Medicinal and combined medicinal/recreational cannabis use in California following the passage of Proposition 64

Background: Proposition 64 (2016) legalized adult-use cannabis in California, reshaping cannabis access and use. This study examines patterns among adults using cannabis for medicinal-only and combined medicinal plus recreational (M+R) purposes post-implementation. Methods: A population-based online questionnaire included 5,178 California adults (4,020 current users; 523 former users; 635 non-users). Analyses focused on current users self-identifying as medicinal-only (n=711) or M+R (n=1,719). Results: Sixty-one percent of current users reported medicinal use. Compared with M+R, medicinal-only users were more often female (OR 1.6, p<0.001), had children in the household (OR 1.5, p<0.001), and initiated cannabis later (mean age 34 vs 23, p<0.001). Pain relief was the most common reason for use, followed by sleep, anxiety, and stress. M+R users reported more negative side effects. Fewer medicinal-only users reported a desire to feel high (42% vs 75%, p<0.001). Medicinal-only users felt less comfortable discussing cannabis with primary care providers than M+R users (75% vs 83%, p<0.01). All users more commonly sought information online (44–57%) or from friends/family (47–52%) than from health professionals (26–27%). Dispensaries were the primary source of cannabis (72% M vs 84% M+R, p<0.01), and licensure was very/extremely important to most (72% M; 66% M+R, p<0.01). Monthly spending was lower among medicinal-only users ($127 vs $186, p<0.001). Medicinal-only users reported waiting longer before feeling safe to drive after use. Conclusion: Medicinal-only cannabis users differ from M+R users across demographics, use patterns, information sources, and perceived effects. Findings highlight the need for improved patient–provider communication and clinically informed guidance to support medicinal cannabis users.

Daniel Ageze, Renee Dell'Acqua, Thomas D. Marcotte, Jill Rybar, Sara Baird, Alice Gold, Tom Shaughnessy, Ilene Lanin-Kettering, Linda Hill