Use of medical cannabis has been on the rise since it first became available to Utah patients in 2020. A medical cannabis card, which can be prescribed for difficult-to-treat conditions including PTSD and chronic pain, allows a patient to access licensed cannabis products in designated pharmacies.
But some people whose medical conditions permit use of medical cannabis use unregulated products instead, which can lead to unforeseen health risks due to additives and contaminants.
A new survey of over 200 people enrolled in Utah's medical cannabis program reveals why some people turn to unregulated cannabis to treat their medical conditions, providing a first step toward reducing barriers to safer, licensed products.
The results are published in Journal of Cannabis Research.
The high cost of health
The cost of legal cannabis is a significant barrier for many participants who use illicit cannabis. Monitoring and regulating cannabis costs money, which means that illicit cannabis can be much cheaper than regulated products.
The high cost of legal cannabis products can perpetuate a vicious cycle of economic and health consequences, the researchers say. The chronic conditions treated by medical cannabis, such as chronic pain or PTSD, can often make it harder to work and hold down a job, so patients seeking relief from these conditions may be more likely to experience economic hardship. But buying cheaper, unregulated products can put patients at risk of making their health condition worse.
"There's this trade-off," explains Jerry Cochran, PhD, senior author on the study as well as a professor of epidemiology and director of the Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA) at the University of Utah. "It's like, 'OK, I have a chronic illness which makes it hard for me to work, and so I have limited resources. I can more easily afford the stuff from my friend on the street, but that stuff on the street might make me sicker in the long run.' It creates this catch-22 where it becomes a health disparity."
Without an established quality assurance process, under-the-table products may vary unpredictably in the levels of CBD and THC they contain. Illicit products may also contain unlabeled additives or contaminants, such as mold, pesticides, or heavy metals, which can make chronic conditions worse.
Given the dangers of illicit cannabis and the recency of Utah's medical cannabis program, it's especially critical to do research to understand how people use the program, says Lirit Franks, PhD, author on the study and a research development associate in PARCKA. "It engenders accountability," Franks says. "You can see areas to improve, you can see what's working, and you can see areas for future research that might be very important."
Knowledge is power
While cost presented a barrier, access to high-quality information appears to strongly help people avoid illicit products, the researchers found. People who primarily use the state website for information about cannabis are much more likely to use legal cannabis products. The authors say that this is a promising sign: when people are provided with accurate, unbiased information rather than relying on cannabis marketing materials, they'll generally choose safer products.
"If you can get rid of all the bias and just give people good, accurate information about medical cannabis, people will use the medical cannabis program," Cochran says.
The results suggest that better communication of unbiased information could help people make safer decisions. If providers can ensure that patients have access to information resources, Cochran says, "they do a good job of keeping patients safe and using safe products."
Boosting safety by lowering barriers
The researchers say that understanding patients' difficulties in accessing the products they need can guide strategies to make the process easier. For instance, given that cost is a primary barrier to access legal cannabis, reducing the cost to renew an existing cannabis card could help patients continue to purchase regulated, safe products.
"If we pay attention to what is standing in the way, maybe we can reduce those barriers and allow people access to safer products," Franks says.
