(8) Relief Is Hard to Reach: Barriers to Medical Cannabis in Bronx, NY

Introduction:
Medical cannabis use is increasing nationally, and 37 U.S. states have passed laws legalizing medical cannabis use [1]. Though over 150,000 patients have been certified to use medical cannabis in New York State since 2014, little is known about whether patients initiate and maintain medical cannabis use after certification.

Objective:
To assess maintenance of medical cannabis after certification and to identify potential barriers to medical cannabis use

Methods:
We administered a cross-sectional phone questionnaire to patients who were certified for medical cannabis at the Montefiore Medical Cannabis Program (MMCP) in 2019. The MMCP is primary care based, has 13 certifying physicians, and operates in an academic medical center in the Bronx, NY. We asked respondents about history of medical cannabis purchases from dispensaries, unregulated cannabis use, routes of administration, and perceived symptom-relief (0-10 Likert scale; 0= no efficacy, 10= highly effective) of medical and unregulated cannabis. Maintenance was defined as purchasing medical cannabis more than once. We asked respondents who did not maintain medical cannabis use reasons for not purchasing medical cannabis.

Results:
Of the 362 patients that were reached out to, 215 (59.3%) completed the phone questionnaire. The respondents were 71.4% female, 47.8% Black, 44.9% Hispanic, and mean age was 55 (22-94). One-hundred-fifty-three purchased medical cannabis at least once, nearly half (n=105; 48.8%) of the respondents did not maintain medical cannabis use. One-hundred-five (49.1%) respondents reported using unregulated cannabis. Respondents who purchased medical cannabis, including those who purchased just once, primarily used sublingual tincture (65.3%). Mean perceived symptom-relief of medical cannabis was 6.83 (SD=3.05). Respondents who used unregulated cannabis primarily used smoked cannabis (81.4%). Mean perceived symptom-relief of unregulated cannabis was 8.24 (SD=1.98). The most cited reasons for not maintaining medical cannabis use were price (46.2%), convenience of purchase (23.1%), and limited efficacy (12.5%). Unregulated cannabis use was more common among respondents who did not maintain medical cannabis use compared to those who maintained medical cannabis use (56.2% vs 42.2%, respectively; χ2(1)= 4.18, p< 0.05).

Conclusions:
Despite increasing numbers of patients certified for medical cannabis, maintenance of use in this cohort was limited. Despite high reported symptom-relief, cost was a barrier to the maintenance of medical cannabis. Further, the majority of respondents who did not maintain medical cannabis use reported using unregulated cannabis products, which have higher risk due to contamination and irregular dosing [2]. The primary route of administration of smoking for unregulated cannabis is also associated with higher risk- long-term sequelae such as chronic bronchitis have been noted [3]. System-level changes to improve accessibility of medical cannabis and limit the use of unregulated cannabis could reduce harm in patients using cannabis.

References:
1. O'Connell M, Levy S, Shrier LA, Harris SK. Trends in cannabis-related attitudes and behaviors among cannabis-using adolescent and young adult outpatients following medical cannabis legalization in Massachusetts. Subst Abus. 2021 Jul 2:1-8.
2. Montoya Z, Conroy M, Vanden Heuvel BD, Pauli CS, Park SH. Cannabis Contaminants Limit Pharmacological Use of Cannabidiol. Front Pharmacol. 2020 Sep 11;11:571832.
3. Tetrault JM, Crothers K, Moore BA, Mehra R, Concato J, Fiellin DA. Effects of marijuana smoking on pulmonary function and respiratory complications: a systematic review. Arch Intern Med. 2007 Feb 12;167(3):221-8.