Medicinal and combined medicinal/recreational cannabis use in California following the passage of Proposition 64.

Background: Proposition 64, the Adult Use of Marijuana Act of 2016, reshaped cannabis use in California. This study explores the use patterns of people who use cannabis for medicinal-only and combined medicinal and recreational use after implementation of Proposition 64.

Methods: A quantitative, population-based online questionnaire included 4,020 current cannabis users, 523 former users, and 635 non-users. This analysis focuses on participants who self-identified as using cannabis for medicinal-only (n = 711) or both medicinal and recreational (M + R, n = 1719) purposes.

Results: Sixty one percent of current cannabis users report medicinal use. Medicinal-only users were more likely to be female (OR 1.6, p < 0.001), have kids in household (OR 1.5, p < 0.001), and began cannabis use later (mean age 34 vs. 23, p < 0.001). Pain relief was the predominant reason for use, followed by sleep, anxiety, and stress relief. While both groups reported positive effects, M + R users experienced more negative side effects. Fewer medicinal-only users cited a desire to "feel the high," (42% vs. 75% M + R, p < 0.001). Medicinal-only users felt less comfortable discussing cannabis with primary care providers than M + R users (75% vs 83%, p < 0.01). All users were more likely to seek information online (44-57%) or from friends/family (47-52%) than health professionals (26-27%). Dispensaries were the main cannabis source for both medicinal groups (72% M vs. 84% M + R, p < 0.01), with licensure being very or extremely important (72% M, 66% M + R, p < 0.01). Monthly spending for medicinal-only users was lower ($127 vs. $186 for M + R, p < 0.001), and they were more likely than M + R users to wait before feeling safe to drive after using cannabis.

Conclusion: People who use medicinal cannabis alone vary in key areas from people who use cannabis for both medicinal and recreational reasons. The need for better patient-provider relationships and clinically informed guidance is evident to support medicinal cannabis users.