title: Older, Less Regulated Medical Marijuana Programs Have Much Greater Enrollment Rates Than Newer 'Medicalized' Programs.
abstract: Twenty-three states and the District of Columbia have passed laws implementing medical marijuana programs. The nineteen programs that were in operation as of October 2014 collectively had over one million participants. All states (including D.C.) with medical marijuana laws require physicians directly or indirectly to authorize the use of marijuana at their discretion, yet little is known about how medical marijuana programs vary regarding adherence to basic principles of medical practice and associated rates of enrollment. To explore this, we analyzed marijuana programs according to seven components of traditional medical care and pharmaceutical regulation. We then examined enrollment rates, while controlling for potentially confounding state characteristics. We found that fourteen of the twenty-four programs were nonmedical and collectively enrolled 99.4 percent of participants nationwide, with enrollment rates twenty times greater than programs deemed to be "medicalized." Policy makers implementing or amending medical marijuana programs should consider the powerful relationship between less regulation and greater enrollment. Researchers should consider variations across programs when assessing programs' population-level effects.
authors.affiliation: Arthur Robin Williams (aw2879@cumc.columbia.edu) is a fellow in the Division on Substance Abuse at Columbia University, in New York City.
authors.forename: Arthur Robin
authors.initials: AR
authors.lastname: Williams
authors.affiliation: Mark Olfson is a professor of psychiatry at Columbia University.
authors.forename: Mark
authors.initials: M
authors.lastname: Olfson
authors.affiliation: June H. Kim is a doctoral candidate in the Mailman School of Public Health, Columbia University.
authors.forename: June H
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Silvia S. Martins is an associate professor in the Mailman School of Public Health.
authors.forename: Silvia S
authors.initials: SS
authors.lastname: Martins
authors.affiliation: Herbert D. Kleber is a professor in the Division on Substance Abuse at Columbia University.
authors.forename: Herbert D
authors.initials: HD
authors.lastname: Kleber
mesh_terms: D000328:Adult; D000368:Aged; D004219:District of Columbia; D005260:Female; D018166:Health Care Reform / Q000458:organization & administration; D006282:Health Personnel / Q000193:education / Q000458:organization & administration*; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology*; D008385:Marijuana Smoking / Q000453:epidemiology*; D064086:Medical Marijuana / Q000627:therapeutic use*; D008875:Middle Aged; D015397:Program Evaluation; D011795:Surveys and Questionnaires
chemical_list: D064086:Medical Marijuana
keywords: Mental Health/Substance Abuse; Pharmaceuticals; Physicians; Public Opinion; State/Local Issues