However variation in study recruitment strategies between sites may also contribute to the observed differences as some venue based recruitment may have targeted drug users at risk for HIV-infection. Reported reasons for marijuana use were similar to previous studies, with stress reduction and appetite stimulation as the most commonly reported reasons for use.While many women report using marijuana for social and relaxation reasons, marijuana use for symptom relief was also noted as an important motivator among these HIV-infected women. Reasons for marijuana use in this study were also consistent with previously reported studies showing appetite stimulation, reduction of pain, relaxation/social use, anxiety reduction, and help with sleep.Research supports the utility of marijuana in reducing these symptoms with improvements in appetite, nausea, anxiety, depression, tingling, weight loss and tiredness reported from marijuana use in other observational studies of HIV-infected individuals. If cannabanoids are proven to reduce these ART-related side effects, medicinal marijuana use may become an increasingly important option for HIV-infected individuals, where laws allow its use. Indeed, recent randomized placebo controlled trials of HIV-infected individuals demonstrated significant reduction in neuropathy-associated pain and improved appetite from smoked cannabis, supporting its utility. As more HIV-infected individuals initiate ART treatment early and remain on treatment for long periods, reduction of ART-associated morbidity is increasingly important. Adherence to ART was lower among current marijuana users than non-users in this study,flood and drain table consistent with previous research.However, ART adherence was not reduced among the more consistent daily marijuana users. These results are similar to those observed by a previous study of 168 HIV-infected patients on ART in California who reported an increase in ART adherence among daily marijuana users despite decreased adherence among marijuana users overall.

It appears that for some women, regular marijuana use reduces HIV associated symptoms, and does not impair adherence to ART. Multiple patterns of use are present in the cohort, ranging from highly adherent regular marijuana users, to higher risk women whose marijuana use may be associated with use of other drugs and higher risk sexual behaviors. The association of recent sexual behavior and drug use with recent marijuana use observed in this study has been shown in many other studies,as risk behaviors are often correlated. The fact that sex and drug use behavior were not associated with daily marijuana use in this study underscores the different nature of daily marijuana use and is consistent with the interpretation that some of daily marijuana use is medicinal rather than recreational. There are several limitations and strengths to the current study. Validity of self-reported drug use has supported in multiple studies,although some studies suggest risk behaviors are under-reported compared to use of computer-assisted self interview.Whether marijuana use was medicinal or recreational was only specifically asked in 2009 and therefore the trend in medicinal marijuana use could not be evaluated. However, earlier surveys did ask about other questions related to reasons for marijuana use and as the frequency of marijuana use was collected longitudinally the trends in daily marijuana use could be explored. Marijuana abuse/dependence was not assessed. In addition, this was an observation study so marijuana users were self selected and this study did not assess the efficacy or safety of marijuana use. Further, we analyzed changes in marijuana use at cohort level , we can not rule out the possibility that immigrative or emmigrative selection bias might in part explain the changes in marijuana use observed in the cohort. Our study demonstrates that marijuana use is common among a representative group of U.S. women living with HIV, and that daily marijuana use did not decrease ART adherence. Further, marijuana use was reported by many users to alleviate HIV-related symptoms. Given this pattern, which appears to be part of a broad trend towards use of marijuana in chronic illness, additional research is needed on the optimal formulation, efficacy, effectiveness and safety of this patient led treatment.

Cannabis, which is often referred to as marijuana, is the most commonly used illicit drug in the United States, and its use has increased over the past decade. In 2010, for example, 11.5% of Americans aged 12 or older were past-year marijuana users. Less than a decade later, in 2018, 16% of the country’s population—nearly 44 million Americans— reported being past-year users , 2020a. Each day, there are approximately 8,400 new marijuana users. While marijuana’s therapeutic benefit has been demonstrated for selected indications , there is general consensus that it adversely effects the developing brain and should be avoided by pregnant women and children/adolescents . A variety of health, social, legal, and financial problems have been associated with high frequency marijuana use—for example, respiratory conditions , social problems , other illicit drug use . In the United States, the population of marijuana users is expected to grow given states’ marijuana policy environments, which are changing rapidly with an overall movement toward liberalization . To date, 36 states and the District of Columbia have legalized medical marijuana, and 15 states and DC have legalized it for adult recreational use. More states are considering such actions drawing on early adopters and lessons from alcohol and tobacco legislation in their approaches In addition to the positive impact these policies have on patients’ access to marijuana for treatment, the trend toward legalization is an effort to respond to the social justice concerns among disadvantaged, minority populations that have shouldered a disproportionate amount of the burden associated with marijuana prohibition . In establishing their policies, states have distinguished between medical and recreational marijuana ; however, it is not understood whether marijuana users make this same distinction. A few studies have compared the characteristics or patterns of marijuana consumption between medical and recreational users; however, limitations in their designs and samples have introduced confounding or limited generalizability . Other studies have relied on data from the early 2000s when far fewer states had legalized marijuana for medical or recreational purposes . Using data from 2017-2019, our study addresses these limitations and advances what is known about why adults use marijuana. Specifically, by comparing users by their reasons for use—medical, recreational, or both—and by identifying the correlates of each subgroup, we were able to develop past-month marijuana user profiles by reasons for use.

Additionally, given the effect states’ policy environments have on attitudes towards and use of marijuana —some research has demonstrated that residents in states that have legalized recreational marijuana more commonly attribute some benefit to marijuana and more commonly use all forms and multiple forms of marijuana —we control for state policy environment. In this way, our findings establish a baseline against which post legalization outcomes can be compared as states’ environments shift. Finally, our study makes use of 2017-2019 data from Behavioral Risk Factor Surveillance System , a national probability sample survey,rolling bench which enabled us to produce national estimates. To our knowledge, this is the first time these national data were used to compare marijuana users by their reasons for use. We used the most current data available from the BRFSS, which is the nation’s premier system of health-related telephone surveys that collect state data from U.S. residents, 18 years and older, about their health-related risk behaviors, chronic health conditions, and use of preventive services , 2020a, 2020b, 2019, 2018a, 2018b, 2018c, 2018d, 2017. Established in 1984, the BRFSS is currently collected in all 50 states, the District of Columbia, and two U.S. territories . More than 400,000 adult interviews are completed each year. In 2016, BRFSS added an optional marijuana module, which included questions about past month marijuana use and routes of administration . In 2017, the question about routes of administration was changed from asking about all routes of administration to the primary route of administration, and a question about respondents’ reasons for marijuana use was added—“When you used marijuana or hashish during the past 30 days, was it for medical reasons to treat or decrease symptoms of a health condition, or was it for non-medical reasons to get pleasure or satisfaction —with five response options: only medical reasons to treat or decrease symptoms of a health condition; non-medical purposes to get pleasure or satisfaction; both medical and non-medical reasons; don’t know/not sure; refused. Since its introduction, the number of states including the optional marijuana module has grown. See Supplemental Table S1 in the online version of this article. For our analysis, we combined the last three years of BRFSS data for the 20 states that asked about respondents’ reasons for using marijuana any of the three years. During the study period, the median, annual response rate among all participating states and territories was 45.9% in 2017, 49.8% in 2018, and 49.4% in 2019 , 2020a, 2018a.The dependent variable of greatest interest was marijuana users’ reasons for use, which was drawn directly from the BRFSS question and had three response categories: medical versus recreational versus both reasons .

Additionally, because several prior studies had categorized marijuana users’ reasons for use differently—for example, comparing those who reported only recreational reasons for use to a category, which combined those who reported only medical with those who reported both reasons for use, referred to as “any medical reason” —we also created two alternative, binary specifications representing these constructs—specifically, medical reasons only versus any recreational and recreational reasons only versus any medical . To capture states’ policy environments, we created separate, binary variables reflecting the status of medical and recreational marijuana legalization from 2017-2019 in each state. See Supplemental Table S1 in the online version of this article. For all but three states, marijuana laws were stable throughout the study period. In Oklahoma, Utah, and West Virginia, medical marijuana laws were enacted and implemented in August 2018, December 2018, and June 2019, respectively. In these cases, the values of the policy variable was adjusted to reflect the month and year of legalization. After examining trends in legalization, we also created an alternative categorical specification, which combined the legal and recreational statuses by each state-year .We estimated overall and state-level percentages of the U.S. adult population who reported past-month marijuana use by reasons for use. We used bivariate analyses to examine the demographic characteristics, health status, and risk behaviors of the sample and the population from which the sample was drawn by reasons for marijuana use . Using multi-variable regression analyses, we tested the relationship between an array of predictors and each reason for marijuana use. Because the outcome of primary interest was categorical—i.e., respondents reported using marijuana for medical reasons only, recreational reasons only, or both reasons—we used multinomial logistic regression and estimated adjusted relative risk ratios. Based on underlying theory and previous research, we incorporated a multitude of covariates for statistical control. Ultimately, the final model included: gender, age, race, ethnicity, marital status, education, employment status, income, number of past-month days of poor mental and physical health, frequency of use , route of administration, tobacco use, binge drinking, and the categorical marijuana policy variable. All models were also adjusted for state and year fixed effects. Because the interpretation of multinomial logistic regression parameter estimates is not straightforward , we made two adjustments. First, we estimated the average marginal effects for each explanatory variable—that is, how an incremental change in each risk factor affects the predicted probability of reporting past-month marijuana use by each reason for use. To explore the relationship between states’ legal environments and marijuana users’ reasons for use, we created user profiles— i.e., hypothetical observations with illustrative values —and varied the legal environment. In each case, we estimated the average predicted probability of reporting each reason for use and compared those probabilities in states that were fully legal versus fully illegal. Additionally, we used the binary version of the dependent variable —i.e., recreational only versus any medical— and used logistic regression to re-estimate the relationships between each covariate and reporting only recreational reasons for marijuana use. To provide nationally representative and generalizable results, all estimates were adjusted for sampling weights and BRFSS’ complex survey design; confidence intervals were based on standard errors computed using the linearized variance estimator. We followed the CDC’s guidelines for combining multiple years of BRFSS data and data reliability/ suppression , 2020b, 2019, 2018b; Klein et al., 2002. Stata/SE version 15.1 was used for all analyses .