Gaps between Medical Cannabis Research and Policy

by Nima Shahidinia

Download eBook for Free

FormatFile SizeNotes
PDF file 6.6 MB

Use Adobe Acrobat Reader version 10 or higher for the best experience.

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


  • Chapter Two

    Building a Cannabis Research Database

  • Chapter Three

    The Wild West of Medical Cannabis

  • 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 publication 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.

This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to this product page is encouraged. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial purposes. For information on reprint and reuse permissions, please visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.