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Self-Reported Medical and Nonmedical Cannabis Use: Results from the 2018 Behavioral Risk Factor Surveillance System in 14 States

Journal of Community Health volume 47, pages 641–649 (2022)Cite this article

Abstract

As policies legalizing adult cannabis use increase in the United States, understanding and characterizing the proportion of individuals consuming cannabis for medical and nonmedical purposes is important to inform targeted health education efforts. Data came from 7672 adults (> = 18 years) with past month cannabis use who responded to questions about reason for cannabis use on the 2018 Behavioral Risk Factor Surveillance System survey in 14 states. State and aggregated data were analyzed using weighted frequencies for descriptive analyses, and prevalence ratios were computed to identify demographic and substance use characteristics associated with medical only use or use for both medical and nonmedical reasons (vs. nonmedical use). Overall, 28.6% (95% CI: 26.7, 30.4) of adults who use cannabis reported using cannabis medically, 34.2% (95% CI: 32.3, 36.2) nonmedically, and 37.2% (95% CI: 35.2, 39.2) both medically and nonmedically. Characteristics associated with medical only use (compared with nonmedical only use) included being female; aged > 45 years; out of work, a homemaker, or unable to work; having daily or near daily cannabis use; having past month cigarette use; having no past month alcohol use; self-reporting poor health; and ever having been diagnosed with certain chronic diseases. Medical only use of cannabis is the least prevalent reason for use; use for both medical and nonmedical reasons is the most prevalent. Monitoring reasons for cannabis use can aid states in understanding differences between medical and nonmedical cannabis users, providing context to use patterns, and targeting health education messages to appropriate audiences.

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Fig. 1

Data Availability

Data used in this study are available from: https://www.cdc.gov/brfss/annual_data/annual_data.htm.

Notes

  1. A number of additional states have medical cannabis programs that allow for use only of CBD or low-THC products, but not a broader range of cannabis products.

References

  1. National Conference of State Legislatures. (2020). State Marijuana Laws. https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx

  2. Caulkins, J. P., Hawken, A., Kilmer, B., & Kleinman, M. A. (2012). Marijuana legalization: What everyone needs to know. Oxford University Press.

    Google Scholar 

  3. National Academies of Sciences Engineering and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research.

  4. Colorado Department of Public Health & Environment. (2016). Monitoring health concerns related to Marijuana in Colorado: 2016.

  5. Colorado Department of Public Health and Environment. (2018). Monitoring health concerns related to Marijuana in Colorado: 2018. https://drive.google.com/drive/u/0/folders/1HEDVleZsVFml12FI7Om95QZ3t4c2RrlA

  6. Colorado Department of Public Health and Environment. (2021). Monitoring health concerns related to Marijuana in Colorado: 2020. https://drive.google.com/drive/folders/1H9g7iwIIW-NMdDCgmtdgk8zvjwWcQGqd

  7. Volkow, N. D., Baler, R. D., Compton, W. M., & Weiss, S. R. (2014). Adverse health effects of marijuana use. New England Journal of Medicine, 370(23), 2219–2227. https://doi.org/10.1056/NEJMra1402309

    Article  CAS  PubMed  Google Scholar 

  8. Substance Abuse and Mental Health Services Administration. (2020, September). National Survey on Drug Use and Health: 2019 NSDUH Detailed Tables. https://www.samhsa.gov/data/report/2019-nsduh-detailed-tables

  9. Compton, W. M., Han, B., Hughes, A., Jones, C. M., & Blanco, C. (2017). Use of Marijuana for medical purposes among adults in the United States. JAMA. https://doi.org/10.1001/jama.2016.18900

    Article  PubMed  PubMed Central  Google Scholar 

  10. Han, B., Compton, W. M., Blanco, C., & Jones, C. M. (2018). Trends in and correlates of medical marijuana use among adults in the United States. Drug and Alcohol Dependence. https://doi.org/10.1016/j.drugalcdep.2018.01.022

    Article  PubMed  PubMed Central  Google Scholar 

  11. Philpot, L. M., Ebbert, J. O., & Hurt, R. T. (2019). A survey of the attitudes, beliefs and knowledge about medical cannabis among primary care providers. BMC Family Practice, 20(1), 17. https://doi.org/10.1186/s12875-019-0906-y

    Article  PubMed  PubMed Central  Google Scholar 

  12. Public Act 12–55: An Act Concerning the Palliative Use of Marijuana, (2013). https://portal.ct.gov/DCP/Medical-Marijuana-Program/Law-and-Regulations

  13. Section 1004.2 - Practitioner issuance of certification, (2020). https://regs.health.ny.gov/content/section-10042-practitioner-issuance-certification

  14. Office of Medical Marijuana Use Florida Department of Health. (2020). Creating a Certification and Orders. https://s27415.pcdn.co/wp-content/uploads/_documents/Instructional_Guides/QP/Create-Certification-Orders_v4.pdf

  15. Washington State Liquor Control Board. (2014). Washington State Register 14-10-044 Amendatory Section, filed 4.30.14, effective 5.31.14. https://lcb.wa.gov/publications/rules/OTS-6471_1Final.pdf

  16. Leafly. (2021). Medical marijuna laws in the United States. https://www.leafly.com/learn/legalization/medical-states

  17. Schauer, G. L., King, B. A., Bunnell, R. E., Promoff, G., & McAfee, T. A. (2016). Toking, vaping, and eating for health or fun: Marijuana use patterns in adults, US, 2014. American Journal of Preventive Medicine. https://doi.org/10.1016/j.amepre.2015.05.027

    Article  PubMed  Google Scholar 

  18. Centers for Disease Control and Prevention. (2018). 2018 BRFSS Questionnaire. https://www.cdc.gov/brfss/questionnaires/pdf-ques/2018_BRFSS_English_Questionnaire-508.pdf

  19. Centers for Disease Control and Prevention. (2019b, July 26). The behavioral risk factor surveillance system (BRFSS) overview: 2018. https://www.cdc.gov/brfss/annual_data/2018/pdf/overview-2018-508.pdf

  20. Centers for Disease Control and Prevention. (2019a). Behavioral risk factor surveillance system: 2018 summary data quality report. https://www.cdc.gov/brfss/annual_data/2018/pdf/2018-sdqr-508.pdf

  21. Ballotpedia. (2018, June). Oklahoma State Question 788, Medical Marijuana Legalization Intitiative. https://ballotpedia.org/Oklahoma_State_Question_788,_Medical_Marijuana_Legalization_Initiative_(June_2018)

  22. Pacula, R. L., Powell, D., Heaton, P., & Sevigny, E. L. (2015). Assessing the effects of medical marijuana laws on marijuana use: The devil is in the details. Journal of Policy Analysis and Management, 34(1), 7–31.

    Article  Google Scholar 

  23. Morean, M. E., & Lederman, I. R. (2019). Prevalence and correlates of medical cannabis patients’ use of cannabis for recreational purposes. Addictive Behaviors. https://doi.org/10.1016/j.addbeh.2019.02.003

    Article  PubMed  PubMed Central  Google Scholar 

  24. Turna, J., Balodis, I., Munn, C., van Ameringen, M., Busse, J., & MacKillop, J. (2020). Overlapping patterns of recreational and medical cannabis use in a large community sample of cannabis users. Comprehensive Psychiatry. https://doi.org/10.1016/j.comppsych.2020.152188

    Article  PubMed  Google Scholar 

  25. Lin, L. A., Ilgen, M. A., Jannausch, M., & Bohnert, K. M. (2016). Comparing adults who use cannabis medically with those who use recreationally: Results from a national sample. Addictive Behaviors. https://doi.org/10.1016/j.addbeh.2016.05.015

    Article  PubMed  PubMed Central  Google Scholar 

  26. Chapter 311 - S.F. No.2470, (2014). https://www.revisor.mn.gov/laws/2014/0/311/ss

  27. Schauer, G. L., Berg, C. J., Kegler, M. C., Donovan, D. M., & Windle, M. (2016). Differences in tobacco product use among past month adult marijuana users and nonusers: findings from the 2003–2012 national survey on drug use and health. Nicotine & Tobacco Research, 18(3), 281–288. https://doi.org/10.1093/ntr/ntv093

    Article  CAS  Google Scholar 

  28. Schauer, G. L., Hall, C. D., Berg, C. J., Donovan, D. M., Windle, M., & Kegler, M. C. (2016). Differences in the relationship of marijuana and tobacco by frequency of use: A qualitative study with adults aged 18–34 years. Psychology of Addictive Behaviors. https://doi.org/10.1037/adb0000172

    Article  PubMed  Google Scholar 

  29. Singh, T., Kennedy, S. M., Sharapova, S. S., Schauer, G. L., & Rolle, I. V. (2016). Modes of ever marijuana use among adult tobacco users and non-tobacco users—Styles 2014. Journal of Substance Use. https://doi.org/10.3109/14659891.2015.1122100

    Article  PubMed  PubMed Central  Google Scholar 

  30. Trivers, K. F., Gentzke, A. S., Phillips, E., Tynan, M., Marynak, K. L., & Schauer, G. L. (2019). Substances used in electronic vapor products among adults in the United States, 2017. Addictive Behaviors Reports. https://doi.org/10.1016/j.abrep.2019.100222

    Article  PubMed  PubMed Central  Google Scholar 

  31. Baker, T. B., Piper, M. E., McCarthy, D. E., Majeskie, M. R., & Fiore, M. C. (2004). Addiction motivation reformulated: An affective processing model of negative reinforcement. Psychological Review. https://doi.org/10.1037/0033-295X.111.1.33

    Article  PubMed  Google Scholar 

  32. Leonard, S., Mexal, S., & Freedman, R. (2007). Genetics of Smoking and Schizophrenia. Journal of Dual Diagnosis, 3(3–4). https://doi.org/10.1300/J374v03n03_05

  33. Prochaska, J. J., Das, S., & Young-Wolff, K. C. (2017). Smoking, mental illness, and public health. Annual Review of Public Health. https://doi.org/10.1146/annurev-publhealth-031816-044618

    Article  PubMed  Google Scholar 

  34. U.S. Department of Health and Human Services. (1988). The Health Consequences of Smoking: Nicotine Addiction. A Report of the Surgeon General (C. for D. C. and Prevention, Ed.). U.S. Department of Health and Human Services.

  35. U.S. Department of Health and Human Services Office of the Surgeon General. (2016). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health.

  36. U.S. Department of Health and Human Services. (2014). The health consequences of smoking -- 50 years of progress. A report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. http://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf

  37. Wang, X., Derakhshandeh, R., Liu, J., Narayan, S., Nabavizadeh, P., Le, S., Danforth, O., Pinnamaneni, K., Rodriguez, H., Luu, E., Sievers, R., Schick, S., Glantz, S., & Springer, M. (2016). One minute of Marijuana secondhand smoke exposure substantially impairs vascular endothelial function. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.116.003858

    Article  PubMed  PubMed Central  Google Scholar 

  38. Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. https://doi.org/10.1001/jama.2016.1464

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, USA

    Gillian L. Schauer

  2. Addictions, Drug & Alcohol Institute, School of Medicine, University of Washington, Seattle, WA, USA

    Gillian L. Schauer

  3. Cannabis Strategy Unit, Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Douglas R. Roehler & Brooke E. Hoots

Authors
  1. Gillian L. Schauer
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  2. Douglas R. Roehler
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  3. Brooke E. Hoots
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Contributions

GLS conceptualized the study, conducted the data analyses, and drafted the manuscript. BH and DRR reviewed the data analyses, discussed the data findings and implications, and edited the manuscript.

Corresponding author

Correspondence to Gillian L. Schauer.

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The Authors report no conflict of interest.

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This study used deidentified publicly available data and did not require any ethics approval.

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Schauer, G.L., Roehler, D.R. & Hoots, B.E. Self-Reported Medical and Nonmedical Cannabis Use: Results from the 2018 Behavioral Risk Factor Surveillance System in 14 States. J Community Health 47, 641–649 (2022). https://doi.org/10.1007/s10900-021-01049-1

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  • DOI: https://doi.org/10.1007/s10900-021-01049-1

Keywords

  • Marijuana
  • Cannabis
  • Medical use
  • Nonmedical use