Legalizing Smokable Medical Cannabis in Florida Sharply Increased THC Per Patient

Legalizing smokable medical cannabis in Florida (SB182, March 2019) was associated with a 42.18% increase in mean weekly dispensed THC per patient (138.45 mg increase, 95% CI: 102.69-174.20) assuming 20% THC concentration. THC continued increasing by 5.62 mg per patient per week for 35 weeks post-policy. The number of certified patients also grew 24.8% in the first 4 months.

Quasi-experimental interrupted time series using Florida Department of Health dispensing data (April 2018-March 2020). Generalized least squares linear model with a 17-week phase-in period. THC estimated at both 10% and 20% flower concentrations.

The finding that dispensed THC far exceeded recommended daily doses raises safety questions about medical cannabis programs that add smokable forms without dosing guidance.

Most medical cannabis programs started with non-smokable forms (oils, capsules) with more controlled dosing. Adding smokable forms introduces the same dosing uncertainty seen in recreational markets, potentially undermining the medical framework.

THC concentration in flower is estimated (10-20%), not measured for each patient. Cannot determine individual consumption patterns from aggregate dispensing data. Pre-post design without a control state. Short post-policy period (35 weeks).