Adverse childhood experiences drove medical cannabis use through disability and poor health, not directly | Research

The takeaway

ACEs were linked to cannabis use overall, but the connection to medical cannabis specifically was fully explained by disability and poor health, suggesting medical users may be treating ACE-related health consequences.

Primary care providers, medical cannabis clinicians, trauma researchers

Disability and poor health fully explained the ACE-to-medical-cannabis pathway

What the researchers found

ACEs were significantly associated with cannabis use overall; however, disability and poor health fully accounted for the association between ACEs and medical cannabis use specifically.

Why it matters

Distinguishing why people with trauma histories use cannabis (recreation vs symptom management) has implications for how clinicians approach cannabis use in patients with ACE histories.

The numbers in context

2019 BRFSS data; 4+ ACEs associated with increased cannabis use; disability and poor health fully mediated the ACE-medical cannabis relationship.

How the study worked

Cross-sectional analysis of 2019 BRFSS data separating recreational and medical cannabis users; logistic regression controlling for health status and disability.

What this study cannot tell us

Cross-sectional BRFSS data prevents causal claims; self-reported ACEs and cannabis use; medical vs recreational distinction relies on self-classification; single survey year.

How to read the evidence

Large nationally representative dataset with clear mediation finding, but cross-sectional design and self-reported measures limit causal interpretation.

When this study was published

Published 2025, 2019 BRFSS data

The bigger picture

Medical cannabis use among people with trauma histories may reflect legitimate symptom management rather than substance misuse, challenging assumptions about cannabis use in this population.

Questions still open

Would longitudinal data confirm this mediation pathway? Should ACE screening be routine when evaluating medical cannabis patients? Do specific ACE types predict different cannabis use patterns?

Common questions

Do childhood adversities lead to cannabis use?

ACEs were associated with greater likelihood of any cannabis use. But the specific link to medical cannabis was fully explained by the disability and poor health that often result from ACEs.

What should clinicians do?

The authors recommend screening for both ACEs and disability status when prescribing medical cannabis, recognizing that medical use may reflect genuine symptom management.

Read the original research

Adverse Childhood Experiences and Cannabis Use Among US Adults: Do Poor Health and Disability Influence Types of Cannabis Use?

Substance use & misuse, 60(4), 586-595

View on PubMed ↗Publisher’s paper ↗

Citation

Chapple, Constance L; Green, Elizabeth M; Milojevich, Helen M; Miller-Cribbs, Julie A; Maher, Erin J. (2025). Adverse Childhood Experiences and Cannabis Use Among US Adults: Do Poor Health and Disability Influence Types of Cannabis Use?. Substance use & misuse, 60(4), 586-595. https://doi.org/10.1080/10826084.2024.2445846