After Getting Medical Cannabis Certification, 41% of Pain Patients Never Actually Used It | Research

The takeaway

Among 225 chronic pain patients on opioids who were newly certified for medical cannabis, 41% did not use any cannabis products in the first three months, with White race, multi-site pain, and sedative use predicting uptake.

Medical cannabis program administrators; pain management clinicians.

41% of certified patients did not use medical cannabis within 3 months

What the researchers found

Within three months of certification, 29% used predominantly high-THC products, 30% used other products, and 41% did not use any cannabis. White race, multi-site pain, and sedative use predicted MC use. Current tobacco and unregulated cannabis use predicted non-use. Among those who used MC, female gender and older age predicted lower likelihood of choosing high-THC products.

Why it matters

Getting certified does not mean patients will use medical cannabis. Understanding who actually follows through -- and what products they choose -- reveals barriers to access and potential disparities that certification alone does not solve.

The numbers in context

225 patients enrolled. 29% used high-THC products, 30% used other products, 41% did not use MC. Non-Hispanic White race, multi-site pain, and past 30-day sedative use predicted MC use. Female gender and older age predicted lower high-THC product choice.

How the study worked

Longitudinal cohort study of 225 adults with chronic/severe pain on opioids who were newly certified for medical cannabis in New York State (November 2018-January 2022). Web-based assessments every 2 weeks for 3 months. Generalized estimating equation models examined predictors.

What this study cannot tell us

New York's medical cannabis program during the study period was restrictive compared to other states, potentially limiting product options and access. The 3-month follow-up may not capture longer-term adoption patterns. The sample may not represent all MC-certified patients.

How to read the evidence

Moderate: prospective longitudinal design with biweekly assessment, but single-state program with restrictive policies may limit generalizability.

When this study was published

2024 study using 2018-2022 data.

The bigger picture

The finding that unregulated cannabis users were less likely to use medical cannabis after certification suggests these patients may already be accessing cannabis outside the medical system and see the legal program as redundant or inferior. This has implications for states trying to transition illicit users into regulated systems.

Questions still open

Would reducing cost barriers increase MC adoption among certified patients? Do patients who never use MC after certification return to or increase their opioid use?

Common questions

Why did certified patients not use medical cannabis?

The study identified that existing tobacco and unregulated cannabis use predicted non-use, suggesting some patients already had access through other channels. Cost, product availability, and the restrictive nature of New York's program may also have been barriers.

Who chose high-THC products?

Male and younger patients were more likely to choose high-THC products. Female patients and older adults tended toward non-THC-dominant formulations, possibly reflecting different pain management priorities or concerns about psychoactive effects.

Read the original research

Factors Associated with Medical Cannabis Use After Certification: A Three-Month Longitudinal Study.

Cannabis and cannabinoid research, 9(3), e859-e869

View on PubMed ↗Publisher’s paper ↗

Citation

Zhang, Chenshu; Slawek, Deepika E; Ross, Jonathan; Zolotov, Yuval; Castillo, Felipe; Levin, Frances R; Sohler, Nancy L; Minami, Haruka; Cunningham, Chinazo O; Starrels, Joanna L; Arnsten, Julia H. (2024). Factors Associated with Medical Cannabis Use After Certification: A Three-Month Longitudinal Study.. Cannabis and cannabinoid research, 9(3), e859-e869. https://doi.org/10.1089/can.2022.0248