Gaps between Medical Cannabis Research and Policy

by Nima Shahidinia

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As of December 2021, medical cannabis use is legal in nearly 40 U.S. states. Given the diversity of products in U.S. cannabis dispensaries and current gaps in cannabis research, medical cannabis patients who do not receive sufficient guidance are at some risk of using cannabis products in a manner that is clinically ineffective (if not harmful) to their symptoms. My three papers re-examine what is known about the therapeutic efficacy of cannabis products, the degree to which patients buy dispensary products in a manner that is consistent with clinical research, and what factors may be driving "clinically inconsistent" purchases. Despite literature review findings from my first paper (up to May 2021) suggesting that only a few health conditions have sufficient evidence to suggest cannabis products are therapeutically effective, 14 U.S. states that have legalized medical cannabis use since 2016 have listed health conditions in their laws that lack clinical evidence and yet allow patients to use cannabis medically. Additionally, according to findings from my second paper, in which I analyze sales from a single medical cannabis company in New York State, approximately half of patients make clinically inconsistent purchases despite their being sufficient research to suggest that certain cannabis products are most therapeutic for their conditions. Although it is difficult to deduce why clinically inconsistent purchases occur, evidence from my third paper—in which I do not find that recreational cannabis legalization in Massachusetts is associated with a reduction of chronic pain patients in New York, and that chronic pain patients are not more likely than non-chronic patients to report recreational cannabis use—suggests that treating pain symptoms is not necessarily a reliable predictor of recreational cannabis use, despite previous research suggesting otherwise. Overall, my findings imply that clinical research has not been adequately incorporated into the U.S. medical cannabis market, and I conclude with possible interventions that policymakers might consider to bridge the gaps between cannabis research and policy.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Building a Cannabis Research Database

  • Appendix A

    Literature Review Search Log

  • Appendix B

    Randomized Controlled Trials (January 2016 to May 2021) Examining the Therapeutic Effects of Cannabis or Cannabinoids for Conditions not Listed in U.S. Medical Cannabis (MC) Laws

  • Appendix C

    Articles that Report on the Same Clinical Study, by Qualifying Condition

  • Chapter Three

    The Wild West of Medical Cannabis

  • Appendix

  • Chapter Four

    Bring the Pain: The Potential Migration of Medical Cannabis Patients after Recreational Cannabis Is Legalized

  • Chapter Five

    Conclusion: Policy Implications, Recommendations

Research conducted by

This document was submitted as a dissertation in June 2022 in partial fulfillment of the requirements of the doctoral degree in public policy analysis at the Pardee RAND Graduate School. The faculty committee that supervised and approved the dissertation consisted of Rosalie Liccardo Pacula (Chair), Rosanna Smart, and Rosemary Mazanet (outside reader).

This dissertation was financially supported by the James Q. Wilson Dissertation Award and the Anne and James Rothenberg Dissertation Award.

This report is part of the RAND Corporation Dissertation series. Pardee RAND dissertations are produced by graduate fellows of the Pardee RAND Graduate School, the world's leading producer of Ph.D.'s in policy analysis. The dissertations are supervised, reviewed, and approved by a Pardee RAND faculty committee overseeing each dissertation.

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