Trends in registered medical marijuana participation across 13 US states and District of Columbia☆
Introduction
Since 1996, 23 states in the United States (US) and the District of Columbia (DC) afford a legal defense for the medicinal use of marijuana (i.e., cannabis) for specific qualifying medical conditions (Hasin et al., 2015). Passage of these medical marijuana (MMJ) provisions coincide with heightened public and scientific debate over the therapeutic potential of marijuana and its chemical constituents (Borgelt et al., 2013, Di Marzo et al., 2004, Rubens, 2014). However, the pace of evidence-based research into the safety and effectiveness of smoked marijuana or its cannabinoid derivative products for the treatment of certain medical conditions has lagged behind the pace at which these MMJ provisions have been enacted (Hill, 2015, Whiting et al., 2015). Further, passage of MMJ provisions have fueled concerns over the impact to the non-medical (i.e., ‘recreational’) use of marijuana and its accompanying health risks, especially among adolescents (Anderson et al., 2014, Cerdá et al., 2012, Lynne-Landsman et al., 2013, Morris et al., 2014, Schuermeyer et al., 2014). Public health and policy issues surrounding access to MMJ could be enhanced with an understanding of trends in MMJ participation over time, but this information is currently lacking.
The size of the MMJ population has been estimated previously based upon data from state MMJ registry programs where qualifying patients are required to register in order to be issued ID cards that protects them from arrest or prosecution for marijuana possession, and registration may be required in order to purchase marijuana in states that allow dispensaries (Marijuana Policy Project, 2013). For example, Bowles (2012) briefly described the proportion of adult state residents registered in MMJ programs in 11 US states around June 2011, showing a relatively high level of participation in Montana (MT) and Colorado (CO; 4.1% and 3.3% of the adult population, respectively), but lower levels in Oregon (OR; 1.3%), and less than 1% for each of the remaining eight states. Sabet and Grossman (2014) also reported the number of state MMJ registrants as recently as 2012. However, their numbers suggest substantial increases in MMJ registration in some states (e.g., Arizona had gained over 10,000 new MMJ participants), while others had declined (e.g., MT appeared to have lost 5000). Previous researchers have noted a sharp increase in the number of MMJ registrants over a short period of time in CO from 2009 (N < 5000) to 2010 (N > 100,000), but it is unclear whether these trends also apply to other MMJ states with mandatory registration programs (Ghosh et al., 2015, Salomonsen-Sautel et al., 2014, Schuermeyer et al., 2014).
The unique contribution of this report is to describe and compare trends in registered MMJ participation over time across 13 US states and DC with mandatory MMJ registration programs. For some states, registry data has been available since 2001, but the majority of states possess data covering the period of 2009–2015. This report has been able to include data from MMJ registries not previously covered by prior publications (e.g., DC, Hawaii, New Jersey, Massachusetts, and Minnesota). Three states with no or only voluntary MMJ registries are not included in the examination of trends (California, Washington, and Maine), while no data is presently available for three states that have yet to begin accepting MMJ participants into their registries (i.e., Maryland, New Hampshire, and New York). Trends in MMJ participation by sex and age are examined in a subset of states that collect and report this data.
Section snippets
Methods
Data for this report come from publically available statistics provided by local governmental agencies responsible for administering their MMJ registry program. Statistics were collected mainly from published reports on governmental websites, and in a few instances from direct email request. Of the 23 US states and DC that as of 2015 that have passed some form of MMJ provision, recent registry data from 16 states and DC are represented: Alaska (AK), Arizona (AZ), Colorado (CO), Connecticut
Availability of medical marijuana registry data and current levels of participation
Details on 23 US states and DC that have MMJ provisions, including date of passage, existence of a MMJ registry, and the availability of registry statistics for this study are shown in Table 1. Ten states and DC passed MMJ provisions within the past five years (2010–2015), eight states passed provisions during the 2000s, and the remaining five states passed provisions prior to 2000. All but three states have mandatory MMJ registration requirements. Two states (CO and HI) had registry statistics
Discussion
This paper sought to provide a basis for comparing trends in MMJ participation across a heterogeneous and rapidly evolving set of laws, regulations, and social norms. The number of registered MMJ users in the US (around 440,000) is certainly an underestimate, and we might expect the figure closer to 650,000 assuming California and Washington are similar to Colorado. The national prevalence of 7.6 MMJ users per every 1000 adults also likely underestimates the true prevalance. Nevertheless,
Conflict of interests
The author declares no conflicts of interests regarding this work.
Role of funding support
The author acknowledges funding support by the National Institutes of Health under the Ruth L. Kirschstein National Research Service Award (T32DA007292, awarded to C. Debra M. Furr-Holden) from the National Institute on Drug Abuse.
Contributors
Sole authorship.
Acknowledgments
The author wishes to acknowledge the help of Drs. Renee Johnson and Silvia Martins, as well as medical marijuana registry program staff, especially Scottina Ruis (HI), Lindsey Wells (VT), Pam Graber (NV), Mike Simoli (RI), Jake Musslewhite (AK), and Seth Crawford (OR).
References (50)
- et al.
Medical marijuana laws in 50 states: investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence
Drug Alcohol Depend.
(2012) - et al.
Medical marijuana laws and adolescent marijuana use in the USA from 1991 to 2014: results from annual, repeated cross-sectional surveys
Lancet Psychiatr.
(2015) - et al.
Characteristics of adults seeking medical marijuana certification
Drug Alcohol Depend.
(2013) - et al.
The prevalence of chronic pain in United States: adults results of an internet-based survey
J. Pain
(2010) - et al.
Perceived risk of regular cannabis use in the United States from 2002 to 2012: differences by sex, age, and race/ethnicity
Drug Alcohol Depend.
(2015) - et al.
Trends in fatal motor vehicle crashes before and after marijuana commercialization in Colorado
Drug Alcohol Depend.
(2014) - et al.
Temporal trends in marijuana attitudes, availability and use in Colorado compared to non-medical marijuana states: 2003–11
Drug Alcohol Depend.
(2014) - et al.
Medical marijuana diversion and associated problems in adolescent substance treatment
Drug Alcohol Depend.
(2011) - et al.
Initial opportunity to use marijuana and the transition to first use: United States, 1979–1994
Drug Alcohol Depend.
(1997) - et al.
Cannabis use for chronic non-cancer pain: results of a prospective survey
Pain
(2003)
Medical marijuana laws and suicides by gender and age
Am. J. Public Health
The pharmacologic and clinical effects of medical cannabis
Pharmacother. J. Hum. Pharmacol. Drug Ther.
Persons registered for medical marijuana in the United States
J. Palliat. Med.
State Population Estimates and Census 2010 Counts: Did They Match? Pew Social and Demographic Trends
Guidance Regarding the Ogden Memo in Jurisdictions Seeking to Authorize Marijuana for Medical Use
Medical Marijuana Regulatory System, Part II—Performance Audit 2013 (Performance Audit)
The endocannabinoid system and its therapeutic exploitation
Nat. Rev. Drug Discovery
Initiation of Marijuana Use: Trends, Patterns, and Implications
Medical marijuana's public health lessons—implications for retail marijuana in Colorado
N. Engl. J. Med.
Medical Marijuana Stores: More Spa, Less Pharmacy
Cancer statistics, 2001
CA Cancer J. Clin.
Medical Marijuana Law Gives Rise to Industry, Causes Worries for Law and Health Authorities
Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: a clinical review
JAMA
The business of bud: slowly, state medical marijuana industry regrowing
Helena Indep. Rec.
Federal Memo: Medical-Marijuana Dispensaries are Prosecution Targets
Cited by (0)
- ☆
Supplementary material can be found by accessing the online version of this paper at http://dx.doi.org and by entering doi:10.1016/j.drugalcdep.2015.11.015.