Medicinal and combined medicinal/recreational cannabis use in California following the passage of Proposition 64.

BACKGROUND

Proposition 64, the Adult Use of Marijuana Act of 2016, reshaped cannabis use in California. This study explores the use patterns of people who use cannabis for medicinal-only and combined medicinal and recreational use after implementation of Proposition 64.

METHODS

A quantitative, population-based online questionnaire included 4,020 current cannabis users, 523 former users, and 635 non-users. This analysis focuses on participants who self-identified as using cannabis for medicinal-only (n = 711) or both medicinal and recreational (M + R, n = 1719) purposes.

RESULTS

Sixty one percent of current cannabis users report medicinal use. Medicinal-only users were more likely to be female (OR 1.6, p < 0.001), have kids in household (OR 1.5, p < 0.001), and began cannabis use later (mean age 34 vs. 23, p < 0.001). Pain relief was the predominant reason for use, followed by sleep, anxiety, and stress relief. While both groups reported positive effects, M + R users experienced more negative side effects. Fewer medicinal-only users cited a desire to "feel the high," (42% vs. 75% M + R, p < 0.001). Medicinal-only users felt less comfortable discussing cannabis with primary care providers than M + R users (75% vs 83%, p < 0.01). All users were more likely to seek information online (44-57%) or from friends/family (47-52%) than health professionals (26-27%). Dispensaries were the main cannabis source for both medicinal groups (72% M vs. 84% M + R, p < 0.01), with licensure being very or extremely important (72% M, 66% M + R, p < 0.01). Monthly spending for medicinal-only users was lower ($127 vs. $186 for M + R, p < 0.001), and they were more likely than M + R users to wait before feeling safe to drive after using cannabis.

CONCLUSION

People who use medicinal cannabis alone vary in key areas from people who use cannabis for both medicinal and recreational reasons. The need for better patient-provider relationships and clinically informed guidance is evident to support medicinal cannabis users.