title: Do recreational cannabis users, unlicensed and licensed medical cannabis users form distinct groups?
abstract: This study aims to gain a more nuanced perspective on the differences between recreationally and medically motivated cannabis use by distinguishing between people who use cannabis for recreational purposes, unlicensed and licensed medical users.
  
  
  
  Data collection was conducted online from a convenience sample of 1479 Israeli cannabis users. Multinomial regression analysis compared unlicensed medical users (38%) with recreational (42%) and licensed medical (5.6%) users in terms of sociodemographics, mode, frequency and problematic cannabis use.
  
  
  
  There were more variables distinguishing unlicensed from licensed users than there were distinguishing features between unlicensed and recreational users. Recreational users were more likely to be male, less likely to eat cannabis, to use cannabis frequently and to use alone and before midday than unlicensed users. Licensed users were older than unlicensed users, they reported less hours feeling stoned, less cannabis use problems and they were more likely to report cannabis use patterns analogous of medication administration for chronic problems (frequent use, vaping, use alone and use before midday).
  
  
  
  This study suggests that a sizable proportion of cannabis users in Israel self-prescribe cannabis and that licensed medical cannabis users differ from unlicensed users. This is, in turn, suggestive of a rigorous medicalized cannabis program that does not function as a backdoor for legal access to recreational use. However, due to methodological limitations this conclusion is only suggestive. The most meaningful differences across recreational, unlicensed and licensed users were mode and patterns of use rather than cannabis use problems. Current screening tools for cannabis use problems may, however, not be well suited to assess such problems in medically motivated users. Indeed, when screening for problematic cannabis use there is a need for a more careful consideration of whether or not cannabis use is medically motivated.
authors.affiliation: School of Public Health, University of Haifa, Eshkol Building, Room 705, Mount Carmel 3190501, Haifa, Israel. Electronic address: sznitman@research.haifa.ac.il.
authors.forename: Sharon R
authors.initials: SR
authors.lastname: Sznitman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008004:Licensure; D008297:Male; D008385:Marijuana Smoking / Q000453:epidemiology*; D064086:Medical Marijuana / Q000627:therapeutic use*; D008875:Middle Aged; D011998:Recreation; D055815:Young Adult
chemical_list: D064086:Medical Marijuana
keywords: Cannabis legalization; Licenced use; Medical cannabis; Mode of use; Recreational cannabis; Unlicensed use