Why Many Primary Care Patients Use Cannabis for Symptoms Without Calling It “Medical”
A 2024 study of nearly 176,000 primary care patients found that cannabis use is often more complicated than the usual “medical” versus “recreational” distinction suggests. About three-quarters of patients who reported using cannabis said they used it to manage a health-related symptom, yet only a small minority described their use as exclusively medical.
The study published in JAMA Network Open analyzed electronic health record and survey data from 175,734 adults who completed cannabis screenings at a university-based health system in Los Angeles between January 2021 and May 2023. Of those patients, 29,898—17%—reported using cannabis during the previous three months.
Among cannabis users, 15.6% said they used it only for medical reasons, while 53.3% reported only nonmedical use and 31.1% reported both medical and nonmedical use. However, approximately 76% said they used cannabis to manage at least one symptom. Sleep problems and stress were each reported by about 56% of users, while roughly 37% cited pain.
The difference suggests that a patient may use cannabis to address a symptom without viewing—or reporting—that use as “medical.” For clinicians, asking whether a patient uses cannabis for pain, sleep, stress, anxiety or another symptom may therefore provide more useful information than asking only whether the patient is a medical or recreational user.
The findings also pointed to a substantial level of potentially problematic use. Of the patients who reported cannabis use, 10,360—or 34.7%—had screening scores indicating moderate to high risk for cannabis use disorder (CUD). The study did not diagnose patients with CUD; it identified people whose responses suggested an elevated risk of developing problems related to their use.
The researchers used a cannabis-focused version of the World Health Organization’s Alcohol, Smoking and Substance Involvement Screening Test, or ASSIST. The tool is designed to identify substance-use-related risks in health care settings and can help determine whether a patient may benefit from counseling, a brief intervention or referral for additional care.
Risk varied across groups. Younger adults and male patients were more likely to report cannabis use and to fall into the moderate- or high-risk category. Patients who used cannabis to manage several symptoms also tended to have higher risk scores. Although cannabis use was less common among people living in the most disadvantaged neighborhoods, risk for disordered use was higher in that group. The authors cautioned that the study’s sample included relatively few patients from the most disadvantaged neighborhoods, limiting conclusions about that association.
These results do not show that cannabis caused any of the symptoms patients reported, nor do they establish that cannabis effectively treated them. The study was cross-sectional, relied on self-reported information and examined patients in one Los Angeles health system. Some screenings were also completed during the COVID-19 pandemic, when patterns of substance use may have differed from those in other periods.
The study’s broader message is about communication and screening, not about assigning cannabis a medical or recreational label. A patient who uses cannabis for sleep or pain may face potential benefits, side effects and risks that deserve discussion regardless of how that patient categorizes the use. The Centers for Disease Control and Prevention’s guidance on cannabis use disorder notes that warning signs include difficulty cutting down, craving, using more than intended and continuing to use despite physical, psychological or social problems.
The authors recommended that primary care systems routinely ask about cannabis use and the symptoms patients are trying to manage. More detailed documentation could help clinicians identify patients at risk for cannabis use disorder while also giving them a clearer basis for discussing uncertain benefits, possible harms and alternative treatments.
