As medical cannabis programs continue to expand, there is a growing need for information about the patient population using the plant for its medicinal benefits. However, due to the ways in which medical cannabis regulations have been implemented in different areas, along with sustained opposition from the federal government despite growing therapeutic use, this data is not always being systematically collected and analyzed.
One such place is California, where physicians have in the past been threatened with the revocation of their license for recommending cannabis to patients, and where dispensaries have been raided despite the federal government’s stated policy to cease this practice. The legal grey area created by the discrepancies between state and federal laws has resulted in a situation where no comprehensive patient database exists, despite estimates that there are more than 200,000 physician-sanctioned medical cannabis (MC) patients in California.
The lack of this information is a hindrance to the medical community, as it keeps physicians from becoming informed and gaining a better understanding of the various medical applications of cannabis.
Three-fourths of medical cannabis (MC) patients in the sample were male and three-fifths were White. On average, people in the sample tended to be somewhat younger, have more education, and be better employed compared to the general California population. These data show that more privileged segments of the population may have an easier time accessing MC.
To this end, a group of Californian researchers, headed by Dr. Craig Reinarman from the University of California, Santa Cruz, undertook a study to evaluate the population characteristics of medical cannabis patients in California. Evaluating a sample of 1,746 patients admitted to nine MC assessment clinics between July-September 2006, the researchers looked at several key characteristics including demographic data, self-reported therapeutic benefits, conditions for which physicians recommended cannabis, and other treatments that had been tried by MC patients.
Three-fourths of MC patients in the sample were male and three-fifths were White. On average, people in the sample tended to be somewhat younger, have more education, and be better employed compared to the general California population. These data show that more privileged segments of the population may have an easier time accessing MC.
Significantly, women, Latinos, and Asian Americans were underrepresented in the sample, while African Americans were overrepresented compared to the general California population. The researchers suggest that women may be underrepresented because, on average, men tend to suffer more workplace, sports, and motorcycle injuries, for which MC is often prescribed to treat pain. However, they also noted that the underrepresentation of women may be related to “the double stigma women face [..] for using an illicit drug and for violating gender-specific norms against illegal behaviour in general”. Lastly, pregnant women or those considering pregnancy may be fearful of possible negative consequences from child protection agencies if they are found to be using an illicit substance.
The underrepresentation of Latinos may have to do with “the undocumented status of many Latinos in California.” Lack of documentation leads many people to avoid contact with government agencies, as this may carry the risk of deportation. And underrepresentation of Asian Americans may have to do with the lower prevalence of cannabis use in this population, or the existence of their own “venerable traditions of herbal medicine.”
As mentioned above, African Americans were overrepresented in the sample, despite the fact that national surveys have shown this population does not have a higher prevalence of cannabis use. Instead, the researchers propose this may be “because they are disproportionately poor, more often lack health insurance, are significantly less likely to be prescribed other medication for pain or to receive treatment for cancer, and because African-Americans are a growing proportion of HIV/AIDS cases.”
In earlier studies, most patients reported using MC to relieve cancer or HIV/AIDS symptoms. However, the current sample revealed that the MC population has evolved into much more diverse uses. Patients self-reported that MC helped to relieve pain (82.6%), muscle spasms (41.1%), headaches (40.7%), anxiety (37.8%), nausea/vomiting (27.7%), depression (26.1%), cramps (19%), panic attacks (16.9%), diarrhea (5%), and itching (2.8%).
Patients also self-reported that MC helped to improve sleep (70.7%), relaxation (55.1%), appetite (37.7%), concentration/focus (22.9%), and energy (15.9%), as well as to prevent medication side effects (22.5%), anger (22.4%), involuntary movements (6.2%), and seizures (3.2%). In addition, half of the patients reported using MC as a substitute for prescription medication (50.9%), while 13% of the group valued using it as a substitute for alcohol.
Physicians recommended MC for a wide range of medical conditions. Among these were back/spine/neck pain (30.6%), sleep disorders (15.7%), anxiety/depression (13%), muscle spasms (9.5%), and arthritis (8.5%). Physicians also recommended MC for injuries (knee, ankle, foot), joint disease/disorders, narcolepsy, nausea, inflammation (spine, nerve), headaches/migraines, and eating disorders, all at a prevalence of less than 5%.
Significantly, many patients had tried a number of other treatment modalities prior to seeking MC for their conditions. These other treatments included prescription medication (79.3%), physical therapy (48.7%), chiropractic treatment (36.3%), surgery (22.3%), counseling (21%), acupuncture (19.4%), therapeutic injection (15.4%), homeopathy (12%), or other types of treatment (11.9%).
It is not clear where one would draw a line between medical and nonmedical cannabis use, or how this distinction would be effectively enforced.
Patients were also surveyed on their nonmedical use of other drugs. On average, patients had slightly higher rates of tobacco use compared to the general population (29.4% vs. 25%) and significantly lower alcohol use (47.5% vs. 61.9%). Self-reported use of other drugs was very low. And while a great majority of MC patients had previously used cannabis recreationally, 41.2% reported not having used it recreationally prior to using it for its medicinal effects.
Lastly, patients were surveyed on their MC use practices. There was great diversity in these data. Some patients reported using three grams or less per week (40.1%) and others using seven or more grams (23.3%). MC was used daily by 67% of the sample, while 26% reported using less than once a week. Just over half of patients (52.9%) reported using one to two times per day, while 10% reported using three or more times per day.
Ingestion methods also varied greatly. Smoking was the most common form of ingestion (86.1%), but 24.4% reported oral ingestion and 21.8% reported vaporization. As the researchers note, patients “are choosing modes of ingestion that reduce the perceived risk of harms from smoking.”
Overall, the results of this sample show that the use of MC has evolved significantly, now being used to treat a wide array of symptoms and conditions. It is especially significant to see how many patients are using MC to replace prescription medications or to treat conditions and symptoms that other treatment modalities have been ineffective in addressing. With this in mind, the researchers call for more systematic research to assess the therapeutic efficacy of cannabis for specific patient groups, conditions, and diseases.
In closing, the issue of diversion is discussed, in which patients obtain prescriptions for what ends up being nonmedical use, an issue that has been used by detractors to oppose the regulation of MC. While the researchers note that the significant risk of arrest for cannabis-related crimes likely means that some patients do indeed “use dispensaries as sources of supply for nonmedical use”, they note that diversion is not unique to cannabis. Rather, diversion is an existing and significant problem with a number of other prescription drugs, including benzodiazepines (i.e. Valium), stimulants (i.e. Ritalin, Adderall), and opiates (i.e. Oxycontin, Demerol).
Further, the line between medical and nonmedical drug use is increasingly being blurred. Trends contributing to this include the use of steroids, so-called “smart drugs”, and ephedra which is commonly available in health food stores.
“Much drug use does not fit into two neat boxes, medical and nonmedical, but rather exists on a continuum where one shades into the other.” Due to this, it is not clear where one would draw a line between medical and nonmedical cannabis use, or how this distinction would be effectively enforced.