United States medical cannabis registration increased significantly between 2016 and 2020

1. Registration for medical cannabis increased 4.5 times from 2016 to 2020 in the United States, with chronic pain and post-traumatic stress disorder (PTSD) being the most common conditions cited.

2. For states where recreational cannabis use was legalized, registration for medical use declined.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Access to cannabis has expanded across the United States, with 37 states legalizing medical cannabis use and 18 permitting recreational use in recent years. These state-specific policies conflict with federal law, deeming cannabis as a Schedule I drug. Such conflict has resulted in inconsistencies in cannabis access. For example, inappropriate indications for use, the absence of unified cannabis standards, and most recently, the crossover of recreational products into medical uses. This study examined state registry data for medical cannabis licensure between 2016 and 2020 to describe the trends of registration and patient-cited qualifying conditions. It was found that enrollment increased 4.5-fold during this period, a change that was consistent across all the reported states. Chronic pain and PTSD were noted as the most common reasons patients requested medical cannabis licenses. Conversely, enrollment declined in states where recreational use was legal. The study’s limitations included missing state data, lack of specific information about cannabis products, and lack of clarity on primary reasons for patients who reported “multiple conditions”. Overall, the study highlighted a rapid rise in the need for medical cannabis and the crossover of recreational products to medical use, emphasizing the need for renewed legislative discussion.

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In-Depth [cross-sectional study]: The present study described medical cannabis licensure in the United States between 2016 and 2020. State registry data was examined to describe trends in medical cannabis enrollment, conditions reported by patients to qualify them for the license, and whether there was evidence of cannabis therapeutic value for such conditions. By 2020, 26 out of 37 states where medical cannabis was legalized reported the patient numbers, and 19 states reported patient-cited qualifying conditions. The total patient number was 2,974,433 in 2020, which was a 4.5-fold increase from 678,408 in 2016. The number of patients per 10,000 also showed a general upward trend, which was most dramatic in Oklahoma (78.1 per 10,000 in 2018 to 927.1 per 10,000 in 2020). By contrast, of the seven states with legalized recreational use, five saw a decrease in medical license registration. Among states where qualifying conditions were reported, chronic pain was the most common. It was cited by 484,386 patients in 2016, which rose to 1,119,668 in 2020 and accounted for 60.6% of all registered patients. PTSD was the second most common, increasing from 27,447 in 2016 to 195,984 in 2020 and accounting for 10.6% of all patients. The other conditions having substantial evidence of efficacy were chemotherapy-induced nausea and vomiting and multiple sclerosis-related spasticity. Notably, the overall percentage of these conditions declined from 84.6% of patients in 2016 to 68.2% in 2020. In summary, this study depicted a rapidly changing landscape of cannabis use and needs, both medical and recreational, and emphasized the need for coherent policies and continued research in this space.

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