Prevalence, Demographics, Use Patterns, and Health Indicators of U.S. Cannabis Consumers
by Chane Leigh
Cannabis has been used for thousands of years both medically and recreationally by people across the globe. In the United States, cannabis has been federally illegal since the 1930s and was given a Schedule I substance classification in 1970 under the Controlled Substances Act (CSA). In 1996, California became the first state to legalize medical cannabis. Colorado and Washington were the first states to legalize recreational cannabis in 2012.
Since then, many states have passed legislation to create medical cannabis programs and/or allow recreational cannabis consumption for adults 21 and older. Initially, medical cannabis and its potential therapeutic benefits drove legalization efforts along with activists dedicated to reforming racist and destructive drug policies that fuel the U.S. prison industrial complex.
Cannabis remains federally illegal in the U.S. today. However, with the liberalization of cannabis policies across dozens of states, more research has been allowed to be conducted both on the potential medical benefits of using cannabis and for separating fact from fiction when it comes to the downsides of cannabis use.
As more states have opted for the legalization of cannabis both medically and recreationally, researchers have been granted more freedom to study the cannabis plant. Interest and need for solid data concerning cannabis and its potential benefits or drawbacks have both grown. Today, we know more about the different cannabinoids and their potential therapeutic benefits than ever before. Let’s explore some of the most researched benefits of cannabis.
Inflammation is a cause and symptom of many chronic conditions, including multiple sclerosis (MS) and muscle spasms, epilepsy, glaucoma, Alzheimer’s disease, and more. Inflammation is one of the most popular health problems treated with medical cannabis. Cannabinoids such as cannabidiol (CBD) are potent anti-inflammatory agents. One of the most popular reports demonstrating that CBD is good for inflammation was published in 2010.
One of the most common reasons people miss work and have a decreased quality of life is due to various types of chronic pain. From PMS cramps and migraines to fibromyalgia and chronic neuropathic pain, many people are debilitated by daily, overwhelming pain. Whether applied topically or consumed orally, cannabis not only provides pain relief but also helps reduce reliance on harsh, addictive opioids and other OTC (over-the-counter) pharmaceuticals that can compromise organ function.
Both the short-term and chronic use of prescription opioids have been associated with increased morbidity and mortality. Access to medical cannabis has been connected with a decrease in opioid prescriptions, opioid doses, and other pharmaceuticals, as well as alcohol and tobacco. According to the National Academies of Sciences, Engineering, and Medicine, “substantial evidence” exists for the use of cannabis and cannabinoids to treat chronic pain.
Many people experience nausea either regularly or occasionally from digestive problems, medications, treatments like chemotherapy, and more. Cannabis may help decrease stomach pain and regulate your body’s digestive processes, like metabolism. Cannabis also reacts with brain receptors to help regulate the feelings that are often associated with nausea. It can also stimulate appetite for people struggling to consume food due to nausea.
Preclinical and clinical research indicate that cannabinoids, including CBD, may be effective for clinically treating both nausea and vomiting. Some THCA studies have found that this cannabinoid has a heightened potential for treating nausea and vomiting. According to one study, THCA proved to be “a more potent alternative to THC in the treatment of nausea and vomiting.” More research is needed in this area to fully explore the different cannabinoids and their medical value.
Meanwhile, synthetic forms of THC like dronabinol and nabilone are already FDA-approved to treat nausea and vomiting after cancer chemotherapy. Dronabinol is also approved to improve weight gain and appetite in patients with AIDS.
In 2010, researchers at Harvard University suggested that cannabis reduces anxiety, improving the user’s mood and acting as a sedative in low doses. A 2018 study on the potential of cannabis to reduce anxiety found that the anxiolytic (anxiety-reducing) effects of cannabis are in part dependent on the strain, terpenes, and THC:CBD ratio.
Specifically, the study stated that delta-9-tetrahydrocannabinol (THC)—known for its psychoactive effects—appeared to reduce anxiety in low doses but increased anxiety in higher doses. CBD, conversely, appears to decrease anxiety across the board since it lacks the negative side effects such as paranoia that come with intoxication. CBD has also been shown to balance out some of the anxiety caused by THC when the cannabinoids are paired.
A 2021 observational study explored the antidepressant and anxiolytic effects of cannabis use and found that it “was associated with lower self-reported depression” and that “medicinal cannabis users also reported superior sleep, quality of life, and less pain on average. Initiation of medicinal cannabis during the follow-up period was associated with significantly decreased anxiety and depressive symptoms, an effect that was not observed in Controls that never initiated cannabis use.”
The study concluded that cannabis use may reduce anxiety and depressive symptoms in clinically anxious and depressed populations, although they noted that future placebo-controlled studies were needed to replicate these results. Similarly, a 2021 systematic review concluded that cannabis was associated with reduced symptoms of post-traumatic stress disorder (PTSD), which often include depression and anxiety.
Preliminary research into cannabis and insomnia suggests that CBD may have therapeutic potential for the treatment of insomnia. THC may decrease the time it takes to fall asleep but could impair sleep quality long-term. According to a 2008 clinical review, “acute administration of cannabis appears to facilitate falling asleep and to increase Stage 4 sleep.”
A randomized, placebo-controlled 2021 randomized, double-blinded, and placebo-controlled clinical trial exploring insomnia and medical cannabis found that “two weeks of nightly sublingual administration of a cannabinoid extract (ZTL-101) is well tolerated and improves insomnia symptoms and sleep quality in individuals with chronic insomnia symptoms.” Likewise, a 2021 study concluded that “medicinal cannabis users perceive a significant improvement in insomnia with cannabinoid use.”
Emerging research is backing up what many have known anecdotally for decades: Cannabis has many therapeutic and beneficial properties worth exploring. However, it’s important to keep a balanced and realistic view of cannabis use and how it impacts consumers.
After being bombarded with false claims of cannabis’ detrimental effects for decades—think Reefer Madness—many are dismissive of the idea that cannabis has any downsides. Nevertheless, it is crucial to acknowledge the real disadvantages and distinguish those from the popular negative stereotypes and myths that have been circulated over the years. Let’s explore some of the physical, social, and legal cons of cannabis use.
It’s a well-known trope that cannabis users have short-term memory loss. This could be particularly true for young adults, whose prefrontal cortex does not fully develop until the age of 25. Although research on cannabis and cognitive function remain limited, results from one study indicated that young adults engaging in cannabis use before age 15 had an increased risk of memory deficits.
This is why age limitations for cannabis use are important in states that have adult-use, recreational cannabis. However, there are medical marijuana patients who may medicate before this age to treat a variety of diseases that medical cannabis is approved for. While THC-heavy cannabis may not be an option for underage patients, non-intoxicating cannabinoids like CBD and cannabigerol (CBG) are still recommended in certain circumstances and should still be further explored.
Another study looked into chronic, daily cannabis use in adults and its association with cognitive impairments. Results showed that any negative impacts on memory and cognitive function recovered after a period of abstinence. A study conducted in Australia on young adults between the ages of 20 and 24 found that “cessation of cannabis use appears to be associated with an improvement in capacity for recall of information that has just been learned.”
A review of the data from 2012 summarized what is known about cognitive function and cannabis consumption saying, “Although there is convincing evidence that acute cannabis use generally affects cognitive and motor functions, it is less clear as to whether those deficits are short-term and transient or if they are more enduring.” In other words, it’s not clear that long-term use of cannabis has lasting impacts on cognitive function.
Research on cognitive function and cannabis consumption is still in its infancy. A paper about recent advances in this field confirmed that the acute effects of cannabis are evident in attentional and information processing abilities but that—similar to memory and cannabis use—recovery of these functions ensues approximately a month or more after abstaining. The study also states that these results remain open to more than one interpretation, attesting to the need for more research.
A 2021 systematic review of 10 meta-analyses of cannabis use and cognition linked cannabis intoxication with small to moderate deficits in memory, verbal learning, and some executive functions like decision-making. However, even residual (persisting after initial use) effects were found to be reversible when cannabis use stopped for an extended period. No significant differences in language or perceptual-motor functioning were seen.
The research team leading the review noted that much of the included data came from small sample sizes, “which limits the inference of a causal relationship between cannabis use and cognition as well as generalizability of results.” Additionally, some of the studies reviewed involved minors, whose developing brains are adversely affected by THC compared to adults. Due to the complexity of cognitive function and the wide variation in cannabis use, more research is needed to assess cannabis’ cognitive impacts.
Smoking of any form can cause lung damage. Although there is only preliminary research comparing cannabis smoke with tobacco smoke and its link to more serious diseases such as lung cancer, available research suggests that cannabis smoke affects the lungs similarly to tobacco smoke, causing symptoms such as increased cough and hyperinflation. Smoking cannabis over an extended period of time has been linked with symptoms of chronic bronchitis.
Research has been inconclusive in forming a concrete link between cannabis use and lung cancer. Additionally, the impacts of cannabis use on general lung functioning haven’t been consistently demonstrated in the currently available research. It should be noted, though, that cannabis smokers inhale five times more carbon monoxide and three times more tar than tobacco smokers. The long-term effects of cannabis smoking on cardiovascular health are still unclear but may increase risks for peripheral arterial occlusion, myocardial infarction, and renal disease, especially in young and at-risk populations like diabetics.
A good way to avoid this cannabis use con entirely is to try alternative consumption methods to smoking. Edibles, tinctures, and topical products are available at recreational cannabis and medical cannabis dispensaries. These alternate modes of ingestion can bypass any worries an individual might have about the negative consequences associated with smoking.
The illegal status of cannabis—both federally and in many states—is a con in regard to the accessibility and quality of marijuana products. The illegal status of cannabis may deter many from seeking it out as a treatment for fear of criminal, employment, and legal repercussions. Even in states with legal cannabis, residents can be barred from federal employment for cannabis use. Having a medical card can also exclude patients from certain actions, such as obtaining a concealed carry permit.
In states where the illicit market is the only option for consumers, there is a heightened risk of consuming products contaminated with mold, pesticides, heavy metals, unknown residues, or even dangerous additives like fentanyl. It’s also difficult to know exactly what strain you are purchasing, growing methods used (e.g., organic or not), terpene profile, and CBD:THC ratio, which are all important components to control in order to avoid or mitigate potential adverse effects.
The social stigma that surrounds cannabis use has lessened somewhat over the past decade as drug policy reform has continued to progress in many states throughout the U.S. However, particularly in places where cannabis remains illegal for recreational use and medical use—but even in places where there are legal programs in place—social stigma continues to surround cannabis use.
Historically, cannabis was criminalized and stigmatized not because of problems associated with its use but rather because of propaganda that encouraged the public to view the plant and its consumers as dangerous. In the early 1900s, American anti-drug activists with nationalist agendas began identifying cannabis as the “The Marijuana Menace” to capitalize on anti-immigrant sentiments against Mexican people.
While cannabis is less stigmatized today than ever before, the stigma continues to be a barrier for patients and recreational users alike. Unlike alcohol consumers, cannabis consumers are often forced into secrecy about their substance use. Marginalized groups often face heightened stigmatization for their cannabis use, suffering consequences such as incarceration, job severance, or having a child removed from the home by the state.
Since cannabis was illegal for so many decades in the U.S.—and continues to be illegal at a federal level—scientists have struggled to study its effects in legitimate and controlled settings. As a result, there is a lack of research on cannabis in general. As more states move forward with legalizing cannabis and more cannabis research is funded, we will continue to understand more about this plant and its effect on humans who consume it.
The research that has been conducted thus far is promising for public health. Studies have explored the analgesic and anti-inflammatory properties of the cannabis plant, which could provide symptom relief to many for a variety of conditions. The legalization of cannabis federally and reform of cannabis laws locally will only further encourage more research on cannabinoids and their medical value, as well as provide clarification about risks and potential downsides.
It’s important to have a complete picture of the benefits and drawbacks of consuming cannabis either medically or recreationally. Remaining up to date with the laws and science surrounding cannabis can help you stay informed. However, there’s no substitute for talking to a healthcare professional. If you are interested in trying medical cannabis, make an appointment with a licensed medical marijuana doctor to find out if you’re eligible for a medical card.
Note: The content on this page is for informational purposes only and is not intended to be professional medical advice. Do not attempt to self-diagnose or prescribe treatment based on the information provided. Always consult a physician before making any decision on the treatment of a medical condition.
This blog post was originally written by Anthony Dutcher and published on 11/28/17. Updated 3/14/22.
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