Marijuana Use to Address Symptoms and Side Effects by Youth With Chronic Medical Conditions

We analyzed baseline data from 451 participants aged 14 to 18 years receiving care for a chronic medical condition who enrolled in a randomized trial of an intervention to reduce alcohol use. Seventy-three participants reported marijuana use in the past 12 months and were included in these analyses. Youth assent was secured with a waiver of parental consent under the approval of the institutional review board.

Participants were asked whether they use marijuana to alleviate disease symptoms or side effects. Marijuana use items included the following: age at first use, number of days in which marijuana was consumed in the past 3 months, past-year frequency of substituting marijuana for alcohol because of their condition, intentions to use marijuana in the next 3 months, and sources of marijuana. Marijuana belief measures included the following: agreement that “marijuana is safe because it is natural,” agreement that “marijuana can be addictive,” agreement that “using marijuana can make my condition worse,” and perceived risk to physical and/or mental health of using marijuana at least once a week.

Analyses were conducted by using SAS 9.4 (SAS Institute, Inc, Cary, NC). Differences in sociodemographics, health characteristics, and substance-use beliefs and behaviors between participants reporting IU and those reporting recreational use (RU) were compared by using χ² tests, Fisher’s exact tests, Kruskal-Wallis tests, and t tests, as appropriate. Characteristics that differed significantly (P < .05) between IU and RU groups in bivariate analyses (each variable modeled separately) were examined by using multivariate logistic regression with IU as the dependent variable, adjusting for age, sex, and parents’ education. Odds ratios and 95% confidence intervals were calculated. Sample mode imputation was used for subjects with missing data (<0.1% of data).

The average age was 17.2 years (SD: 1.0 years); 50.7% (n = 37) were male and 80.8% (n = 59) were white non-Hispanic. Most adolescents (n = 51; 70.8%) reported buying marijuana for themselves or having someone buy for them, 29 (40.3%) got it at a party or from friends, 12 (16.7%) got it from someone at school, 5 (6.9%) got it from a sibling or relative, 1 (1.4%) got it from a parent or guardian, and 5 (6.9%) reported taking it from their house without asking. Past-year self-rated health was negatively correlated with frequency of marijuana use in the last 3 months (r = −0.28; P =.03). No correlation was found between weekly frequency of marijuana use and frequency of alcohol use over the past 3 months.

Twenty-two participants (30.1%) reported IU for the following: pain (n = 11; 50.0%), anxiety (n = 15; 68.2%), nausea or upset stomach (n = 9; 40.9%), appetite (n = 10; 45.5%), or other (n = 3; 13.6%) (Table 1). In adjusted analyses, younger age at first marijuana use, higher frequency of marijuana use in the past 3 months, substituting marijuana for alcohol because of a medical condition, greater likelihood of using marijuana in the next 3 months, and monthly or more frequent tobacco use were all associated with increased odds of IU (all P values < .05, Table 2).

Nearly one-third of surveyed YCMC who use marijuana do so to address symptoms or side effects of their condition, and such IU was associated with more frequent use and greater intention to use in the future compared with youth who only use recreationally. YCMC reporting IU and RU did not differ in overall health, mental health, or missing activities because of their condition. Despite limited evidence, marijuana is promoted as an effective treatment of a wide variety of symptoms, and such claims may be driving indiscriminate IU. It appears that marijuana IU may be fundamentally different from opioid IU. Youth that report opioid IU (primarily for pain) have lower risk of substance-use disorders, heavy drinking, and other drug use compared with those who use recreationally.^1–4  Here, YCMC who reported marijuana IU report greater frequency of marijuana use, greater intention to use marijuana in the future, and more comorbid tobacco use, placing them at higher risk for cannabis- and potentially other substance-use disorders, a concerning result that belies youth goals of using marijuana to ameliorate problems and support wellbeing.

The self-reported data for these analyses were derived from a small, predominantly white convenience sample drawn from a single institution. Research in larger, more diverse samples, including healthy youth who may also use marijuana instrumentally, is needed to better understand this phenomenon and support preventive interventions.

We acknowledge the support of clinician champions who facilitated access to their patient populations for survey research, including Drs Katharine Garvey, Fatma Dedeoglu, and Laurie Fishman. Help with article preparation was provided by Rachele Cox, MPH, and Shenjia Shi, MPH.

IU

instrumental use

RU

recreational use

YCMC

youth with chronic medical conditions