1. In this retrospective cohort study, enrollment in medical cannabis programs increased overall in the United States (US) between 2020 and 2022.

2. In jurisdictions with nonmedical adult-use laws, enrollment in medical access programs declined within this time frame.

Evidence Rating Level: 2 (Good)

Study Rundown: Despite the introduction and expansion of legal cannabis use for both medical and non-medical use across the US, cannabis remains designated as a Schedule I drug. This has limited research and education into its use for both physicians and patients. There is a proposal to re-designate cannabis to schedule III, acknowledging its therapeutic potential. The study was an ecological study of medical cannabis licensure in the US from 2020 to 2022 using the state registry. It was found that enrollment in medical cannabis programs has increased in proportion and number. However, in jurisdictions with non-medical adult-use laws, enrollment in medical cannabis programs has declined. The most common patient-reported conditions for use included chronic pain, anxiety, and post-traumatic stress disorder (PTSD). Nevertheless, there was a decline in the proportion of patient-reported conditions with good supporting scientific evidence. The study was limited by the inconsistent quality of the registry data and a limited sample of jurisdictions. As the landscape of medical cannabis use rapidly evolves, these results emphasized the need for rigorous research and reporting of its use to inform policies, education, and clinical guidelines.

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In-Depth [retrospective cohort study]: The current study was a retrospective cohort utilizing publicly available state registry data to assess medical cannabis use and prescription in the US from 2020 to 2022. Patients were people enrolled in a medical cannabis program. The number of enrolled patients increased by 33.3% from 3,099,096 (2020) to 4,132,098 (2022). Accordingly, the prevalence of medical cannabis rose by 23.0% from 175.0 per 10,000 in 2020 to 215.2 per 10,000 in 2022. Notably, 13 of the 15 jurisdictions with adult-use law, except Massachusetts and Maine, saw an overall decline in medical cannabis enrollment from 146.5 per 10,000 in 2020 to 124.8 in 2022, with Arizona reporting the most significant decrease. Chronic pain was the most common patient-reported qualifying condition, accounting for 1,119,678 instances (65.7%) in 2020 and 934,603 (48.4%) in 2022. In 2022, the other common patient-reported qualifying conditions were anxiety (14.2%) and PTSD (13.0%). Anxiety specifically saw a 53-fold increase in reports from 5067 in 2020 to 274,556 in 2022. Notably, the proportion of reported conditions for which cannabis use was supported by good evidence fell from 70.4% in 2020 to 53.8% in 2022. In contrast, there was an increase in conditions with weaker evidence or vague categorizations. In 2022, there were more authorizing clinicians per patient in jurisdictions with non-medical adult-use laws (12.9 clinicians per 1000 patients) than those with medical-only use (6.1 clinicians per 1000 patients). 53.5% of authorizing clinicians were physicians, 34.4% were nurse practitioners, and 11.0% were physician assistants. The common medical specialties reported were family and internal medicine ((63.4%), physiatry (9.1%), and anesthesia or pain medicine (7.9%). In summary, these were the most up-to-date results on medical cannabis use, and its findings prompted a need for further research into the benefits and risks of cannabis to inform policy and education.

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