Legalizing cannabis for recreational use is linked to lower prescription medication usage. Between 2016 and 2020, the number of people enrolled in state-level medicinal cannabis programs more than quadrupled. More than a quarter of U.S. respondents to a 2019 poll reported using CBD-only products in the preceding year. Additionally, the majority of medical cannabis patients in the UK believe that neither society at large nor medical professionals support their prescription.

These are just a few of the noteworthy conclusions from a flurry of recent research looking at cannabis use and attitudes in the U.S., Canada, and the U.K. Together, they paint a vivid picture of the present, when marijuana is more widely used and tolerated than ever in these nations, despite the fact that it is still stigmatized and frequently not well understood. Additionally, they show present patterns in consumer product preferences and labeling conventions that will undoubtedly change as this sector grows quickly.


Over the past five years or so, a number of studies have demonstrated the link between medicinal marijuana use and lower prescriptions for opioids and other medicines. Less is known, however, regarding the connection to legalized recreational marijuana. Ashley Bradford, a doctoral student at Indiana University, and Shyam Raman, a doctoral student at Cornell University, examined quarterly data on Medicaid prescriptions in the United States from 2011 to 2019 for a July 2022 article in the journal Health Economics. These studies were coauthored by Ashley Bradford and her father, professor W. David Bradford of the University of Georgia.

Indeed, they observed “significant reductions in the volume of prescriptions within the drug classes that align with the medical indications for pain, depression, anxiety, sleep, psychosis, and seizures,” and come to the conclusion that legalizing recreational cannabis use may result in Medicaid cost savings.


Two further recent studies provide information on the state of medical marijuana in the US and the UK. The first study, which will be published in the journal Annals of Internal Medicine in June 2022, indicates that the overall number of patients participating in state-level medical cannabis programs increased about 4.5-fold between 2016 and 2020 in the 26 out of 37 states for which data were available. Unsurprisingly, a large portion of this expansion was centered in states without legalized recreational marijuana, most notably Oklahoma, which passed a law legalizing medical marijuana in 2018 and had 927 patients per 10,000 population by 2020. Medical cannabis patient populations decreased in five of the seven states that allowed recreational use and reported statistics during this time period, perhaps as a result of the removal of the requirement for a medical license, which frequently entails a price.

A study published in June in the International Journal of Environmental Research and Public Health reports that patients in the U.K., where cannabis-based medicinal products are also prescribed more frequently, still don’t feel completely comfortable about their use—or, at the very least, worry that others won’t accept it. Only 38% of the 450 patients who answered to the study believed that their prescription was being approved by medical professionals, and 33% believed that society as a whole agreed. In addition, 57% were concerned about how the police or criminal justice system would react to their prescription, and 55% were worried about the reaction of other government organizations.

With the exception of high-CBD products, FLOWER REIGNS STILL.
Although dried flower is still by far the most widely used cannabis product in the United States and Canada, more processed versions are steadily gaining traction, especially in states where cannabis usage is permitted. The International Cannabis Policy Study found that between 2018 and 2020, the prevalence of flower use among recent cannabis consumers decreased from 81 percent to 73 percent in Canada, 78 percent to 72 percent in U.S. legal states, and 81 percent to 76 percent in U.S. illegal states. These findings were published in the June 2022 issue of Annals of Internal Medicine. Contrarily, practically every other product form, including edibles and vape oils, the most popular items after flower, saw a rise in the incidence of past-year consumption.

While this was going on, another research by some of the same authors discovered that more than a quarter of U.S. respondents (26.1 percent of 30,288 respondents) had used CBD products in the previous year, compared to just 16.2 percent of 15,042 Canadian respondents. The findings, which were reported in the June 2022 issue of Cannabis and Cannabinoid Research, show that oils and drops, which were used by about half of consumers in both countries, were by far the most popular product type. Topicals, edibles, vape oils, and capsules, which were used by about 15 to 25 percent of CBD consumers, and dried flower, which was used by about 10 percent of CBD consumers in the United States and 16 percent in Canada, were the next most popular product types.


Two last studies highlight two areas that are poised for future expansion in the medical and recreational cannabis fields: product labeling and consumer understanding.

Given the variety of cannabis products and the challenges consumers have adjusting the THC dosage, there is a need for more consumer education regarding cannabinoid levels.

The first study, which will be published in Frontiers in Pharmacology in June 2022, analyzes the THC:CBD ratios mentioned on 8,500 goods that 653 dispensaries in nine U.S. states have online uploaded. Nearly 60% of products lacked any mention of the CBD content as all, according to the authors from the University of Wake Forest School of Medicine. They come to the more general conclusion that both recreational and medicinal programs fall short in properly contextualizing the significance and possible therapeutic applications of various THC:CBD ratios.

Given this, the conclusions of our final paper are not at all unexpected. Cannabis consumers in both legal and illegal U.S. states, as well as in pre-legalization Canada, have generally limited knowledge of the THC and CBD levels in the products they use, according to a study out of the University of Waterloo in Canada that was published in Cannabis and Cannabinoid Research in June and again drew on data from the International Cannabis Policy Study.

Despite some indications to the contrary, the authors write, “knowledge was still poor in states with legal cannabis markets.” “Many consumers reported implausible readings, even among those who claimed to know the THC and CBD levels. … More consumer education is required about cannabinoid levels, especially in light of the growing variety of cannabis products and the challenges consumers face when correctly adjusting their THC intake.


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