Jugl Sebastian, Sajdeya Ruba, Buhlmann Melanie, Cook Robert L, Brown Joshua D, Winterstein Almut G, Goodin Amie J
Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA.
Center for Drug Evaluation & Safety (CoDES), Gainesville, Florida, USA.
Cannabis Cannabinoid Res. 2025 Apr;10(2):207-212. doi: 10.1089/can.2024.0073. Epub 2024 Oct 7.
Florida's medical cannabis (marijuana) program is among the largest in the United States. Smokable cannabis forms were not legally available in this program until 2019, and five years after other forms of cannabis were available. This study assessed changes in Δ-9 tetrahydrocannabinol (THC) dispensed per patient following legalization of smokable cannabis in Florida. This quasi-experimental study used data from the Florida Department of Health Office of Medical Marijuana Use Reports on THC dispensing from April 6, 2018, through March 13, 2020. Certified medical cannabis user during the study period was included. The exposure was the dispensed amount of THC from legalized smokable forms of medical cannabis (statute identified as SB182), effective as of March 2019. Changes in level and trend of average milligram (mg) of dispensed THC per certified patient with 95% confidence intervals (CIs), before and after SB182, were calculated by fitting a generalized least squares linear model and allowing a 17-week phase-in period. The number of certified patients increased by 24.8% from 197,107 (March 22, 2019) to 246,079 (July 19, 2019) and to 325,868 by March 13, 2020. Assuming that a 20% THC concentration in smokable products, there was a significant level increase in the mean weekly dispensed THC amount per certified patient of 138.45 mg (95% CI: 102.69-174.20), translating to a 42.18% increase (95% CI: 33.14-50.28), from the pre-policy period. We noted a continuous increase of 5.62 mg per certified patient per week (95% CI: 4.35-6.89) throughout the 35 weeks following the policy, when compared with the period before. Assuming 10% THC concentration in smokable products, we observed a significant level increase of 35.10 mg (95% CI: 5.31-64.88), corresponding to an increase of 10.70% (95% CI: 1.70-18.89), and a trend increase of 2.23 mg per certified patient per week (95% CI: 1.18-3.29). The expansion of the Florida medical cannabis program to include smokable cannabis forms was associated with a significant increase in the mean amount of weekly dispensed THC per certified patient. Findings suggest that the dispensed amount of THC after legalization of smokable medical cannabis far exceeds the maximum recommended daily dose, based on extrapolation from oral cannabis product dosing recommendations from one expert consensus statement, raising questions about the safety, and need for consumer education.
佛罗里达州的医用大麻计划是美国规模最大的计划之一。在该计划中，可吸食的大麻形式直到2019年才合法供应，比其他形式的大麻晚了五年。本研究评估了佛罗里达州可吸食大麻合法化后每位患者的Δ-9四氢大麻酚（THC）配药量变化。这项准实验研究使用了佛罗里达州卫生部医用大麻使用办公室2018年4月6日至2020年3月13日期间关于THC配药的报告数据。研究纳入了研究期间的认证医用大麻使用者。暴露因素是自2019年3月起合法的可吸食医用大麻形式（法规认定为SB182）的THC配药量。通过拟合广义最小二乘线性模型并设定17周的逐步引入期，计算了SB182前后每位认证患者的平均毫克（mg）配药THC水平和趋势变化以及95%置信区间（CI）。认证患者数量从197,107人（2019年3月22日）增加了24.8%，至246,079人（2019年7月19日），到2020年3月13日增加至325,868人。假设可吸食产品中THC浓度为20%，每位认证患者每周的平均配药THC量显著增加了138.45mg（95%CI：102.69 - 174.20），较政策实施前增长了42.18%（95%CI：33.14 - 50.28）。我们注意到，与政策实施前相比，在政策实施后的35周内每位认证患者每周持续增加5.62mg（95%CI：4.35 - 6.89）。假设可吸食产品中THC浓度为10%，我们观察到平均水平显著增加了35.10mg（95%CI：5.31 - 64.88），相当于增加了10.70%（95%CI：1.70 - 18.89），且每位认证患者每周有2.23mg的趋势性增加（95%CI：1.18 - 3.29）。佛罗里达州医用大麻计划扩大到包括可吸食大麻形式与每位认证患者每周的平均THC配药量显著增加有关。研究结果表明，基于一份专家共识声明中口服大麻产品给药建议的推断，可吸食医用大麻合法化后的THC配药量远远超过了最大推荐日剂量，这引发了对安全性以及消费者教育需求的质疑。
