Understanding Motives for Illicit Medicinal Cannabis Use: An Exploratory Analysis in a Medical Cannabis Program

Background Medical Cannabis (MC) is authorized in numerous state-legislated programs to treat approved medical conditions. Notwithstanding MC access, some participants continue to use cannabis purchased outside of a state licensed MC pharmacy, otherwise known as illicit medicinal cannabis (IMC), to treat their medical conditions. Identifying barriers and contributors to MC use and motives for IMC use can promote safety, improve program design, and inform future research efforts. Methods This exploratory analysis utilized baseline survey data from a convenience sample-based prospective cohort evaluation of newly registered (< 6 months) adult participants in Utah’s MC program who had been diagnosed with chronic pain, post-traumatic stress disorder, and/or cancer. Participants completed surveys assessing physical and mental health, program experience, and barriers and contributors to MC access. We employed descriptive analysis, chi-squared analysis, and logistic regression to identify factors influencing IMC use. Results Among 273 MC program participants screened for eligibility, 227 were enrolled in the cohort evaluation, and 211 participants completed the baseline survey. Approximately 1 in 10 survey respondents (N = 24, 11.9%) reported IMC use within the past two weeks. Participants accessing IMC were 40.5 years old, 58.3% male, 70.8% employed, and 87.5% white. Participants using IMC reported barriers to MC, including product cost (n = 19, 79%) and assurance of adequate supply (n = 11, 45.8%) as the most common motives for IMC use. Participants who reported experiencing MC access barriers were significantly more likely to report IMC use than those reporting no barriers (Odds Ratio (OR) = 4.73, p < 0.001). Participants using IMC reported lower levels of trust in (p < 0.04) and reliance (p < 0.02) upon the state program and less reliance on MC pharmacists (p’s < 0.01). However, participants who relied on the state program for MC information were less likely to report IMC use (Adjusted Odds Ratio AOR = 0.16, p < 0.05). Conclusions In a state MC program, barriers related to MC access and cost indicated a significant increase in the likelihood of IMC use, while reliance on the state program for MC information indicated a significant decrease in the likelihood of IMC use. Future research can explore how increasing affordable access to MC and availability of reliable information may affect IMC use.