Marijuana In The United States Research Articles

Cannabis Use Disorder Associated With Increased Risk of Postoperative Complications After Hip or Knee Arthroplasties: A Meta-analysis of Observational Studies.

With the legalization of marijuana in the United States, the number of patients with cannabis use disorder (CUD) in the joint arthroplasty population has increased markedly. The primary purpose of this meta-analysis was to determine whether there were differences in clinical and economic outcomes after total joint arthroplasty (TJA) between patients with and without perioperative CUD. We searched PubMed, Embase, Scopus, and Web of Science databases up to July 2018 to identify all eligible studies investigating the association of CUD with postoperative outcomes in patients undergoing TJA. Postoperative outcomes assessed consisted of complications, readmission, length of stay (LOS), implant revision, and cost of care. For dichotomous outcomes, pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random effects model. We identified 10 retrospective cohort studies with a total of 17,981,628 study participants. Patients with CUD had significantly higher odds of medical complications (OR 1.33 [95% CI 1.07 to 1.66], P = 0.01) and implant-related complications (OR 1.75 [95% CI: 1.64 to 1.88], P < 0.00001) than noncannabis users. Specifically, CUD was associated with significantly increased odds of cardiac complications (OR 1.95 [95% CI 1.50 to 2.54], P < 0.00001), cerebrovascular accidents (OR 2.06 [95% CI 1.66 to 2.57], P < 0.00001), postoperative infections (OR 1.68 [95% CI 1.34 to 2.10], P < 0.00001), periprosthetic fracture (OR 1.42 [95% CI 1.19 to 1.70], P < 0.0001), mechanical loosening (OR 1.54 [95% CI 1.42 to 1.66], P < 0.00001), and dislocation/instability (OR 1.88 [95% CI 1.32 to 2.68], P = 0.0005). Longer LOS and higher cost of care were also found in patients with CUD. This study strengthens the body of evidence that patients with CUD face higher risk of postoperative complications and greater financial burden after knee and hip arthroplasties. Physicians should inform patients about adverse outcomes and undertake appropriate risk adjustments before elective orthopaedic surgery. Level III.

Peri-Operative Impact of Cannabis Use in Conjunction With Elective Primary Breast Augmentation in a Private Practice.

Background The consumption of recreational and medicinal cannabis in the United States continues to increase. Understanding the effects of cannabis in patients undergoing elective primary breast augmentation (EPBA) is of paramount importance with the expanding rates of reported cannabis consumption. Objectives This study aims to analyze the peri-operative impact of cannabis use in conjunction with EPBA in a single-surgeon practice in San Francisco, California. Methods A retrospective chart review was performed of 134 adult female patients undergoing EPBA from August 2018 to January 2022 within a single-surgeon practice plastic surgery office. Cannabis use was self-reported as current use or former use. Cohorts were grouped as cannabis users and cannabis non-users. Results Of the 134 patient charts identified for analysis, 58 (43.3%) reported cannabis use. Cannabis users were significantly younger than cannabis non-users (26.8 years versus 31.5 years, P<0.001). No significant differences were found between groups among intra-operative blood loss, post-operative complication rates, post-operative narcotic use, or intra-operative anesthetic requirements. The incidence of adverse events, including wound breakdown, skin necrosis, and capsular contracture requiring reoperation, did not differ significantly between cannabis users and cannabis non-user groups. Ninety-six percent of patients had their implants placed subpectorally, and all procedures were done using a Keller funnel. Eighty-three percent of patients had Sientra implants, and 96% of all implants were silicone gel implants. All procedures were done under general anesthesia. Patients were followed for up to two years. Discussion This review found no significant differences in peri-operative and post-operative outcomes between cannabis users and cannabis non-users.

Discussing the Legalisation of Recreational Cannabis Supply Chain: Will It Weaken Drug Trafficking Organisations?

Since the Netherlands’ tolerance policy, which allows the purchase of cannabis at ‘coffeeshops’, has been linked to issues of public order and safety, as well as dangers made by drug trafficking organisations, there has been a long debate regarding legalising cannabis production and supply. It was so decided to launch an experiment with a restricted legal (‘closed’) cannabis supply chain for recreational use. This has international implications due to the ongoing illegal cannabis exports from the Netherlands, the importance of sharing knowledge about the effectiveness of cannabis policy, and the accumulation of evidence required to review and revise international treaties. We will detail and discuss the experiment’s background, general approach, and design. In this experiment, ten trusted cannabis growers are contracted to manufacture and supply cannabis to coffeeshops in intervention municipalities, with product quality control, legal enforcement against criminal interference, and preventive measures to decrease health hazards in place. The cannabis supply to coffee cafes in participating control municipalities will remain unchanged. A process study will determine if the chain of production to sale in the intervention towns is indeed closed. In a quasi-experimental study comparing intervention and control communities, the chain’s effects on public health, cannabis-related crime, safety, and public annoyance will be assessed. Earlier experiences with medical cannabis in the United States, as well as limited access and production models in Europe, have provided valuable insights. However, these amendments go far further, introducing a new area of cannabis policy. The absence of empirical knowledge on the effects of such measures presents a problem for policymakers. As a result, establishing future legal changes will require a thorough grasp of the specifics of each country. The literature comparing Colorado’s and the Netherlands’ models is limited. This study is based on a thorough analysis of the policies, regulations, and discussions related to criminal activities common to drug trafficking organizations. The research and analysis presented herein will provide policymakers with a better understanding of the laws and regulations governing legal cannabis in these jurisdictions, as well as highlight some potential impacts and challenges of cannabis reform that require further consideration to ensure public safety and health.

The Synergistic Benefit Mechanism of Medical and Recreational Marijuana: Economic Gains of Cannabis Taxation based on US Federal Law for Corporate Governance and Sustainability

Purpose: Marijuana legalization is brought about by the demands of people as social utility either for medical or recreation consumption. It is essential that the control of cannabis fulfills the goals of corporate governance and sustainability. This paper aims to measure the profitability of marijuana taxation over a time period as trend analysis of economic gains.&#x0D; Methodology: The socio-legal taxation of marijuana in the United States follows a descriptive research design. The beneficial gains of marijuana as medical use created this substance to be controlled under contract law transactions. The removal of cannabis in US Pharmacopeia modified the tort law restriction for legalization of marijuana as recreational consumption. The recreational cannabis taxation together with medical marijuana state taxes are essential to fulfill the 4 pillars of corporate governance and sustainability for strengthening constitutional rights. The legalization of marijuana through votes of the people repeals the criminal punishments imposed by federal law to advocate the synergistic concepts of economic theory.&#x0D; Findings: State tax theory creates voluntary principles in transactions together with trend analysis in prices and demands of people resulting to efficiency in mutual gains through lessening the value of participation under a harmful environment. Hence, Pigouvian tax follows the public welfare of medical marijuana and common revenue of recreational cannabis diminishes the overall costs of social consumption. Federal laws control marijuana usage through Pigouvian taxes of medical use with lessened participation in externalities and common revenue in cannabis consumption, as a legalization process of other states in reinstating tort law for business purposes, while still enforcing criminal penalties to remaining states, in compliance with US federal laws, not in favor of medical and recreational marijuana use. The economic theory supports the legalization of medical and recreational cannabis use through taxation as profitable gains by allowing voluntary market transactions of marijuana as fulfillment to corporate governance and sustainability for more allocation of public funds. From 2002 to 2018, medical and recreational cannabis users increased to 70% of social utility through lessening the value of participation, a win-win in efficiency of economic design. In 2010, marijuana taxation generated $8.7 billion as federal public funds, with accompanied criminal penalties to other states.&#x0D; Recommendations: Economic theory is a conceptual design supporting the beneficial gains of legalizing marijuana via taxation. This economic design promotes fair responsibility of market gains while still in strict compliance of enforcing criminal punishments to violators. The people’s votes for legalization of marijuana taxation indicates that this economic policy has come by choice in a particular state as constitutional right of either a medical opinion or business ethics. However, cannabis is deemed to be a substance subject for criminal liabilities, similar to other patent drugs under taxation as well. Hence, it is suggested to create artificial intelligence using authorless works for clinical trials and other relevant studies subject to patent law of marijuana use, as advocacy of public welfare and safety since voluntary transactions are apparent harmful environment.

Urine Toxicology Test for Children With Altered Mental Status.

The rate of unintentional ingestion of edible cannabis products in young children is rising rapidly as laws decriminalizing both recreational and medical marijuana in the United States become more widespread.1 Cannabis poisoning in children can lead to a myriad of symptoms, most notably neurologic changes. The abrupt onset and severity of signs and symptoms after ingestion can cause diagnostic uncertainty for practitioners in the emergency department. Here, we present a case series of 5 children, 6 years of age and younger, who initially presented with altered mental status and were ultimately diagnosed with acute δ-9-tetrahydrocannabinol toxicity after cannabis ingestion confirmed by urine toxicology testing. Although urine toxicology testing is not routinely used as a diagnostic tool in pediatrics, the increasing accessibility of edible cannabis products suggests that more widespread urine toxicology testing in children with undifferentiated altered mental status is warranted.

A Pragmatic, Person-Centered View of Cannabis in the United States: Pursuing Care That Transcends Beliefs.

Rates of cannabis use are increasing in the United States, likely as a result of changes in societal attitudes and expanding legalization. Although many patients report wanting to discuss the risks and benefits of cannabis use with their clinical providers, many providers hold conflicting beliefs regarding cannabis use and often do not engage patients in discussion about cannabis. This dilemma is underscored by the limitations imposed on cannabis related research, and lack of empirically based best-practice guidelines for clinicians when addressing cannabis use with patients. We aimed to briefly summarize clinician and patient attitudes toward cannabis use and review current clinical guidelines and provide suggestions to assist health care providers and clinicians in increasing their comfort and skill in discussing cannabis use with patients. A narrative review on attitudes toward cannabis use and clinical guidelines was performed to summarize the literature and provide evidence-based recommendations. Attitudes toward cannabis use have been shaped by personal and political factors and contribute to clinician hesitance in speaking with patients about the topic. Administrative barriers have hindered the development of clearer public health guidelines that might enable the dissemination of evidence-based information on the health effects of cannabis use and might ultimately lead to better health outcomes. Not discussing cannabis use with patients may be a crucial missed opportunity for harm reduction. In the absence of empirically supported best-practice guidelines, a person-centered approach can facilitate conversations on the harms and benefits of cannabis use.

Marijuana legalization and traffic fatalities revisited

AbstractThe legal landscape for marijuana in the United States has changed dramatically over the last three decades. While several studies have examined the relationship between marijuana legalization and traffic fatalities, some of the research is becoming outdated and existing evidence remains mixed. Our research revisits the topic with two updates. First, our study includes states that legalized marijuana more recently and provides updated evidence on the effects of marijuana legalization. Second, considering recent discussions about the limitations of difference‐in‐differences designs, we employ alternative estimators that are robust to heterogeneous and dynamic treatment effects. Overall, our alternative estimators suggest either a smaller reduction (i.e., 3.9% drop in the overall fatality rate) or no change in traffic fatalities associated with legalizing marijuana for medical use, compared to the two‐way fixed‐effect estimator. We find no significant impact on traffic fatalities associated with legalizing marijuana for recreational use.

Lost Boys, Invisible Men: Racialized Policy Feedback after Marijuana Legalization

One benefit of legalizing marijuana in the United States was that reform would end racial disparities in law enforcement and the negative effects of the so-called War on Drugs. However, the communities that have been most harmed by cannabis prohibition are benefiting the least. Apple-esque weed dispensaries now operate as legitimate storefronts while Black men, specifically, continue to be punished for past marijuana-related crimes. Yet, the research to-date has not paid sufficient attention to this emergent problem—that policy change predicated on reducing racial disparities has not sufficiently addressed past harms of prohibition. This paper takes a conceptual approach to explore and adapt theories about how justice-involved individuals might become alienated after reform. It begins by exploring data from the Black Voter Project (BVP) to explain Black support for legalization of marijuana, then provide a critical policy analysis on how current reforms have the potential to exacerbate racial inequality among Black men.

Sumptuary administration: How contested market actors shape the trajectory of policy when regulated under fragmented governance

AbstractIn contemporary society, sumptuary laws regulate contested markets by delegating enforcement responsibilities to the private sector. This can decouple the intention behind policies from the practices to implement them. When state interests do not align concerning the legality of a market, can policy and practice recouple, and if so, how? This article reports on a case study of commercial cannabis in the United States to answer this question. Interviews with 56 cannabis industry stakeholders in California, Arizona, and Texas reveal that policy and practice recoupled through a patterned process that I call sumptuary administration. In each state, regulators drew on a unique set of schemas, or “framework of accountability,” that prioritized a subset of cannabis market participants during the policy‐making process. This resulted in missing or ambiguous sumptuary laws. To address business challenges that were tethered to this regulatory environment, cannabis businesses drew on similar schemas to identify appropriate practices. I show how grounding practices in these frameworks legitimized the preferences of the cannabis industry in the eyes of state authorities and influenced specific program policy revisions. Sumptuary administration represents a novel mechanism for understanding the social construction of legality in markets that are regulated under fragmented governance.

Medical cannabis identity and public health paternalism

ObjectivesState-dependent and variable lists of medical conditions granting access to medical cannabis in the United States may be an example of public health paternalism. While purporting to ensure that medical use is clearly defined, the variability of approved conditions has created an atmosphere of ambiguity and medical precarity. The purpose of this study is to examine the relationship between “state” and “self” medical cannabis user identities and the ways non-medical users understand their cannabis consumption. Study designThis is a mixed methods study consisting of semi-structured interviews and survey data. MethodsIn Phase 1, we examined the relationship between self and state-sanctioned cannabis identity, drawing on the 2022 New Frontier Data Consumer Survey of current cannabis consumers (N = 4682). In Phase 2, we conducted eight semi-structured interviews with a separate sample of adults who use cannabis regularly but do not consider themselves “medical consumers”. ResultsSelf-reported cannabis identity was significantly related to the adoption of a cannabis consumer identity. Those who self-identified as solely medical or recreational consumers were more likely to reject the identity of “cannabis consumer” than those who identified as both. Self-medical identity was overshadowed by use for “wellness” among interviewees. Most interviewees, despite not identifying as medical users, report therapeutic benefit. Their identity as a cannabis consumer, is tied to the definition of “medical cannabis patient” where they live as well as the fluctuating role of cannabis related to their well-being across their lifespan. ConclusionsThe designation of medical vs. nonmedical use of cannabis varies from state to state, which is not the case for other medicine. This highly variable designation may be paternalistic in nature as governments attempt to differentiate between “legitimate” and “illegitimate” use in the context of federal cannabis prohibition. As a result, lines between medical use and wellness are blurred, which impacts consumer self-identity.

Abstract 13524: Rising Burden of Acute Cardiovascular and Cerebrovascular Events in Young Females (18-44 Years) With Cannabis Use Disorder

Background: With the increasing recreational use of Cannabis in the United States, there is limited data on the impact of Cannabis use on young females. Therefore, we aimed to assess the risk and outcomes of cardiovascular and cerebrovascular events in young females with Cannabis use disorder (CUD). Method: The National Inpatient Sample (2019) was assessed to identify young, female hospitalizations (age 18-44 years) with CUD using relevant ICD-10 codes. Baseline characteristics and comorbidities were compared between two cohorts, CUD + and CUD -. The primary outcome was acute cardiovascular and cerebrovascular events evaluated using a multivariable regression analysis adjusting for confounders. Result: Of 1,72,36,228 young female hospitalizations, 2% had CUD+ (n=340560). CUD+ arm consisted of younger (median age-34 vs 59), black patients (28.2vs15.5%) and had a higher rate of drug abuse (62.1% vs 3%), smoking (50.7% vs 12.4%) and alcohol abuse (13.9% vs 2.5%) when compared to CUD- cohort (p&lt;0.001). Despite a lower prevalence of comorbidities (p&lt;0.001) such as Hypertension, Diabetes, Hyperlipidaemia, Obesity, PVD, CKD, Prior MI, Prior PCI, Prior CABG, Prior Stroke, Prior VTE, CUD+ group showed higher odds of Type 1 MI (OR=1.11,95%CI-1.04-1.18,p=0.001), Dysrhythmia (OR=1.08,95%CI-1.05-1.11,p-&lt;0.001), however the CUD+ cohort had lower odds of Type 2 MI(OR=0.89,95%CI-0.83-0.96,p-0.003), Cardiogenic Shock (OR=0.78,95%CI-0.7-0.87,p&lt;0.001), Cardiac arrest including VF (OR=0.79,95%CI-0.72-0.87,p&lt;0.001), and Acute PE (OR=0.74,95%CI-0.68-0.8,p&lt;0.001) as compared to without CUD cohort. Conclusion: Despite having an overall lower CVD risk burden, the CUD+ female cohort had a higher risk of Type 1 MI and Dysrhythmia after controlling for other confounding risk factors and substance abuse. abuse.

S3675 Steroid Treatment for Patient With Intractable Nausea, Vomiting and Abdominal Pain With Underlying Autoimmune Gastritis

Introduction: Gastritis and cannabinoid hyperemesis syndrome (CHS) share many overlapping symptoms: nausea and vomiting (N&V), and abdominal pain.1 With the continued legalization and adoption of marijuana in the United States, it will become crucial to determine the etiology of the aforementioned cardinal symptoms to improve treatment plans. Case Description/Methods: Pleasant 29-year-old male with PMH of N&V in teen years presents with onset of nausea and episodes of vomiting over the last few months. Patient complained of heightened baseline nausea, exacerbations of post-prandial N&V, and occasional N&V without food. Claims bloating and denied dysphagia, GERD, headaches, or visual changes. Minimal relief with use of marijuana and ondansetron and adverse symptoms with promethazine. EGD was performed with subsequent gastric biopsy positive for H. pylori with concurrent autoimmune gastritis and underlying intestinal metaplasia; erythema and erosions found in the antrum and stomach body. Progressive worsening of symptoms, 20 lbs weight loss and LLQ abdominal pain prompted EGD and colonoscopy six weeks after initial upper endoscopy. Prior to EGD/Colonoscopy, patient reported previous history of yearly idiopathic pericarditis which is believed to be autoimmune in nature. Gastric mapping upon his second EGD showed ongoing autoimmune gastritis of the gastric body (lesser and greater curve). Prednisone 40 mg was started for patient with full resolution of GI symptoms in three weeks. Discussion: Patient’s initial symptoms were believed to be related to CHS. However, further EGD evaluation and patient’s updated PMH of pericarditis suggest a possible autoimmune origin. With steroid use, patient found resolution with N&V and abdominal pain. Hallmark symptoms of CHS are abdominal pain and recurring episodes of N&V with the cessation of adverse symptoms when cannabis use is stopped. If symptoms persist past cessation of cannabinoids, other sources of intractable N&V need to be evaluated. In the setting of autoimmune gastritis, with intractable nausea, vomiting, and abdominal pain, a trial of short-term steroids can be considered in a patient that has otherwise refractory GI symptoms, despite treatment of H Pylori and conservative pharmacologic management.

Practices and perspectives on medical cannabis and cannabinoids: A survey of the National Psoriasis Foundation Medical Advisory Board

Practices and perspectives on medical cannabis and cannabinoids: A survey of the National Psoriasis Foundation Medical Advisory Board

Case Study of Hyperemesis Cannabinoid Syndrome in a Postpartum Patient

Due to the legalization of cannabis in the United States, use has increased in the general population, including pregnant and postpartum women. Cannabinoid hyperemesis syndrome (CHS) is a condition that affects individuals who use cannabis habitually. The hallmark presentation of this syndrome is intractable nausea, vomiting, abdominal pain, and compulsive-showering behavior. Cases of CHS due to chronic cannabis intoxication are found in the literature, but the documentation of this illness among pregnant and postpartum women is scarce.

Surveillance, Social Control, and Managing Semi-Legality in U.S. Commercial Cannabis

Abstract This article presents a case study of commercial cannabis in the United States. Drawing on 56 interviews with cannabis stakeholders collected between 2018–2020, I examine how different governmentalities of surveillance became distorted by the contradiction between state and federal cannabis laws. As in other regulated markets, these governmentalities informed state-sponsored surveillance initiatives to stop, contain, or support certain forms of deviance by commercial cannabis businesses. Due to fragmented governance, the efficacy of these initiatives depended in part upon the actions of the regulated cannabis industry. Commercial cannabis businesses looked to how surveillance was configured to develop strategies that could help them overcome challenges stemming from their semi-legality. These strategies included incorporating practices that were not required by law, partnering with the state in surveillance efforts, and engaging in activities to combat the black market. I argue that the embedded relationship between governmentalities, surveillance initiatives, and commercial cannabis activities transformed these strategies into mechanisms through which structure emerged in this nascent market. This paper introduces a set of surveillance categories, proposes new directions for research on social control and markets, and offers a novel study of commercial cannabis that can help to explain the trajectory of this market.

The phytochemical diversity of commercial Cannabis in the United States.

The legal status of Cannabis is changing, fueling an increasing diversity of Cannabis-derived products. Because Cannabis contains dozens of chemical compounds with potential psychoactive or medicinal effects, understanding this phytochemical diversity is crucial. The legal Cannabis industry heavily markets products to consumers based on widely used labeling systems purported to predict the effects of different "strains." We analyzed the cannabinoid and terpene content of commercial Cannabis samples across six US states, finding distinct chemical phenotypes (chemotypes) which are reliably present. By comparing the observed phytochemical diversity to the commercial labels commonly attached to Cannabis-derived product samples, we show that commercial labels do not consistently align with the observed chemical diversity. However, certain labels do show a biased association with specific chemotypes. These results have implications for the classification of commercial Cannabis, design of animal and human research, and regulation of consumer marketing-areas which today are often divorced from the chemical reality of the Cannabis-derived material they wish to represent.

Attitudes in 2020 Towards Medical and Recreational Marijuana in Prohibitionist Nebraska

Despite considerable change in the legal status of marijuana in the United States in the 21st century, the state of Nebraska has become an outlier in maintaining a complete prohibition on the substance. We estimate overall public support for medical and recreational marijuana in the state of Nebraska. Our data comes from the 2020 Nebraska Annual Social Indicators Survey, an address-based sample of Nebraskan adults. We asked a question from the Pew Research Center if participants support legal marijuana for medical AND recreational use, medical use only, or if they think it should not be legal. We estimate that 83.18% of Nebraskans support medical marijuana legalization. There is less consistent support for legal recreational use than medical use alone. There are also associations between support preferences and age, political party, gender, and the amount of stigma a participant reports in their community towards people that use various substances.

Do We Have Structure, Process and Outcomes to Support Cannabis as Supportive Therapy in Cancer?

Cannabis is becoming more popular and more available in the United States. It has been approved for use by multiple states for various conditions and several states now allow recreational cannabis. We explore the structure of cannabis distribution, the process of acquisition, outcomes, and the safety of cannabis in the United States.

A difference-in-difference approach to examining the impact of cannabis legalization on disparities in the use of cigarettes and cannabis in the United States, 2004-17.

To estimate the impact of recreational and medical cannabis laws (RCL, MCL) on the use of cannabis and cigarettes in the United States. A difference-in-difference approach was applied to data from the 2004-17 National Survey on Drug Use and Health (NSDUH). United States. Nationally representative cross-sectional survey of Americans aged 12 years and older (combined analytical sample for 2004-17, n = 783 663). Data on past-month use of (1) cigarettes and (2) cannabis were used to classify respondents into four groups: cigarette and cannabis co-use, cigarette-only use, cannabis-only use or no cigarette or cannabis use. State of residence was measured by self-report. MCL/RCL status came from state government websites. Difference-in-difference analyses suggest that MCL was associated with an increase in cigarette-cannabis co-use overall [adjusted odds ratio (aOR) = 1.09; 95% confidence interval (CI) = 1.02-1.16], with the greatest increases among those aged 50 years and above (aOR = 1.60; CI = 1.39-1.84), married (aOR = 1.19; CI = 1.07-1.31), non-Hispanic (NH) black (aOR = 1.14; CI = 1.02-1.07) and with a college degree or above (aOR = 1.15; CI = 1.06-1.24). MCL was associated with increases in cigarette-only use among those aged 50 years and above (aOR = 1.07; CI = 1.01-1.14) and NH black (aOR = 1.16; CI = 1.06-1.27) and increases in cannabis-only use among those aged 50 years and above (aOR = 1.24; CI = 1.07-1.44) and widowed/divorced/separated (aOR = 1.18; CI = 1.01-1.37). RCL was associated with an increase in cannabis-only use overall (aOR = 1.21; 95% CI = 1.09-1.34), a decline in cigarette-only use overall (aOR = 0.89; 95% CI = 0.81-0.97) and increases in co-use among those who were married (aOR = 1.24; CI = 1.02-1.50) and aged 50 years and above (aOR = 1.37; CI = 1.03-1.84). Recreational and medical cannabis legalization have had a varying impact on the use, and co-use, of cannabis and cigarettes in the United States.

A Failure to Guide: Patient Experiences within a State-Run Cannabis Program in Pennsylvania, United States

Introduction Medical cannabis has been available for purchase in dispensaries in Pennsylvania, United States since April 2018. Patients wanting to access medical cannabis must receive certification from physicians for a limited number of physical and psychological conditions. Despite increasing numbers of patients using cannabis in the United States, little is known about the patient experience during certification and entry into state-regulated cannabis programs and how and if they are guided by health care professionals and dispensary staff. Through focus group discussions, we sought to capture patient perspectives of certification, cannabis acquisition and cannabis use. Methods Twenty-seven Pennsylvania participants took part in 7 virtual focus groups from June to July 2020. Participants were recruited statewide from the community, medical settings, and dispensaries. Results Focus group results indicate that while the medical cannabis program is functional, policymakers and the medical community have failed to meaningfully integrate cannabis into the health care system. Participants expressed frustration around two central themes: there was no overarching education about medical use of cannabis and there was little consistency and availability for people once they found a suitable product, resulting in inadequate symptom relief and exorbitant out of pocket costs to pursue cannabis use as an adjuvant therapeutic. Participants noted a siloed experience between the certification process, accessing dispensaries, and receiving ongoing medical care. The lack of integrated care required high levels of self-reliance and experimentation with medical cannabis for participants. Conclusion We recommend that cannabis be better integrated into medical care for patients with qualifying conditions.