Dual Use Cannabis Consumers Face Sharply Higher Health Risks Than Single Use Peers

Study Compares Medicinal, Recreational and Dual Cannabis Users

University of Delaware researchers have published a cross-sectional study comparing medicinal cannabis users with recreational users, rather than the more common comparison of users with nonusers. The team analyzed 2018 2021 data from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System.

The study was led by Tarang Parekh, assistant professor of epidemiology at the University of Delaware College of Health Sciences. Collaborators included Daniel Harris, assistant professor of epidemiology; Kareem Khairy, a doctoral student in the Department of Epidemiology; and Dharmi Desai, a doctoral student and mentee at George Mason University.

Results were published in the Journal of Medicine, Surgery, and Public Health. The researchers identified patterns, demographics and health characteristics across user groups.

Medicinal users had an average age of 49, and nearly half were women. “This population had the poorest health with more arthritis, disability, obesity and chronic disease,” Parekh said.

Recreational users were generally younger, healthier men. Despite having the highest levels of physical activity, 45% reported binge drinking.

Dual Users Carry the Heaviest Health Burden

The analysis also identified a third, often-overlooked group: dual users, who use cannabis for both medicinal and recreational purposes. Most dual users were ages 25 34.

“Dual use was the most common pattern in our data, and as access to cannabis increases, this is the group to watch,” Parekh said. “Demographically, they look very different from the other populations.”

“They also carry the heaviest burden of mental health distress and cigarette smoking,” Parekh said.

Among dual users, 44% also smoke cigarettes, and 42% reported binge drinking. Nearly half of recreational users report binge drinking.

Unpublished Delaware data from the 2020 2021 BRFSS, analyzed by Parekh before the legal market opened, showed similar patterns. Nearly 60% of Delawareans who used cannabis in a one-month period used it on at least 11 days per month, and smoking was the most popular form of consumption at 74%.

Clinicians Urged to Screen for Co-Use and Mental Health

The findings highlight potential public health concerns and can help clinicians better understand what questions to ask patients about their cannabis use. “As younger adults come into the health system, and we ask them about their cannabis use, we must also prompt them on their alcohol use,” Parekh said.

“For those using both medicinally and recreationally, clinicians should probe about their mental health as well,” Parekh said.

Parekh said significant data gaps must be addressed before public health policies are enacted. Researchers must understand why people use cannabis, how often, and what products they use.

Recreational cannabis is now legal in 24 states, including Delaware, where retail sales began just over a year ago.

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