What a U.S. Patient Database Reveals About Medical Cannabis Use Among People Under 21
A 2024 study offers a detailed — but limited — look at who seeks medical cannabis authorization before turning 21. Rather than measuring whether cannabis works for anxiety, post-traumatic stress disorder (PTSD), or pain, the research describes the conditions that patients and caregivers reported when applying through a medical-cannabis telehealth service.
Published in Adolescent Health, Medicine and Therapeutics, the study analyzed data from 13,855 patients under 21 whose information was recorded in the Leafwell Patient Database between January 2019 and mid-2023. The researchers included 790 minors ages 0 to 17 and 13,065 young adults ages 18 to 20.
The dataset is not a national registry of all young medical-cannabis patients. It consists of people who used Leafwell’s services and completed at least part of a baseline questionnaire. That distinction matters: the results describe this commercial patient population, but they cannot establish how common medical cannabis use is among young people across the United States.
Anxiety was the most frequently reported primary condition
Anxiety was the leading primary condition in both age groups, accounting for about 40.5% of patients who provided a primary reason for seeking medical cannabis. Chronic pain and PTSD were also among the most frequently reported conditions, although the mix varied by state.
Chronic pain was the leading primary condition in some states, including Michigan, Montana, Ohio, and Illinois, while anxiety ranked first in several others. The researchers also found meaningful differences between minors and young adults. Cancer and epilepsy appeared more often among minors, whereas young adults more frequently listed conditions such as depression, insomnia, and chronic pain.
Most patients reported more than one condition. Only 40.25% of minors and 31.61% of young adults listed a single condition; the remainder reported additional medical concerns. The average number of reported conditions was slightly higher among young adults than minors.
What the study does — and does not — show
The findings should not be interpreted as evidence that cannabis treats anxiety, PTSD, chronic pain, cancer, or epilepsy in young patients. This was a retrospective, cross-sectional analysis of patient questionnaires. It did not test a cannabis product, compare cannabis with another treatment, track symptoms over time, or determine whether cannabis improved patients’ health.
The study also used self-reported information. For minors, state rules required a parent or legal guardian to complete the questionnaire, so the responses were not necessarily provided directly by the child. The authors noted additional limitations, including the possibility that Leafwell’s patient base does not represent the broader medical-cannabis population and that the data may reflect the company’s market reach as much as actual state-level participation.
These limitations are especially important when the reported conditions involve mental health. A patient may seek cannabis because of anxiety or PTSD symptoms, but the database cannot determine whether cannabis caused, relieved, worsened, or had no effect on those symptoms. Nor can it establish why a clinician approved a particular patient under that state’s medical-cannabis rules.
Pediatric evidence remains limited
Research on cannabis-based medicines in children and adolescents remains far narrower than research involving adults. The National Academies of Sciences, Engineering, and Medicine found substantial evidence for cannabis or cannabinoids in treating chronic pain in adults and chemotherapy-related nausea and vomiting, but much less evidence for anxiety and PTSD. Those conclusions should not automatically be extended to children.
The U.S. Food and Drug Administration has approved specific cannabinoid medicines for defined uses, including cannabidiol for seizures associated with Lennox-Gastaut syndrome, Dravet syndrome, and tuberous sclerosis complex in patients who meet the approved age requirements. That is different from approving medical cannabis generally or confirming the safety and effectiveness of dispensary products for pediatric anxiety, PTSD, or chronic pain.
There are also potential risks associated with cannabis exposure during adolescence. The Centers for Disease Control and Prevention notes that the developing brain may be particularly vulnerable to cannabis, with concerns involving attention, memory, learning, mental health, and the risk of cannabis use disorder. These risks do not resolve the clinical questions raised by patients with serious illnesses, but they reinforce the need for careful medical supervision and age-specific evidence.
A starting point for better research
The study’s main contribution is descriptive. It identifies a sizable group of younger patients who are seeking medical-cannabis authorization and shows that their reported reasons differ somewhat by age and location. It does not demonstrate growing use over time, establish treatment benefits, or justify applying adult evidence to minors.
The authors call for both clinical studies and continued analysis of real-world patient data. Future research would need to examine specific products, doses, routes of administration, side effects, interactions with other medicines, and changes in symptoms over time. Until that evidence is available, decisions about cannabis for patients under 21 should weigh potential benefits against developmental and psychiatric risks and be made with qualified healthcare professionals.
