Original Research
9 April 2024

Trends in U.S. Medical Cannabis Registrations, Authorizing Clinicians, and Reasons for Use From 2020 to 2022

Publication: Annals of Internal Medicine
Volume 177, Number 4
Visual Abstract. Trends in U.S. Medical Cannabis Registrations, Authorizing Clinicians, and Reasons for Use From 2020 to 2022
The authors discuss key data regarding licensed medical cannabis use in the United States, including changes in estimates of patients using medical cannabis overall, conditions for which patients obtain medical cannabis licenses, passage of new state-level medical cannabis laws, the number and type of clinicians authorizing medical cannabis use, and shifts in the number of patients based on the presence of nonmedical adult use laws.



As medical cannabis availability increases, up-to-date trends in medical cannabis licensure can inform clinical policy and care.


To describe current trends in medical cannabis licensure in the United States.


Ecological study with repeated measures.


Publicly available state registry data from 2020 to 2022.


People with medical cannabis licenses and clinicians authorizing cannabis licenses in the United States.


Total patient volume and prevalence per 10 000 persons in the total population, symptoms or conditions qualifying patients for licensure (that is, patient-reported qualifying conditions), and number of authorizing clinicians.


In 2022, of 39 jurisdictions allowing medical cannabis use, 34 reported patient numbers, 19 reported patient-reported qualifying conditions, and 29 reported authorizing clinician numbers. Enrolled patients increased 33.3% from 2020 (3 099 096) to 2022 (4 132 098), with a corresponding 23.0% increase in the population prevalence of patients (175.0 per 10 000 in 2020 to 215.2 per 10 000 in 2022). However, 13 of 15 jurisdictions with nonmedical adult-use laws had decreased enrollment from 2020 to 2022. The proportion of patient-reported qualifying conditions with substantial or conclusive evidence of therapeutic value decreased from 70.4% (2020) to 53.8% (2022). Chronic pain was the most common patient-reported qualifying condition in 2022 (48.4%), followed by anxiety (14.2%) and posttraumatic stress disorder (13.0%). In 2022, the United States had 29 500 authorizing clinicians (7.7 per 1000 patients), 53.5% of whom were physicians. The most common specialties reported were internal or family medicine (63.4%), physical medicine and rehabilitation (9.1%), and anesthesia or pain (7.9%).


Missing data (for example, from California), descriptive analysis, lack of information on individual use patterns, and changing evidence base.


Enrollment in medical cannabis programs increased overall but generally decreased in jurisdictions with nonmedical adult-use laws. Use for conditions or symptoms without a strong evidence basis continues to increase. Given these trends, more research is needed to better understand the risks and benefits of medical cannabis.

Primary Funding Source:

National Institute on Drug Abuse of the National Institutes of Health.

Get full access to this article

View all available purchase options and get full access to this article.

Supplemental Material

Supplement Tables


National Conference of State Legislatures. State medical cannabis laws. Updated 22 June 2023. Accessed at www.ncsl.org/health/state-medical-cannabis-laws on 30 August 2023.
National Academies of Sciences, Engineering, and Medicine. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. National Academies Pr; 2017.
Evanoff AB, Quan T, Dufault C, et al. Physicians-in-training are not prepared to prescribe medical marijuana. Drug Alcohol Depend. 2017;180:151-155. [PMID: 28892720] doi: 10.1016/j.drugalcdep.2017.08.010
Rønne ST, Rosenbæk F, Pedersen LB, et al. Physicians' experiences, attitudes, and beliefs towards medical cannabis: a systematic literature review. BMC Fam Pract. 2021;22:212. [PMID: 34674661] doi: 10.1186/s12875-021-01559-w
Earp BD, Lewis J, Hart CL; Bioethicists and Allied Professionals for Drug Policy Reform. Racial justice requires ending the war on drugs. Am J Bioeth. 2021;21:4-19. [PMID: 33413050] doi: 10.1080/15265161.2020.1861364
Keyhani S, Steigerwald S, Ishida J, et al. Risks and benefits of marijuana use: a national survey of U.S. adults. Ann Intern Med. 2018;169:282-290. [PMID: 30039154] doi: 10.7326/M18-0810
The White House. Statement from President Biden on marijuana reform. 6 October 2022. Accessed at www.whitehouse.gov/briefing-room/statements-releases/2022/10/06/statement-from-president-biden-on-marijuana-reform on 25 May 2023.
Sacco LN, Sheikh HZ. Department of Health and Human Services Recommendation to Reschedule Marijuana: Implications for Federal Policy. Congressional Research Service; 2023.
Boehnke KF, Dean O, Haffajee RL, et al. U.S. trends in registration for medical cannabis and reasons for use from 2016 to 2020. An observational study. Ann Intern Med. 2022;175:945-951. [PMID: 35696691] doi: 10.7326/M22-0217
Boehnke KF, Gangopadhyay S, Clauw DJ, et al. Qualifying conditions of medical cannabis license holders in the United States. Health Aff (Millwood). 2019;38:295-302. [PMID: 30715980] doi: 10.1377/hlthaff.2018.05266
United States Census Bureau. Data. 2023. Accessed at www.census.gov/data.html on 25 May 2023.
Bachhuber M, Arnsten JH, Wurm G. Use of cannabis to relieve pain and promote sleep by customers at an adult use dispensary. J Psychoactive Drugs. 2019;51:400-404. [PMID: 31264536] doi: 10.1080/02791072.2019.1626953
Van Green T. Americans overwhelmingly say marijuana should be legal for medical or recreational use. Pew Research Center. 22 November 2022. Accessed at www.pewresearch.org/short-reads/2022/11/22/americans-overwhelmingly-say-marijuana-should-be-legal-for-medical-or-recreational-use on 16 December 2022.
Booker B. 'Illegal to essential': how the coronavirus is boosting the legal cannabis industry. NPR. 20 April 2020. Accessed at www.npr.org/2020/04/20/831861961/illegal-to-essential-how-coronavirus-is-boosting-the-legal-cannabis-industry on 20 April 2020.
Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395:912-920. [PMID: 32112714] doi: 10.1016/S0140-6736(20)30460-8
Boehnke KF, McAfee J, Ackerman JM, et al. Medication and substance use increases among people using cannabis medically during the COVID-19 pandemic. Int J Drug Policy. 2021;92:103053. [PMID: 33250438] doi: 10.1016/j.drugpo.2020.103053
Vidot DC, Islam JY, Camacho-Rivera M, et al. The COVID-19 cannabis health study: results from an epidemiologic assessment of adults who use cannabis for medicinal reasons in the United States. J Addict Dis. 2021;39:26-36. [PMID: 32933383] doi: 10.1080/10550887.2020.1811455
Zelaya CE, Dahlhamer JM, Lucas JW, et al. Chronic pain and high-impact chronic pain among U.S. adults, 2019. NCHS Data Brief. 2020:1-8.[33151145]
Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. National Academies Pr; 2011.
Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14:162-173. [PMID: 25575710] doi: 10.1016/S1474-4422(14)70251-0
Häuser W, Walitt B, Fitzcharles MA, et al. Review of pharmacological therapies in fibromyalgia syndrome. Arthritis Res Ther. 2014;16:201. [PMID: 24433463] doi: 10.1186/ar4441
Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016;315:1624-1645. [PMID: 26977696] doi: 10.1001/jama.2016.1464
Dowell D, Ragan KR, Jones CM, et al. CDC clinical practice guideline for prescribing opioids for pain—United States, 2022. MMWR Recomm Rep. 2022;71:1-95. [PMID: 36327391] doi: 10.15585/mmwr.rr7103a1
Boehnke KF, Scott JR, Litinas E, et al. Pills to pot: observational analyses of cannabis substitution among medical cannabis users with chronic pain. J Pain. 2019;20:830-841. [PMID: 30690169] doi: 10.1016/j.jpain.2019.01.010
Boehnke KF, Gagnier JJ, Matallana L, et al. Substituting cannabidiol for opioids and pain medications among individuals with fibromyalgia: a large online survey. J Pain. 2021;22:1418-1428. [PMID: 33992787] doi: 10.1016/j.jpain.2021.04.011
Lucas P, Baron EP, Jikomes N. Medical cannabis patterns of use and substitution for opioids & other pharmaceutical drugs, alcohol, tobacco, and illicit substances; results from a cross-sectional survey of authorized patients. Harm Reduct J. 2019;16:9. [PMID: 30691503] doi: 10.1186/s12954-019-0278-6
Illinois Department of Public Health. Opioid Alternative Pilot Program. 2023. Accessed at https://dph.illinois.gov/topics-services/prevention-wellness/medical-cannabis/opioid-alternative-pilot-program on 17 October 2023.
Richard EL, Althouse AD, Arnsten JH, et al. How medical are states' medical cannabis policies? Proposing a standardized scale. Int J Drug Policy. 2021;94:103202. [PMID: 33765514] doi: 10.1016/j.drugpo.2021.103202
Colorado Medical Marijuana Registry Program. Colorado Medical Marijuana Registry 2021 Annual Report. Colorado Department of Public Health and Environment; 2022.
Brown JD, Costales B, van Boemmel-Wegmann S, et al. Characteristics of older adults who were early adopters of medical cannabis in the Florida medical marijuana use registry. J Clin Med. 2020;9:1166. doi: 10.3390/jcm9041166
Anderson SP, Zylla DM, McGriff DM, et al. Impact of medical cannabis on patient-reported symptoms for patients with cancer enrolled in Minnesota's medical cannabis program. J Oncol Pract. 2019;15:e338-e345. [PMID: 30860938] doi: 10.1200/JOP.18.00562
Sakal C, Lynskey M, Schlag AK, et al. Developing a real-world evidence base for prescribed cannabis in the United Kingdom: preliminary findings from Project Twenty21. Psychopharmacology (Berl). 2022;239:1147-1155. [PMID: 33970291] doi: 10.1007/s00213-021-05855-2
Shover CL, Humphreys K. Six policy lessons relevant to cannabis legalization. Am J Drug Alcohol Abuse. 2019;45:698-706. [PMID: 30870053] doi: 10.1080/00952990.2019.1569669
Haffajee R, Mauri A. Cannabis liberalization in the US: the policy landscape. Robert Wood Johnson Foundation. 1 July 2021. Accessed at www.rwjf.org/en/insights/our-research/2021/07/policy-and-health-implications-of-legalizing-and-liberalizing-cannabis-use-in-the-united-states.html on 12 October 2023.
Devinsky O, Cross JH, Laux L, et al; Cannabidiol in Dravet Syndrome Study Group. Trial of cannabidiol for drug-resistant seizures in the Dravet syndrome. N Engl J Med. 2017;376:2011-2020. [PMID: 28538134] doi: 10.1056/NEJMoa1611618
Thiele EA, Marsh ED, French JA, et al; GWPCARE4 Study Group. Cannabidiol in patients with seizures associated with Lennox-Gastaut syndrome (GWPCARE4): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2018;391:1085-1096. [PMID: 29395273] doi: 10.1016/S0140-6736(18)30136-3
Nijs J, George SZ, Clauw DJ, et al. Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine. Lancet Rheumatol. 2021;3:e383-e392. [PMID: 38279393] doi: 10.1016/S2665-9913(21)00032-1
Fisher E, Moore RA, Fogarty AE, et al. Cannabinoids, cannabis, and cannabis-based medicine for pain management: a systematic review of randomised controlled trials. Pain. 2021;162:S45-S66. [PMID: 32804836] doi: 10.1097/j.pain.0000000000001929

Information & Authors


Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 177Number 4April 2024
Pages: 458 - 466


Published online: 9 April 2024
Published in issue: April 2024




    Anesthesiology Department, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, Michigan (K.F.B., F.G., T.S.)
    Cannabis Strategy Unit, Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, and Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee (R.S.)
    Anesthesiology Department, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, Michigan (K.F.B., F.G., T.S.)
    Veterans Affairs Ann Arbor Healthcare System and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan (A.H.)
    Cannabis Strategy Unit, Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia (D.R.R., B.H.).
    Tristin Smith, MPH
    Anesthesiology Department, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, Michigan (K.F.B., F.G., T.S.)
    Brooke Hoots, PhD
    Cannabis Strategy Unit, Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia (D.R.R., B.H.).
    Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
    Grant Support: Dr. Boehnke’s effort on this publication was partially supported by grant K01DA049219 from the National Institute on Drug Abuse of the National Institutes of Health.
    Reproducible Research Statement: Study protocol: Not applicable. Statistical code: All graphs were created in Excel, so no code was used. Data set: Available from Dr. Boehnke (e-mail, [email protected]).
    Corresponding Author: Kevin F. Boehnke, PhD, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106; e-mail, [email protected].
    Author Contributions: Conception and design: K.F. Boehnke, B. Hoots, D.R. Roehler, R. Sinclair.
    Analysis and interpretation of the data: K.F. Boehnke, F. Gordon, B. Hoots, D.R. Roehler, R.A. Sinclair, T. Smith.
    Drafting of the article: K.F. Boehnke, B. Hoots, D.R. Roehler, R. Sinclair, T. Smith.
    Critical revision for important intellectual content: K.F. Boehnke, B. Hoots, A. Hosanagar, D.R. Roehler, T. Smith.
    Final approval of the article: K.F. Boehnke, F. Gordon, B. Hoots, A. Hosanagar, D.R. Roehler, R. Sinclair, T. Smith.
    Statistical expertise: K.F. Boehnke, T. Smith.
    Obtaining of funding: K.F. Boehnke.
    Administrative, technical, or logistic support: K.F. Boehnke.
    Collection and assembly of data: K.F. Boehnke, F. Gordon, R. Sinclair, T. Smith.
    This article was published at Annals.org on 9 April 2024.

    Metrics & Citations



    If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. For an editable text file, please select Medlars format which will download as a .txt file. Simply select your manager software from the list below and click Download.

    For more information or tips please see 'Downloading to a citation manager' in the Help menu.


    Download article citation data for:
    Kevin F. Boehnke, Rachel Sinclair, Felicia Gordon, et al. Trends in U.S. Medical Cannabis Registrations, Authorizing Clinicians, and Reasons for Use From 2020 to 2022. Ann Intern Med.2024;177:458-466. [Epub 9 April 2024]. doi:10.7326/M23-2811

    View More

    Get Access

    Login Options:

    You will be redirected to acponline.org to sign-in to Annals to complete your purchase.

    Create your Free Account

    You will be redirected to acponline.org to create an account that will provide access to Annals.

    View options


    View PDF/ePub

    Related in ACP Journals

    Full Text

    View Full Text







    Copy the content Link

    Share on social media