More than 20% of medical marijuana users live in states that have not legalized its use, a finding that suggests physicians may be recommending the drug regardless of its legal status. In addition, 10% of medical marijuana users also report using the drug recreationally, new data show.

“We thought it was important to look at medical and nonmedical use of marijuana in all states, because marijuana might be recommended by a physician regardless of whether it’s legal or not,” lead author Wilson Compton, MD, MPE, National Institute on Drug Abuse, Bethesda, Maryland, told Medscape Medical News.

“In fact, even in the states where marijuana has been legalized under state law, it’s still not legal under federal law, so legal status is not necessarily relevant to whether a physician may or may not recommend marijuana to their patients. While I knew that a medical recommendation is not tied to the state legal status in any direct way, I was still surprised to find that the public is reporting that clinicians recommended marijuana to them even in those nonmedical marijuana states,” he added.

The research letter was published online December 19 in JAMA.

Numbers Still Low

Data from the 2013-2014 National Survey on Drug Use and Health were analyzed for 96,100 respondents aged 18 years of age and older.

Participants were asked whether any marijuana use had been recommended by a healthcare professional. Positive responses were classified as indicating medical marijuana use.

“We estimated the 12-month prevalence of medical marijuana use only, nonmedical marijuana use only, and combined medical and nonmedical use,” the researchers note.

Of 96,100 respondents, 12.9% of adults in the United States ― almost 13% ― reported they had used marijuana in the past year.

“This is everyone from the ages of 18 to 102 – so that’s a pretty large percentage, and it translates into some 31 million people in the United States who have used marijuana in the past year. If we were just looking at those 18 to 25, the rate would have been higher,” said Dr Compton.

Across the full sample of respondents, 0.8% reported that they used marijuana strictly for medical reasons; 0.5% of the full survey sample reported that they used marijuana both recreationally and for medical purposes.

Together, this brought the total of medical marijuana users to 1.3% of the full survey sample, or a total of about 3 million people in the United States who have used marijuana for medical purposes.

Researchers then looked at the reasons for respondents marijuana use.

With respect to past-year use, more than 90% indicated that they had used marijuana for nonmedical reasons, and 6.2% indicated that they had used marijuana strictly for medical reasons.

Some 3.6% of the same group reported using marijuana both for recreational and for medical purposes.

Researchers were also interested in identifying whether medical marijuana users lived in states where medical marijuana was legal.

This was true for more than three quarters of medical marijuana users, but more than one fifth of adults who reported using medical marijuana in the past year resided in states where medical marijuana had not been legalized.

As expected, “medical use only was more common among those reporting fair or poor health than better health and among those with stroke,” the researchers note. They add that medical use was also more common among disabled adults.

The data also suggest that at least some marijuana users are accessing medical marijuana without having any medical need for it.

Dr Compton noted that anecdotal reports from states such as Colorado and California, where marijuana is legalized, suggest that there is a “low threshold” for a medical recommendation or referral for marijuana and that adults may well access medical marijuana simply for recreational use.

“I think what we clearly identify is that most people are using marijuana for recreational purposes. While I’m not terribly surprised by this, what we were able to do [with this report] is put some numbers behind how many US adults are now reporting using marijuana for medical purposes, and we found that as a percentage, it is still quite low,” he said.

“So most people are using marijuana for recreational purposes despite all the attention on medical marijuana,” he added.

Dr Compton reiterated what many others have reported before – namely, that the conditions for which medical marijuana might be helpful have yet to be fully elucidated and that more research is needed to better identify the reasons why people are using marijuana only for medical reasons.

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