A new study examining medical marijuana patients in the U.S. who are under the age of 21 finds that minors and young adults typically qualify for state cannabis programs for many of the same reasons that older adults do, including anxiety, PTSD and chronic pain.
Those three qualifying conditions were the most commonly cited by young cannabis patients as the primary condition allowing them to legally access medical marijuana, according to the research, which was published last month in the journal Adolescent Heath, Medicine and Therapeutics. Other common conditions included insomnia and depression.
Among minor patients—those under 18—cancer and epilepsy were more common reasons for obtaining a medical marijuana recommendation than they were among young adults, ages 18 to 20. Patients in the older age group, meanwhile, were comparatively more likely to cite depression, chronic pain or insomnia as their primary qualifying condition.
“We found that there is a significant number of medical cannabis users aged 20 or younger, with variations in demographics and conditions between minors (under 18) and young adults (18-20).”
Qualifications also varied by state. “Notably, anxiety was the most frequently self-reported medical condition across several states, including California, Massachusetts, New Jersey, Oklahoma, and Pennsylvania,” the study notes. “Chronic pain emerged as the primary self-reported condition for Michigan, Montana, Ohio, and Illinois.”
Authors, from the health sciences department at DePaul University in Chicago, noted that while the dataset “does not encompass the entire population of medical cannabis users in the United States,” it nevertheless “represents an initial step toward understanding the demographics and medical conditions of pediatric medical cannabis patients and the reasons for their medical use.”
While the data for the study was self-reported—coming from the patient database at Leafwell, a telehealth company that connects patients with doctors who recommend medical marijuana—authors wrote that the research “represents the largest cohort of pediatric medical cannabis users in the world.”
Leafwell operates in 34 states, the study says, helping patients obtain marijuana cards. As part of that service, clients fill out a baseline questionnaire, which goes into the company’s patient database.
The research team analyzed 13,855 patient records of people under 21, which spanned a period from 2019 to mid-2023. Of those patients, 5.7 percent were under 18 years old (referred to in the study as “minors”) and 94.3 percent were 18 through 20 (referred to as “young adults”).
Most patients reported having multiple health conditions—only 40.25 percent of minors and 31.61 percent of young adults had a single condition. On average, members of each group had a little more than two conditions.
The goal of the study was to provide “a population-level description of pediatric and young adult medical cannabis patients from a large patient database in the United States,” it says, in order “to help develop better and more comprehensive regulatory frameworks and safety guidelines, to improve patient care, and to provide researchers with a potential pool of participants for further clinical studies.”
Emily Fisher, CEO of Leafwell, the company that provided data for the new research, said the report “shines a light on a traditionally under-researched group of young medical cannabis patients.”
“The findings reveal that many young people are using cannabis to manage conditions such as anxiety and chronic pain,” Fisher said in a press release. “Understanding this patient group and how cannabis is being used as a medicine is essential for developing safe and effective treatment protocols. This study represents a significant step forward in advancing our knowledge and ensuring that the unique needs of younger patients are met with thoughtful and precise care.”
June Chin, a doctor and professor as well as the chief medical officer at Leafwell, said the study “shows that it is crucial to understand the emotional, social, and psychological reasons why teens and young adults might turn to cannabis, especially as a way to cope with stress or mental health challenges.”
“I advocate for having open, non-judgmental conversations with teens and young adults, and providing them with the guidance they need to make informed decisions about cannabis use,” she said in Leafwell’s press release about the new report. “Additionally, I emphasize the importance of a balanced, evidence-based approach when considering medical cannabis for younger populations, while also addressing the root causes behind its use.”
Authors of the study said the findings underscore the need for further research into young people and medical marijuana, calling for “additional clinical studies to understand the role of medical cannabis in addressing symptoms and improving the quality of life for conditions such as chronic pain, anxiety, and PTSD in the pediatric population.”
They also noted that while in 2017 the “National Academies of Science did conclude substantial evidence supporting the use of medical cannabis for chronic pain and limited evidence for PTSD and anxiety,” those findings were “specific to the adult population.”
But they acknowledged that including minors and younger adults in trials remains an obstacle for clinical researchers.
“There remains a lack of pediatric specific evidence supporting the efficacy of medical cannabis in treating anxiety, chronic pain, and PTSD,” they wrote, adding that the lack of evidence “is largely explained by the difficulty of including pediatric patients in clinical cohorts.”
The team says the lack of pediatric-specific evidence “may necessitate a two-pronged approach toward comprehending the utilization of medical cannabis among young adults.” First, clinical studies should aim to establish efficacy of treatments as well as “to provide information on adverse events, the preferable route of administration (eg, edible cannabis vs whole plant cannabis), and dosage specifics in the pediatric population.”
At the same time, authors wrote, “research utilizing population-level self-reported patient databases should integrate electronic health information.”
“This integration will enable the utilization of real-world data on a larger scale to address some of the aforementioned questions,” the study says. “These future research trajectories, when pursued concurrently, have the potential to furnish physicians and public health advocates with essential details regarding the appropriate integration of medical cannabis alongside established medical guidelines.”
The majority of academic research around youth cannabis use focuses not on medical benefits but instead on youth consumption patterns in the wake of cannabis legalization. Many critics have worried that legalization would lead to a sharp rise in teen use of marijuana, but so far that hasn’t materialized.
For example, a recent federal report published by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that past-year marijuana use among minors—defined as people 12 to 20 years of age—had generally fallen in the years since states started legalizing marijuana for adults.
Notably, the percentage of young people aged 12 to 17 who’ve ever tried marijuana dropped 18 percent from 2014, when the first legal recreational cannabis sales in the U.S. launched, to 2023. Past-year and past-month rates among young people also declined during that time period.
Multiple other studies have debunked the idea that cannabis reform broadly increases youth use, with most finding that consumption trends are either stable or decrease after the reform is implemented. Use by heavy users may increase, however.
For example, a research letter published by the Journal of the American Medical Association (JAMA) in April said there’s no evidence that states’ adoption of laws to legalize and regulate marijuana for adults have led to an increase in youth use of cannabis.
Another JAMA-published study earlier that month that similarly found that neither legalization nor the opening of retail stores led to increases in youth cannabis use.
Data from a recent Washington State survey of adolescent and teenage students found overall declines in both lifetime and past-30-day marijuana use since legalizations, with striking drops in recent years that held steady through 2023. The results also indicate that perceived ease of access to cannabis among underage students has generally fallen since the state enacted legalization for adults in 2012.
Rates of youth marijuana use in Colorado, meanwhile, declined slightly in 2023—remaining significantly lower than before legalization. That’s according to results of the biannual Healthy Kids Colorado Survey released this month that found that past-30-day use of cannabis among high schoolers was at 12.8 percent in 2023, a dip from the 13.3 percent reported in 2021.
A separate study late last year also found that Canadian high-school students reported it was more difficult to access marijuana since the government legalized the drug nationwide in 2019. The prevalence of current cannabis use also fell during the study period, from 12.7 percent in 2018–19 to 7.5 percent in 2020–21, even as retail sales of marijuana expanded across the country.
In December, meanwhile, a U.S. health official said that teen marijuana use has not increased “even as state legalization has proliferated across the country.”
“There have been no substantial increases at all,” said Marsha Lopez, chief of the National Institute on Drug Abuse’s (NIDA) epidemiological research branch. “In fact, they have not reported an increase in perceived availability either, which is kind of interesting.”
Another earlier analysis from CDC found that rates of current and lifetime cannabis use among high school students have continued to drop amid the legalization movement.
A study of high school students in Massachusetts that was published last November found that youth in that state were no more likely to use marijuana after legalization, though more students perceived their parents as cannabis consumers after the policy change.
A separate NIDA-funded study published in the American Journal of Preventive Medicine in 2022 also found that state-level cannabis legalization was not associated with increased youth use. The study demonstrated that “youth who spent more of their adolescence under legalization were no more or less likely to have used cannabis at age 15 years than adolescents who spent little or no time under legalization.”
Yet another 2022 study from Michigan State University researchers, published in the journal PLOS One, found that “cannabis retail sales might be followed by the increased occurrence of cannabis onsets for older adults” in legal states, “but not for underage persons who cannot buy cannabis products in a retail outlet.”
The trends were observed despite adult use of marijuana and certain psychedelics reaching “historic highs” in 2022, according to separate data released last year.
A new study examining medical marijuana patients in the U.S. who are under the age of 21 finds that minors and young adults typically qualify for state cannabis programs for many of the same reasons that older adults do, including anxiety, PTSD and chronic pain. Those three qualifying conditions were the most commonly cited by Read More