Where recreational use of marijuana is legalized, medical use is declining

Data shows medical marijuana use has declined in U.S. states that have legalized recreational use

If marijuana is legal as a medical treatment, will there be people who will use this excuse to use it for recreational purposes? This appears to be the result of a study in the United States, which demonstrated that, on the contrary, enrollment in medical cannabis programs increased overall between 2016 and 2022, but enrollment increased in states that legalized the non-medical use of cannabis experienced a decline in enrollment. This means that if marijuana is legal as a recreational drug, there won’t be as many people demanding its medical use. Combined with data from a previously published analysis, the number of patients using cannabis for medical purposes has increased by more than 600% since 2016.

The United States has become a great laboratory for comparing the effects of regulation on marijuana. Cannabis is legal for adult medical or non-medical use in 38 and 23 states, respectively. However, it remains a Schedule I substance of the Controlled Substances Act. This status has hindered research into its health effects and prevented many physicians from receiving training to treat patients who use cannabis. Recently, the Department of Health and Human Services recommended moving cannabis to Schedule III. Before this potential change occurs, it is important to understand the current state of cannabis use and licensing for medical and non-medical purposes.

Researchers from the University of Michigan School of Medicine and the Centers for Disease Control and Prevention conducted an ecological repeated measures study of medical cannabis licensees and clinicians approving cannabis licenses in the United States between 2020 and 2022. The authors included 39 jurisdictions (38 states and Washington, DC) that permitted the use of medical cannabis in their analysis. Of these jurisdictions, 34 reported the number of patients, 19 reported patient-reported eligibility requirements, and 29 reported the number of licensed physicians. Overall, they reported a 33 percent increase in patient enrollment in these jurisdictions between 2020 (3.1 million) and 2022 (4.1 million). However, 13 of the 15 jurisdictions with active adult use laws experienced declines in enrollment. Between 2020 and 2022, the proportion of qualifying conditions reported by patients with substantial or conclusive evidence of therapeutic value fell from 70.4 to 53.8 percent.

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The most common illness was chronic pain, followed by anxiety and post-traumatic stress disorder. The authors report that there were 29,500 physicians licensing medical cannabis in 2022 and that the most common specialty of these physicians was internal medicine or general practice. According to the authors, their findings highlight the need for better surveillance methods to adequately understand the outcomes of medical cannabis use, as well as thoughtful policies and public health efforts to reduce the harms of increased cannabis availability.


Trends in U.S. medical cannabis registrations, licensed physicians and reasons for use from 2020 to 2022

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