Cannabis-related information sources among US residents: A probability-weighted nationally representative survey | Journal of Cannabis Research

Results from our nationally representative survey show that most cannabis consumers obtain information about cannabis from friends or family, websites, and their own experiences, with very few obtaining information from medical or healthcare providers or government agencies. Even among the 173 participants using cannabis for medical purposes, only 16.3% reported obtaining information from a healthcare provider. Unsurprisingly, past-year cannabis use was most strongly associated with use of most information sources. Of note, higher income was associated with drawing information from peer-reviewed scientific articles and identifying as a race other than White was associated with lower odds of obtaining information from one’s own experimentation, friends/family, or articles in the popular media. Further qualitative research is needed to elucidate racial differences in information sources. Overall, these patterns are critical to understand for effective public health outreach strategies, especially given that the US Federal government may soon reschedule cannabis [3].

Because the majority of states have legal medical cannabis and nearly half of U.S. citizens live in states with legal adult-use cannabis [13], there is substantial need to improve cannabis-related public health outreach efforts. Practical education efforts should go beyond “abstinence only” messaging and focus on providing actionable advice on how to minimize harm and, if appropriate, maximize benefits of cannabis products. This could be done by briefly addressing content areas including routes of administration, differential effects of cannabinoids delta-9-tetrahydrocannabinol (THC) vs. CBD, dosing (“start low, go slow”), tolerance and side effects, as well as being explicit about understanding use intentions and goals to help enable mindful consumption [14,15,16,17]. Such efforts are critical to harmonize with education among healthcare providers. Indeed, a nationally representative survey conducted in 2017 showed that participants whose most influential cannabis-related information sources were health professionals and traditional media sources had lower odds of endorsing misinformation about cannabis than those who drew information from other sources, especially cannabis industry advertisements and social media platforms [9]. However, whereas clinicians frequently receive patient requests for medical cannabis authorization, many do not feel comfortable communicating about cannabis products, partially because they lack knowledge around medical effects, safety, and how to appropriately support patients using these products [18, 19]. Surveys and qualitative studies demonstrate that many physicians and medical students desire further relevant training (especially during medical school) [20,21,22], but only 9% of medical schools in 2016 offered medical cannabis-specific curricula [23]. As such, our findings suggest that in addition to conversations about cannabis occurring outside clinical settings, insufficient physician education may exacerbate misinformation about cannabis.

Limitations and strengths

Our study has several limitations, including self-report and non-response bias, a fairly low response rate, and that we did not investigate how geographic variation affected responses. Further, we were unable to investigate how information sources used related to knowledge and understanding of the effects of cannabis products. Because we assessed information sources used rather than most influential or commonly used information source, we are unable to infer how these information sources rank in influencing decision making around cannabis. Additionally, we did not specifically delineate between internet websites and social media (the latter of is a major source of information for cannabis at present [9]), nor did we have explicit response options for television and radio. Although we did offer an “other source” option for people to fill in the blank, these limitations may have contributed to why 28.4% of participants reported “None of the above” for our information sources mentioned. It is also possible that there are other unmeasured sources of confounding that may influence which information sources people use, including but not limited to living in an urban versus rural area, previous legal issues related to cannabis (e.g., arrest or incarceration), and cultural factors. Although the Amerispeak panel implements best practices for probability-based recruitment, there may be unmeasured sampling biases [10]. Further, cannabis is still a stigmatized topic and self-reported data may be prone to social desirability bias. However, we minimized these risks by using a confidential survey design in which we only received de-identified data per NORC policies. Overall, these study limitations are also offset by our large sample size, minimal missing data (< 5%) and rigorous probability-weighted, nationally representative survey design.