Medicinal versus recreational cannabis use among youth: A systematic review

Abstract

Background: Adolescents and young adults have high rates of cannabis use. Although a sizeable portion of youth report that they use cannabis for medicinal reasons (Wardell et al., 2020; Wardell, in press), most research on youth cannabis use tends to focus on recreational use. It is important to understand how youth who use cannabis for medicinal reasons differ from those who use for recreational reasons. We aimed to review the limited research comparing youth engaging in medicinal cannabis use to those engaging in recreational cannabis use. Methods: A systematic literature search of three databases (PsychInfo, PubMed, MEDLINE) was conducted to identify studies that compared adolescents and/or young adults who engage in medicinal cannabis to those who engage in recreational cannabis use. Studies that defined medicinal cannabis use either as self-reported use of cannabis for therapeutic reasons or as obtaining authorization/prescription for medical cannabis from a healthcare provider were included. Only quantitative research studies published in a peer-reviewed journal were included. After conducting the initial search and removing duplicates, 748 abstracts were reviewed independently by two researchers. Any discrepancies were resolved by consensus in consultation with a third researcher. Results: A total of 13 articles met inclusion criteria. Outcome variables reported in the literature included cannabis use (frequency and amount), cannabis-related problems, use of other substances including illicit drug use or prescription medication misuse, and health-related variables such as mental health symptoms or physical pain. Overall, the literature suggests that youth who use cannabis medicinally are more likely to use greater amounts of cannabis, to use more frequently, and to use a variety of different forms of cannabis, relative to youth who use cannabis recreationally. Further, several studies reported that medicinal cannabis use among youth was associated with problems related to cannabis use, such as the risk for cannabis use disorder and problematic behaviour (e.g., driving under the influence). Several studies also found that medicinal (vs. recreational) cannabis use was related to poorer mental or physical health, although a couple of studies did not support this finding. However, the results were mixed regarding the associations between medicinal cannabis use and the likelihood of using other drugs. Conclusion: There is evidence that using cannabis for medicinal reasons is associated with greater cannabis consumption, cannabis-related problems, and negative health-related correlates among youth. Although there was some consistency in findings across studies, the limited number of studies make it difficult to draw firm conclusions. Causal inferences are difficult to make owing to the frequent reliance on cross-sectional designs. The findings are further complicated by the heterogeneous definition of medicinal cannabis use (i.e., self-report vs. medically authorized). Given that many young people engage in both medicinal and recreational cannabis use, it is difficult to fully disentangle the differences. Additional research is needed for a complete understanding of the unique outcomes associated with medical cannabis use among youth.