First Large Public Health Study of Medical Marijuana Use in Young Adults to Begin with NIH Grant

Dr. Stephen Lankenau, an associate professor in the Drexel University School of Public Health

Drexel University has received a grant for a five-year study of medical marijuana and its impact on drug use and physical and psychological health among young adults in Los Angeles. It is the first large-scale NIH project funded to directly investigate medical marijuana use among young adults aged 18 to 26.

The study, “Medical Marijuana, Emerging Adults & Community: Connecting Health and Policy,” is being led by Dr. Stephen Lankenau, an associate professor in Drexel’s School of Public Health, who was awarded an R01 grant from the National Institutes of Health for $3.3 million over five years, beginning July 1. Ultimately, Lankenau hopes the study’s findings can guide medical marijuana policies at local, state and national levels to result in the most positive health outcomes for young adults and communities.

Lankenau aims to determine the impact of medical marijuana policies in Los Angeles on young adults’ physical and psychological health. A core focus is understanding the significance and influence of dispensaries – storefronts that sell medical marijuana – on health.

“Dispensaries are a relatively new and unusual institution, and they haven’t been studied much,” Lankenau said. One study hypothesis is that dispensaries, which often provide social support in addition to medical marijuana, may provide the basis for better physical and psychological outcomes for medical marijuana users, compared to non-medical users who purchase the drug on the black market.

The study emerged out of preliminary findings from an earlier NIH-funded project, which examined non-medical prescription drug use among high-risk young adults in two cities. Among Los Angeles participants, Lankenau observed key differences in patterns of drug use and health between those who had a physician recommendation for medical marijuana, and those who used marijuana without a recommendation.

Guided by these findings, his new study has three specific aims:

1. Determine the basis for medical marijuana patient status and its impact on trajectories of physical and psychological health among emerging adults.
2. Determine the impact of medical marijuana patient status on patterns of drug use among emerging adults, including intensity of marijuana use and misuse of alcohol, prescription drugs and illicit drugs.
3. Describe the natural history of marijuana use in Los Angeles among medical marijuana patients and non-medical users.

“The young adults we recruit into this study represent an important group,” Lankenau said. This population will have many years of their lives ahead to experience the consequences, whether positive or negative, of policies that allow for medical marijuana use.

Young adult patients were not the norm when medical marijuana first became legal in California in 1996. At that time, most patients who qualified for a physician recommendation for the drug were older adults with chronic conditions or seeking palliative care, Lankenau said. But the list of health conditions eligible to receive a medical recommendation for marijuana in California has since grown to over 200, including conditions such as anxiety and insomnia. A growing number of younger people are receiving access to the drug with a medical recommendation.

California is one of 18 states, plus the District of Columbia, where medical use of marijuana is allowed under state law. Several other states have medical marijuana legislation pending, and two states have legalized non-medical use of marijuana.

Federal funding of medical marijuana research has been minimal to date likely because under federal law the drug remains a Schedule 1 controlled substance, a category that includes other drugs such as heroin, LSD and ecstasy. Lankenau noted that, as a result, most existing studies are smaller in scale, or involve secondary analysis of survey data without direct recruitment of medical marijuana-using populations.

Lankenau’s study will recruit 380 young medical marijuana patients and young non-medical marijuana users in natural settings and will use qualitative and quantitative methods. Lankenau and co-investigator Ellen Iverson at Children’s Hospital Los Angeles will enroll a diverse set of participants this fall and expect to complete baseline interviews and surveys by early 2014. Participants will then complete annual follow-up interviews for three years.

In addition to broadly characterizing the role medical and non-medical use of marijuana has in the lives of young adults, Lankenau is also interested in specific aspects of the relationship between drug policy, drug usage and health in this population. Some of the relevant issues include: how the “gateway” concept applies to young medical marijuana patients; the basis for medical marijuana recommendations among young adults in Los Angeles, including the role of criminal justice issues; and the influence of medical marijuana on patterns of use among young non-medical users, including the problem of drug diversion.