Sex-Related Differences in Medical Cannabis Use: A Nationwide Database Study

Introduction: With the increasing use of medical cannabis (MC) worldwide, understanding potential sex-related differences in treatment patterns and outcomes has become increasingly important. The objective of this study was to characterize medical cannabis use in Israel, focusing on sex-related differences in usage patterns and adverse effects. Methods: We conducted a population-based, retrospective cohort study using data from the Israeli Medical Cannabis Agency registry (April 2018–March 2022). The dataset includes license holders’ demographics, indication for use, monthly dose, THC/CBD concentrations, and reported adverse effects. Sex-related differences were assessed using time-series analyses, Cox models, and relative risk estimates. Results: A total of 135,698 individuals (62% men) were issued a license to use MC in Israel during the study period. Men using MC were significantly younger than women (49 ± 18.3 vs. 55.3 ± 18.1). The leading indications among both sexes were chronic pain, symptoms related to oncological disease and chemotherapy treatment, and post-traumatic stress disorder. At initiation, men received higher monthly quantities than women (29.3 g vs. 26.1 g; p < 0.001), higher THC concentrations (14.3% vs. 11.9%; p < 0.001), and lower CBD concentrations (5.1% vs. 6.5%; p < 0.001). These differences remained significant over 2 years. Men had a lower discontinuation rate (HR 0.95, 95% CI: 0.93–0.97). Women were more likely than men to report at least one adverse effect (RR 1.51, 95% CI: 1.43–1.58). Conclusion: Sex-related differences in MC use likely reflect biological, behavioral, and systemic factors, influencing both outcomes and risk of misuse. These disparities highlight the need for sex-informed clinical approaches and further research to support equitable, evidence-based treatment.