Evaluations of State Medical Cannabis Programs in the USA: A Narrative Review

Medical cannabis (MC) use is increasing across the USA, with functional MC programs now operating in 38 states. While program policies and practices vary widely, little is known about whether and how states evaluate their programs. Better characterization of state MC program evaluation to date could inform states, program officials, and providers about best practices and provide a roadmap for future program evaluation.

We conducted a narrative review of state MC program evaluations, including peer-reviewed literature and reports produced by independent state-based and non-state-based evaluators. Among 304 abstracts initially screened, seven evaluations met inclusion criteria. Within these evaluations, we report results according to three overarching themes: (1) evaluation characteristics, including comparison across evaluations; (2) program experience, including perceptions of providers and patients; and (3) assessment of cannabis use, including self-reported efficacy for qualifying medical conditions, patterns of medical and nonmedical cannabis use, and assessment of risk factors relevant to MC use. Additionally, we found that while goals and methods for state MC evaluations varied widely, evaluations that relied on independent, non-state entities tended to have more comprehensive and quantitatively rigorous results.

Few states operating MC programs have completed a formal evaluation of their program. Among states that have completed an evaluation, approaches varied widely; however, common themes were also present, which may inform future state evaluation efforts. Evaluation through independent, non-state partners may provide an optimal strategy to ensure high-quality data and meaningful results.