(B-075) Persistence of Medical Marijuana Use among Certified Patients in the State of Florida

Background: Evidence on medical marijuana (MMJ) use mostly originates from patient-reported cross-sectional surveys, which are subject to response and selection bias. Understanding MMJ utilization patterns can guide relevant policy and inform research.

Objectives: To assess the persistence of MMJ use among certified patients in the state of Florida and evaluate determinants thereof.

Methods: We conducted a retrospective cohort study using the Florida Medical Marijuana Use Registry containing patient-level data on physician-issued MMJ certifications. We identified certified patients between 2018-2022 and excluded temporary residents and patients with insufficient follow-up (i.e. 450 days). The primary outcome was 2-year persistence, defined as the proportion of patients with active recertification at 2 years. Patients were censored at the end of follow-up or death, identified via death certificates. Age, sex, qualifying condition, route of administration, and type of MMJ were evaluated as predictors in a multivariable logistic regression model with stepwise selection.

Results: A total of 796,676 newly certified patients were identified with a mean age of 47 + 17) years and a maximum certification period of 210 days. The mean duration of persistence was 493 days. At 2 years, 21.50% of MMJ initiators retained a certification. Adjusting for index year and other covariates, female patients had lower odds of persistence (20.6%, OR: 0.93 [0.92, 0.94]) compared to males. Patients aged 0-12 years (13.8%, OR: 0.51 [0.42, 0.62] and > 65 years (19.1%, OR: 0.84 [0.83, 0.85]) had significantly lower odds of persistence compared to patients aged 18-64 years. Persistence varied by qualifying conditions, as follows: glaucoma (25.1%, OR: 1.22 [1.15, 1.29]), Crohn’s disease (26.4%, OR: 1.16 [1.09, 1.22]), multiple sclerosis (22.9%, OR: 1.09 [1.03-1.16]), conditions of the same kind or class (35.7%, OR: 1.18 [1.16, 1.20]), chronic non-malignant pain (28.1%, OR: 0.88 [0.86, 0.90]), cancer (18.4%, OR: 0.79 [0.77, 0.81]), terminal condition (15.2%, OR: 0.63 [0.48, 0.82]), Parkinson’s disease (13.1%, OR: 0.54 [0.49, 0.59]), ALS (12.9%, OR: 0.53 [0.39, 0.70]) vs more than one condition. Inhalational (n=22.1%, OR: 2.07 [2.0, 2.13]), smokable (19.6%, OR: 1.97 [1.94, 2.0]), oral (21.7%, OR: 1.14 [1.11, 1.17]) and topical (20.6%, OR: 1.09 [1.07, 1.11]) routes of administration, and low THC cannabis (21.7%, OR: 1.17 [1.16, 1.19]) were positively associated with persistence.

Conclusions: A lower persistence was noted among the age extremes, female patients, and for certain conditions. Further research must investigate whether MMJ discontinuation is related to a lack of effectiveness, safety concerns, or other issues.