• Kevin F Boehnke, Rachel Sinclair, Felicia Gordon, Avinash Hosanagar, Douglas R Roehler, Tristin Smith, and Brooke Hoots.
• Anesthesiology Department, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, Michigan (K.F.B., F.G., T.S.).
• Ann. Intern. Med. 2024 Apr 1; 177 (4): 458466458-466.

BackgroundAs medical cannabis availability increases, up-to-date trends in medical cannabis licensure can inform clinical policy and care.ObjectiveTo describe current trends in medical cannabis licensure in the United States.DesignEcological study with repeated measures.SettingPublicly available state registry data from 2020 to 2022.ParticipantsPeople with medical cannabis licenses and clinicians authorizing cannabis licenses in the United States.MeasurementsTotal patient volume and prevalence per 10 000 persons in the total population, symptoms or conditions qualifying patients for licensure (that is, patient-reported qualifying conditions), and number of authorizing clinicians.ResultsIn 2022, of 39 jurisdictions allowing medical cannabis use, 34 reported patient numbers, 19 reported patient-reported qualifying conditions, and 29 reported authorizing clinician numbers. Enrolled patients increased 33.3% from 2020 (3 099 096) to 2022 (4 132 098), with a corresponding 23.0% increase in the population prevalence of patients (175.0 per 10 000 in 2020 to 215.2 per 10 000 in 2022). However, 13 of 15 jurisdictions with nonmedical adult-use laws had decreased enrollment from 2020 to 2022. The proportion of patient-reported qualifying conditions with substantial or conclusive evidence of therapeutic value decreased from 70.4% (2020) to 53.8% (2022). Chronic pain was the most common patient-reported qualifying condition in 2022 (48.4%), followed by anxiety (14.2%) and posttraumatic stress disorder (13.0%). In 2022, the United States had 29 500 authorizing clinicians (7.7 per 1000 patients), 53.5% of whom were physicians. The most common specialties reported were internal or family medicine (63.4%), physical medicine and rehabilitation (9.1%), and anesthesia or pain (7.9%).LimitationMissing data (for example, from California), descriptive analysis, lack of information on individual use patterns, and changing evidence base.ConclusionEnrollment in medical cannabis programs increased overall but generally decreased in jurisdictions with nonmedical adult-use laws. Use for conditions or symptoms without a strong evidence basis continues to increase. Given these trends, more research is needed to better understand the risks and benefits of medical cannabis.Primary Funding SourceNational Institute on Drug Abuse of the National Institutes of Health.

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