Medical Cannabis Utilization Across States With Varying Legal Status

Despite increasing legalization of medical cannabis across the U.S., significant barriers to access and utilization remain, particularly in states with restrictive policies. This study aimed to explore the patterns of medical cannabis use, methods of acquisition, perceived efficacy, and barriers to use, with a focus on how these factors vary by state-level legal status.

A cross-sectional, nationwide survey was administered online during August-September 2023 to a purposefully sampled U.S. adult population. Of 2,824 respondents, 996 individuals self-identified as using cannabis for medical purposes and were included in the final analysis. Measures included demographic variables, cannabis usage patterns, therapeutic indications, perceived effectiveness, and challenges related to legal frameworks and healthcare disclosure.

Cannabis use varied significantly by state legal status (chi-square=22.26, p=0.001), with 43.1% of respondents in fully legal states using medical cannabis, compared with 27% in prohibition states. Anxiety (65.9%), depression (48%), and chronic pain (37%) were the most commonly reported conditions. Participants reported diverse consumption methods, with smoking (74.3%) being the most common, although also associated with the highest rate of side effects (chi-square=216, p<0.001). Overall, 32.3% of participants rated medical cannabis as a great deal effective for their primary condition. Legal status also influenced the conditions treated: bipolar disorder was more frequently reported in prohibition states, whereas degenerative neurologic conditions were more common in legal states. Notably, 43.2% of medical cannabis users had not disclosed their use to a primary care provider. Of those, nearly 40% cited fear of provider disapproval, and 27.1% cited concerns about legality-even in states where medical cannabis was permitted. In addition, 45% of those who experienced barriers cited cost as a deterrent, and over half reported using less medical cannabis owing to these challenges.

The findings highlight significant variations in medical cannabis usage and associated challenges based on state legal frameworks. Barriers such as cost and fear of disclosure underscore the need for clearer communication and policy reforms to improve access and patient-provider dialog. Further research is warranted to explore the clinical implications of medical cannabis use across diverse populations.