Factors Associated with Possible Cannabis Use Disorder among Adults Using Medical Cannabis in Florida: A Cross-sectional Study

Background: The number of people using medical cannabis has increased in the United States, but little is known about the prevalence or risk factors for Cannabis Use Disorder (CUD) in this population. We sought to estimate the prevalence of CUD and to identify individual characteristics and cannabis use patterns associated with CUD in a statewide sample of adults certified to use medical cannabis. Methods: The sample included 632 adults (median age 45, 63% female, 75% non-Hispanic White) certified and currently using medical cannabis in Florida. Participants were recruited from medical cannabis clinics and completed an online cross-sectional survey in 2022. The primary outcome, based on the 8-item Cannabis Use Disorder Identification Test-Revised (CUDIT-R), was categorized as possible CUD (CUDIT-R score ≥12), hazardous use (score ≥8), or non-hazardous use (<8). Independent variables included sociodemographics; mental health diagnoses; past-5-year substance use; cannabis use history, motives, and patterns; and concern about addiction or dependence. Bivariate analyses and multivariable logistic regression examined associations with possible CUD, with secondary analysis examining associations with any hazardous use. Results: Overall, 20% (95% CI 17%-24%) had possible CUD) and 54% (95% CI 50%-58%) had hazardous use. Possible CUD was significantly associated with younger age (aOR 0.98, 95% CI 0.96-1.0), >1 year of daily marijuana use (1-5 years aOR 2.2 95% CI 1.2 – 5.2; 6+ years aOR 3.1 95% CI 1.5 – 7.2), lower preference for oral concentrates (aOR 0.29, 95% CI 0.10- 0.70), and self-reported recreational reasons for marijuana use (aOR 5.1, 95% 1.5 – 17.3). Possible CUD was not associated with sex, race/ethnicity, mental health conditions, or preferred THC percentage. Hazardous use was associated with >1 year of daily marijuana use, recreational reasons for use, younger age at marijuana use, greater preference for marijuana flower, and anxiety diagnosis. Few (4%) reported concern about addiction of dependence. Discussion: About 1 in 5 adults certified to use medical cannabis in Florida had possible CUD, and over half (54%) had hazardous use. Possible CUD was associated with younger age, prolonged daily use, lower preference for oral concentrates, and recreational motives for marijuana use.