Rural Americans Are Less Likely to Tell Their Doctors About Cannabis Use

Living in an urban area was positively associated with disclosing marijuana use to healthcare providers compared to rural areas. No urban-rural difference was found for CBD disclosure. The authors argue that rural stigma around marijuana use may disproportionately harm rural residents by preventing integrated medical care.

Cross-sectional survey of 1,045 adult Pennsylvanians using a web panel. Rurality was determined by overlaying ZIP Code Tabulation Areas with U.S. Census urban area definitions. Logistic regressions controlled for gender, age, race/ethnicity, political affiliation, ideology, and veteran status.

When patients do not tell their doctors about cannabis use, providers cannot screen for drug interactions, adjust treatment plans, or monitor for adverse effects. Rural residents already face healthcare access barriers, and stigma-driven nondisclosure adds another layer of risk.

Pennsylvania had an operating medical cannabis program at the time of the study, yet rural stigma still appeared to suppress honest conversations with doctors. This suggests that legal access alone does not eliminate the cultural barriers to transparent patient-provider communication.

Web panel survey may not be representative of all Pennsylvanians, particularly those without internet access in rural areas. Self-reported disclosure and cannabis use may be subject to recall and social desirability bias. Pennsylvania-specific findings may not generalize to other states.