Medically Recommended Cannabis Use for U.S. Adolescents

As more states legalize medical cannabis, there is growing interest in its use in adolescents. This nationally representative study assesses the prevalence of medically recommended cannabis use in adolescents and associations between medical cannabis use and adverse correlates.

Cross-sectional data from the 2021-2023 National Survey on Drug Use and Health were used to identify adolescents aged 12-17 years who reported past-year cannabis use. Respondents were asked whether healthcare professionals recommended any cannabis use. The prevalence of past-year medically recommended and nonmedical cannabis use was estimated among all adolescents, and differences in sociodemographic factors, cannabis use disorder, and other substance use between these 2 groups were estimated. Multivariable-adjusted logistic regression models then assessed the odds of cannabis use disorder and other substance use, adjusted for sociodemographic factors.

Among 3,906 adolescents reporting past-year cannabis use, 183 (5.2% weighted) reported medically recommended use. Medically recommended users were more likely to be male (RR=1.66, 95% CI=1.10, 2.51), to be Black non-Hispanic (RR=1.88, 95% CI=1.11, 3.19), and to have Medicaid or Medicare (compared with private insurance) (RR=1.87, 95% CI=1.01, 3.43) than those with nonmedical use. Medically recommended users reported more frequent cannabis use and were more likely to meet criteria for moderate or severe cannabis use disorder (adjusted RR=1.57, 95% CI=1.06, 2.30) and report past-year opioid, stimulant, and cocaine use.

Among adolescents, medical cannabis use may co-occur with moderate-to-severe cannabis use disorder and other substance use. Before recommending medical cannabis use to adolescents, practitioners should be aware of and monitor these important risks.