US medical cannabis enrollment grew 33% but declined in states with recreational access

Enrolled patients grew from 3,099,096 (2020) to 4,132,098 (2022), a 33.3% increase. Population prevalence: 175 to 215 per 10,000. But 13/15 adult-use states had decreased enrollment. Evidence-supported qualifying conditions dropped from 70.4% to 53.8%. Chronic pain was the top condition (48.4%), followed by anxiety (14.2%) and PTSD (13.0%). 29,500 authorizing clinicians (7.7 per 1,000 patients).

Ecological study analyzing publicly available state medical cannabis registry data from 2020-2022 across 39 jurisdictions. Assessed patient volume, qualifying conditions, and authorizing clinician characteristics.

The shift toward conditions without strong evidence support suggests medical cannabis programs are expanding into areas where therapeutic value is unproven. Combined with declining enrollment in recreational states, this paints a complex picture of medical cannabis in the US.

The US medical cannabis landscape is bifurcating: growing in medical-only states while shrinking in recreational states, with an increasing proportion of patients using cannabis for conditions where the evidence base is limited.

Missing data from major states including California. Descriptive analysis without causal modeling. Cannot assess individual use patterns. Qualifying conditions may not reflect actual reasons for use. Data reporting varies by state.