Conditions Relating To Psychological Problems

To our knowledge, this is the first detailed report on the physical and psychological health of young adult patients in the scientific literature. Overall, these results support the conclusion that young adult patients enrolled in this study reported health conditions and motivations for use that were consistent with medical use of marijuana under California law.

The primary types of problems ever experienced by young patients included psychological conditions (e.g. insomnia, anxiety, depression, ADHD), pain, nausea, and migraines. While these health problems are commonly found in the general population of adolescents and young adults [17,21], patients were more likely than non-patients to report them, suggesting higher prevalence among patients in the sample. Our results are in contrast to an US study comparing adult patients and non-patients, which found few differences in physical or psychological health between patients and non-patients [51]. Among young patients ever reporting one of these health problem, top reasons for current marijuana use were problems relating to psychological conditions and pain as well as gastrointestinal and neurological problems, which is consistent with the trend toward reporting using marijuana for psychological and pain conditions among older [5,9,12] and younger patients [13]. A small but notable subgroup reported using marijuana to treat reported drug or alcohol misuse, possibly using marijuana as substitute for these other substances [52-56].

Patients were more likely to report motivations for marijuana use as adolescents consistent with medical use (i.e. focusing, anxiety, depression) compared to non-patients. These results suggest that patients may have discovered some medical benefits for marijuana as non-patients [55] years before getting a medical marijuana recommendation, which was corroborated by patients reporting self-treatment with marijuana for health conditions approximately two years before obtaining a recommendation. In the past 90 days, patients were also more likely to report motivations aligned with medical use, e.g. anxiety, focusing, physical pain. Among patients, these results suggest a consistent trajectory of motivations for medical use linking periods before and after receiving a medical marijuana recommendation.

Consistent with their lifetime health histories, patients in this sample reported the types of health problems to a physician that would qualify them for a medical marijuana recommendation under California law [5]. Conditions relating to psychological problems. Pain comprised nearly 90% of conditions reported to a physician. Over 85% reported that the health condition they indicated to a physician when obtaining a medical marijuana recommendation was genuine.

Notably, a group of patients reporting a fabricated health problem to a physician did so to obtain a recommendation as protection against arrest for marijuana possession, a legitimate concern given that approximately 10% of patients reported being arrested for marijuana. Drug-related convictions can substantially impact young adults’ future economic and educational opportunities [57,58]. While not part of the original intention of California’s medical marijuana law, reducing drug arrests among some young adult marijuana users may be an unintended effect of the law.

Findings indicate that a majority of patients also used marijuana for non-medical or recreational purposes [59,60]. Given that all patients initiated marijuana use prior to receiving a recommendation, use for recreational purposes is not surprising since marijuana use has historically been learned in the context of “pleasure” [61] with its medical applications discounted [62]. Patients who use for both medical and non-medical purposes, however, may present challenges to broader definitions and conceptions of what constitutes legitimate or appropriate use of marijuana. Non-patients were found to be significantly less likely to have had psychological. Physical health problems or report marijuana motivations aligned with medical use compared to patients. Non-patients, however, reported relatively high levels of physical and psychological problems overall [22, 38-42] as well as current motivations associated with medical use, e.g., pain, anxiety, or sleep. One-third reported using marijuana to cope with depression, some other problem, or as a substitute for alcohol. Hence, it is clear that non-patients in the sample had also experienced a range of health problems but to a lesser extent than patients. Their health conditions suggest that a proportion of non-patients might qualify for a medical marijuana recommendation in California. Related, non-patients expressed greater privacy concerns (e.g. name stored in a state database, family finding out) about obtaining a medical marijuana recommendation than patients [43]. These privacy concerns could partially explain why some non-patients - who might have had a qualifying physical. Psychological condition - decided against obtaining a medical marijuana recommendation.

Demographically, there were no significant differences between patients and non-patients regarding age, gender, sexual identity, race/ethnicity, education or employment status, which suggests that young adult patients reflect the broader population of young adult non-patients along several key background characteristics. However, significant differences between patients and non-patients around concerns of drug testing and failing a drug test for marijuana use suggest that apprehensions linked to employment eligibility may be discourage some non-patients from seeking a medical marijuana recommendation. With 43.7% of young adult patients reporting Hispanic or Latino ethnicity, this is the first study of patients to capture more Hispanics than non-Hispanic whites, which also reflects the broader demographic features of Los Angeles with Hispanics approaching 50% of the city’s population.

Results from this analysis suggest that medical marijuana laws are reaching its intended target among young adults in Los Angeles since persons with histories of physical and psychological problems comprised the great majority of young adult patients. High proportions of non-patients reporting histories of physical. Psychological problems suggest that some of these young adults may be eligible for a medical marijuana recommendation. Future studies should examine additional factors beyond privacy concerns, e.g. knowledge of program, cost of recommendations, cost of medical marijuana, that prevent young adults with medical conditions from obtaining a medical marijuana recommendation.

There are several limitations to this study. First, causal relationships cannot be determined due to the cross-sectional study design. Second, the sample was not randomly selected so the results may not be representative of all young patients and non-patients in Los Angeles. Related, a high proportion reported some college or above, which means that the sample is likely to over represent college-educated young adults. However, the sampling approach captured a largely diverse sample of young adult patients and non-patients that were closely matched along key demographic variables. Third, responses to interview questions are subject to recall bias and social desirability bias, particularly questions pertaining to whether the health condition reported to physician to obtain the recommendation was genuine or not.