.
“As one of the first health systems to routinely ask about reasons for cannabis use, including health symptoms managed with cannabis,” the report says, “we provide a crucial point-of-care opportunity for clinicians to understand their patients’ risk for CUD [cannabis use disorder] given the association between reasons for cannabis use and the risk of disordered use.”
Notably, the study concluded that among self-reported marijuana users, more than a third were at moderate to high risk for cannabis use disorder—about 5.8 percent of all patients surveyed.
Of the 17.0 percent of those who said they used marijuana, just over a third 34.7 percent, “had results indicative of moderate to high risk for cannabis use disorder,” the report says.
Risk for CUD was measured through a World Health Organization screening called the Alcohol Substance Involvement Screening Test (ASSIST), which was modified by the National Institute of Drug Abuse. Authors of the study further modified the scoring algorithm in “consultation with the ASSIST developers and motivated by a desire to identify patients who were not just frequent users of cannabis but also experiencing health or social consequences as a result of their cannabis use.” Scoring thresholds for low and moderate risk were increased to reflect that goal; specifically, “low risk for CUD was defined as a score of 7 or less (compared with ≤3 in the original scoring algorithm)” and “moderate risk for CUD was defined as a score of 8 to 26 (compared with 4–26 in the original scoring algorithm).”
“The data from this study show that the prevalence of cannabis use and the risk of disordered use were highest among male patients and younger adults,” the study found. “Comparable with findings from a recent study, more than a third of patients were at moderate to high risk for CUD (5.8% of the overall sample). This group could benefit from a primary care clinician-based brief intervention to prevent those at moderate risk for cannabis use disorders from developing more serious CUD and to evaluate and refer high-risk users for possible addiction treatment.”
Clinicians should also “take note that if patients are using cannabis for 4 or more symptoms they might be more likely to be at risk of CUD,” authors wrote, adding, “Despite the commonplace use of cannabis to manage these symptoms, there is little evidence to guide clinicians on how to advise their patients regarding the benefits of cannabis for alleviating these symptoms.”
“Interestingly,” they continued, “while the prevalence of cannabis use was lowest among patients living in the most disadvantaged neighborhoods, risk for CUD was higher among this group. The influence of neighborhood on health outcomes has been well established; however, the influence of neighborhood on substance use and especially cannabis use is limited or conflicting.”
The study cautions, however, that its sample’s “underrepresentation of patients from the most disadvantaged neighborhoods prevents drawing strong conclusions on the specific links with risk of CUD.”
Overall, in light of “the high rates of cannabis use and medical cannabis use that we found in this large urban health care system, it is essential that health care system implement routine screening of all primary care patients,” the report, published on Wednesday in JAMA Network Open, advises. “Integrating screening efforts to include information regarding cannabis use for symptom management could help enhance the identification and documentation of medical cannabis usage, particularly in the health care context.”
At the state level, most laws still draw a bright line between medical and nonmedical use, with laws commonly requiring a doctor’s recommendation and registration as a medical marijuana patient before someone can access medical cannabis. But in some jurisdictions, that’s slowly changing.
In Delaware, for example, the governor this year signed into law a bill that would significantly expand the state’s medical marijuana program, including allowing patients over the age of 65 to self-certify for medical cannabis access without the need for a doctor’s recommendation and by removing the list of specific qualifying conditions that patients need to have to gain legal access to the program.
The newly published findings follow a JAMA-published report in April that said there’s no evidence that states’ adoption of laws to legalize and regulate marijuana for adults have led to an increase in youth use of cannabis. That research indicated states’ adoption of recreational marijuana laws (RMLs) had no association with the prevalence of youth cannabis consumption.
“In this repeated cross-sectional study, there was no evidence that RMLs were associated with encouraging youth marijuana use,” it said. “After legalization, there was no evidence of an increase in marijuana use.”
Another JAMA-published study earlier that month that found that neither legalization nor the opening of retail stores led to increases in youth cannabis use. That study, published in the journal JAMA Pediatrics, concluded that the reforms were actually associated with more young people reporting not using marijuana, along with increases in those who say they don’t use alcohol or vape products either.
In March, meanwhile, JAMA published findings that teen use of delta-8 THC, a psychoactive cannabinoid commonly derived from hemp, was higher in states where marijuana was illegal.
In states where marijuana remains prohibited, 14 percent of high-school seniors said they had used a delta-8 product in the past year, the federally funded research found. Where marijuana was legal, that figure was 7 percent.
Along with the study, JAMA published an editorial about the new findings meant to “assist health professionals in advocating for stronger regulatory oversight of cannabis products.”
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