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

The takeaway

Rural Pennsylvanians were significantly less likely than urban residents to disclose marijuana use to healthcare providers, potentially compromising their medical care.

Healthcare providers serving rural communities and cannabis users who have not discussed their use with their doctors.

Rural residents significantly less likely to disclose marijuana use to doctors

What the researchers found

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.

Why it matters

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.

The numbers in context

N = 1,045 adults surveyed in Pennsylvania. Urban residence was positively associated with marijuana disclosure but not CBD disclosure. Covariates included gender, age, race/ethnicity, political affiliation, political ideology, and veteran status.

How the study worked

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.

What this study cannot tell us

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.

How to read the evidence

Cross-sectional survey with appropriate statistical controls, though limited to one state and self-reported data.

When this study was published

Published in 2025.

The bigger picture

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.

Questions still open

Would targeted stigma-reduction campaigns in rural areas increase disclosure rates? Does nondisclosure lead to measurable adverse health outcomes in rural cannabis users?

Common questions

Why does it matter if you tell your doctor about cannabis use?

Cannabis can interact with prescription medications, affect anesthesia, and influence the interpretation of symptoms. Without knowing about use, doctors may miss drug interactions or make incorrect diagnoses.

Was CBD disclosure also lower in rural areas?

No. The urban-rural gap only applied to marijuana disclosure. CBD, which is more widely accepted and available over the counter, did not show the same stigma-driven reporting gap.

Read the original research

Rural reticence to inform physicians of cannabis use.

The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 41(2), e12885

View on PubMed ↗Publisher’s paper ↗

Citation

Mallinson, Daniel J; Servinsky, Timothy J. (2025). Rural reticence to inform physicians of cannabis use.. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 41(2), e12885. https://doi.org/10.1111/jrh.12885