Understanding Motives for Illicit Medicinal Cannabis Use: An Exploratory Analysis in a Medical Cannabis Program

Understanding Motives for Illicit Medicinal Cannabis Use: An Exploratory Analysis in a Medical Cannabis Program | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Understanding Motives for Illicit Medicinal Cannabis Use: An Exploratory Analysis in a Medical Cannabis Program Carter Reeves, Lirit Franks, A. Taylor Kelley, Michael Incze, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5596197/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Jul, 2025 Read the published version in Journal of Cannabis Research → Version 1 posted 6 You are reading this latest preprint version Abstract Background Medical Cannabis (MC) is authorized in numerous state-legislated programs to treat approved medical conditions. Notwithstanding MC access, some participants continue to use cannabis purchased outside of a state licensed MC pharmacy, otherwise known as illicit medicinal cannabis (IMC), to treat their medical conditions. Identifying barriers and contributors to MC use and motives for IMC use can promote safety, improve program design, and inform future research efforts. Methods This exploratory analysis utilized baseline survey data from a convenience sample-based prospective cohort evaluation of newly registered (< 6 months) adult participants in Utah’s MC program who had been diagnosed with chronic pain, post-traumatic stress disorder, and/or cancer. Participants completed surveys assessing physical and mental health, program experience, and barriers and contributors to MC access. We employed descriptive analysis, chi-squared analysis, and logistic regression to identify factors influencing IMC use. Results Among 273 MC program participants screened for eligibility, 227 were enrolled in the cohort evaluation, and 211 participants completed the baseline survey. Approximately 1 in 10 survey respondents (N = 24, 11.9%) reported IMC use within the past two weeks. Participants accessing IMC were 40.5 years old, 58.3% male, 70.8% employed, and 87.5% white. Participants using IMC reported barriers to MC, including product cost (n = 19, 79%) and assurance of adequate supply (n = 11, 45.8%) as the most common motives for IMC use. Participants who reported experiencing MC access barriers were significantly more likely to report IMC use than those reporting no barriers (Odds Ratio (OR) = 4.73, p < 0.001). Participants using IMC reported lower levels of trust in (p < 0.04) and reliance (p < 0.02) upon the state program and less reliance on MC pharmacists (p’s < 0.01). However, participants who relied on the state program for MC information were less likely to report IMC use (Adjusted Odds Ratio AOR = 0.16, p < 0.05). Conclusions In a state MC program, barriers related to MC access and cost indicated a significant increase in the likelihood of IMC use, while reliance on the state program for MC information indicated a significant decrease in the likelihood of IMC use. Future research can explore how increasing affordable access to MC and availability of reliable information may affect IMC use. Medical Cannabis Marijuana Illicit Use Barriers Contributors Motives Figures Figure 1 Figure 2 1. Introduction Medical Cannabis (MC) is an increasingly common treatment for a variety of medical conditions. Over four million Americans across 38 states and the District of Colombia are registered with their state MC programs. 1 Individual states and districts have taken responsibility to legislate MC use and distribution for their constituents due to the current Drug Enforcement Administration Schedule I status of cannabis. Despite MC being legally available in most states, cannabis remains the most used illicit substance in the United States. 2 Previous research has demonstrated that some patients authorized to purchase MC still utilize illicit cannabis to treat their health conditions that qualify them for the MC program, with prevalence of illicit use as high as 10%. 3 This notable prevalence of illicit cannabis use, cannabis purchased outside of a state licensed MC pharmacy, or illicit medicinal cannabis (IMC), raises concern when considering its potential health and legal consequences. Engaging in illicit cannabis use, regardless of motive, can result in legal repercussions such as incarceration 4 , undesired or unpredictable side effects from illicit products with higher general THC content, 5 and a lack of reliable product information, quality, standardization, or access 6 - which all may impact treatment efficacy for participants’ medical conditions. 7 Despite the potential negative consequences to IMC use, MC program participants still access IMC at notable rates. IMC use might be explained in part by potential barriers to MC within state programs. For example, previous research suggests experiencing healthcare-related barriers may increase illicit substance use, 8 with one study reporting that 24.7% of participants using illicit substances experience unmet healthcare needs. 9 These data suggest similar concerns may exist in MC programs. Notwithstanding barriers to MC access, medical provider and pharmacist relationships may also influence IMC use. For example, positive provider relationships and trust have been shown to attenuate illicit substance use. 10 , 11 Pharmacists can also facilitate substance use treatment through screening, intervention, and referrals. 12 Since healthcare providers are involved in MC participants’ enrollment and treatment in MC state programs, they can have a substantive impact on IMC use. Medical professionals can leverage expertise and trusting relationships with participants to recommend safer practices around cannabis use as well as alternative low-cost treatment options for chronic health conditions. These risks related to IMC use and the limited available empirical information available in the field—especially related to MC program-level factors 13 — underscore the need for further research into the motivations behind this behavior. Understanding why MC program participants engage in IMC use may help identify ways to reduce overall illicit cannabis use, limit health disparities, and enhance the health and safety of individuals in MC programs. This exploratory study aimed to investigate barriers and contributors to MC access and the motivations of MC program participants who use IMC. 2. Methods 2.1 Design, Data Source, and Participants We conducted cross-sectional exploratory analyses of self-reported baseline variables from the Study of Utahns’ Beliefs and Life Experiences with Integrative Medicine (SUBLIME). This program evaluation aimed to measure participants' reported benefit and efficacy of the MC program by assessing many factors, including variables measuring and influencing IMC use in the state of Utah. SUBLIME was a mixed-methods prospective cohort evaluation of Utah’s Medical Cannabis Program ongoing from 2023 to 2025. Notably, Utah has a medical-only cannabis program and adult use of cannabis is prohibited. Evaluation procedures were approved by the University of Utah Institutional Review Board. The SUBLIME MC cohort included adult ( ≥ 18 years old) Utah residents who were state-registered MC program participants for ≤ 6 months. Participants were English-speaking who were able to provide reliable contact information for themselves and two other collateral contacts. Additionally, we restricted cohort enrollment to diagnoses of one or more of the three most prevalent qualifying conditions in the state program to obtain a generalizable sample: chronic pain, post-traumatic stress disorder, or current cancer treatment. Diagnoses were self-reported and not mutually exclusive. Exclusion criteria included current incarceration, pregnancy, and/or mania or psychosis within the past month to protect vulnerable populations and increase data accuracy. To recruit cohort participants, we distributed recruitment material at MC pharmacies, advertised on social media platforms (Facebook, Twitter, LinkedIn, Instagram), and attached recruitment material in the Utah Department of Health and Human Services (DHHS) Center for Medical Cannabis monthly newsletter. Our team contacted eligible prospective participants to provide details regarding evaluation participation, and for those eligible and interested, to request written informed consent to participate. After enrollment, a link to an online survey was emailed to participants at three time points: baseline, 6-months post-enrollment, and 12-months post-enrollment. Study data were collected and managed using Research Electronic Data Capture (REDCap), a secure web-based application. 2.2 Assessments We assessed baseline survey data regarding physical health, mental health, and MC program experience using multiple survey instruments that specifically assessed potential barriers and potential contributors to IMC use: 1) the Cannabis as Medicine Survey (CAMS) and 2) Patient Experiences Survey. Cannabis use. The CAMS is a common measure to assess participant cannabis usage. 14 , 15 The CAMS consisted of questions assessing the age of first access to cannabis, weekly medicinal cannabis cost, prescriber qualifications, pharmacy, reasons for discontinuing MC, barriers to MC access, and IMC use. We specifically employed participant responses to the MC access items in our current analysis as previous research has indicated that healthcare-related barriers may increase the risk of illicit substance use. 8 , 9 Participants were asked, “Did you ever have problems getting medicinal cannabis?”. If participants indicated that they did, they were prompted to choose from a set of barriers relating to healthcare provider access, program enrollment process, MC product access, and individual factors largely related to perception and cost (See Appendix A ). Trust and reliance. The Patient Experiences Survey assessed program satisfaction factors such as distance to the pharmacy, referral source, program application, pharmacy experience, product variety, program accessibility, program efficacy, and varying MC information sources. The survey also asked participants to report on levels of trust and reliance on MC information sources. Trust and reliance on various sources of MC information have been previously identified as potential contributors that may influence IMC use 10 – 12 . Trust items asked participants to rate how much they trusted people/entities to address questions/concerns about MC use on a 5-point Likert scale from “Strongly distrust” to “Strongly trust”. Reliance items asked participants to report where they receive their MC information from amongst the included entities. Responses included “No to little information,” “Some information,” or “Majority of information.” Trust refers to participants indicating that they either trust or strongly trust the information source and reliance refers to where participants indicated they receive the majority of their information regarding MC. Demographics. In addition, demographic information including age, sex, employment status, qualifying medical condition, educational background, marital status, ethnicity, and race were collected. 2.3 Analyses This exploratory analysis was designed to be hypothesis-generating in nature. Analysis included utilizing descriptive statistics to characterize the analytical cohort. The “IMC use” group included participants who indicated IMC use at least once in the previous 12 months, with plans to continue in the future. The “no IMC use” group included participants who indicated no IMC use in the previous 12 months with no plans for future use or no IMC lifetime use. Participants who used IMC more than 12 months ago were also included in the “no IMC use” group. We described survey responses for “IMC use” and “no IMC use” participants using measures of motivation and behavior for IMC use gathered in the survey. Chi-squared analysis was employed to determine if there were any group differences among reported barriers/contributors to MC access. Fisher’s exact test was used to compensate for cell counts less than five. Univariate logistic regression was then used to identify associations between barriers/contributors and current IMC use, using p < .10 as the statistical significance cutoff. This cutoff was chosen to aid the exploratory nature of the project analysis. Once possibly associated factors were identified, a stepwise multivariate logistic regression was employed to identify important risk factors that were associated with an influence in IMC use. In the final stepwise model, factors were considered statistically significant and retained if p < .05. All data cleaning and statistical analysis were conducted using STATA 18. 3. Results 3.1 IMC Participants Characteristics Among 273 MC program participants screened, 47 also met exclusion criteria, leaving 227 enrolled in the evaluation cohort. There were 16 enrolled participants who did not complete the survey, primarily because they did not complete the survey within the given timeframe (n = 7). 211 participants completed the baseline survey (Fig. 1 ). In our sample, 11.9% (n = 24) of participants reported IMC use. These participants were mostly white (83.3%) and male (58.3%). and slightly older (40.5 vs 38.7 years of age) than those who did not report IMC use. Chronic pain condition is reported higher in participants indicating IMC use than those not reporting IMC use (87.5% vs. 75.9%). There were no differences between groups for any demographic variables (P’s > .05; Table 1 ). Table 1 Demographics of Patients with and without IMC use. Baseline Characteristic IMC Use (n = 24) No IMC Use (n = 187) x̅ SD x̅ SD Age 40.5 2.51 38.7 0.86 n % n % Male 14 58.3 73 40.1 Non-Hispanic/Latino 21 87.5 156 85.7 White 21 87.5 154 84.6 Chronic Pain* 21 87.5 142 75.9 PTSD* 7 29.2 62 33.2 Cancer* 0 0.0 11 5.9 >High School Educ. 20 83.3 149 79.7 Married 12 50.0 74 39.6 Employed 17 70.8 112 61.5 Note: P’s > .05 for comparisons between IMC and No IMC for all characteristics. *Qualifying conditions were not mutually exclusive. 3.2 Barriers Participants accessing IMC reported problems getting MC at a greater rate than those who did not access IMC (54.2% vs 20.2%, p = .002; Table 2 ). There were specific barriers that were experienced at higher rates among participants with IMC use versus participants without IMC use. These statistically significant barriers (p’s < .10) were categorized into three groups based on observed commonalities: (1) healthcare access, (2) program enrollment, and (3) perception of MC use. Regarding healthcare access (1), participants using IMC reported a greater proportion of lack of health insurance to access MC (16.7% vs. 3.9%, p = .03) and greater problems with the cost of MC products (45.8% vs 15.4%, p < .001). Concerning experiences with program enrollment (2), participants using IMC reported greater problems compared to those without IMC with renewal requirements (25.0% vs 0.6%, p = .04), enrollment costs (29.2% vs 7.1%, p = .003), the renewal process (16.7% vs. 4.4%, p = .04), and confidence to obtain MC products (12.5% vs 1.7%, p = .02), respectively. Regarding perceptions of MC use (3), participants using IMC reported higher rates compared to those without IMC of provider stigma (8.3% vs 0.6%, p = .04) and fear of discrimination at work (37.5% vs. 8.8%, p = .001). Table 2 Chi-Squared Analysis of Contributors and Barriers to Illicit Medical Cannabis Use Variables IMC Use No IMC Use p Χ² n % n % *Did you ever have problems getting medicinal cannabis? 13 54.2 37 20.2 .002 13.3 Barriers Healthcare Provider Access + Incompatible insurance 0 0.0 1 0.6 .88 0.13 * + Lack of insurance coverage 4 16.7 7 3.9 .03 6.9 + Long wait time 2 8.3 5 2.8 .19 2.0 + No MC-authorized provider available 0 0.0 6 3.3 .47 0.81 Program Enrollment Process + Difficulty navigating state website 3 12.5 7 3.9 .10 3.4 *+ Difficulty in knowledge of renewal requirements 6 25.0 1 0.6 < .001 38.6 * + Problems with renewal process 4 16.7 8 4.4 .04 5.8 *Problems with enrollment cost 7 29.2 6 7.1 .003 11.7 Medical Cannabis Accessibility * + Provider Stigma/Bias 2 8.3 1 0.6 .04 9.0 + No medical cannabis near them 3 12.5 5 2.8 .05 5.4 + Incompatible pharmacy hours 2 8.3 5 2.8 .19 2.0 Individual Factors *Cost of MC products 11 45.8 27 15.4 .001 12.8 + Transportation issues 3 12.5 10 5.5 .18 1.8 + Caregiver responsibilities 1 4.2 0 0.0 .12 7.6 + Not safe to keep cannabis products in my home 1 4.2 2 1.1 .31 1.4 *Fear of discrimination at work 9 37.5 16 8.8 .001 16.4 * + Lack of confidence to obtain MC products 3 12.5 3 1.7 .02 8.8 Negative cultural perception of MC 7 29.2 10 5.5 .001 15.7 Negative friend/family perception 5 20.8 14 7.69 .05 4.4 Contributors to IMC Use Trusted Sources of MC Information Trust in MC Pharmacist 20 87.0 164 89.1 .24 1.13 Trust in Medical Provider 21 87.5 156 89.1 .51 06 *Trust in State MC Program 10 45.5 116 67.4 .04 4.14 Trust in Friends 17 73.9 116 67.8 .37 0.35 Trust in Internet 9 37.5 55 31.8 .37 0.31 Reliance on Sources of MC Information *Info Reliance on MC Pharmacist 8 33.3 103 58.9 .01 10.6 Info Reliance on Medical Provider 18 75.0 155 87.6 .09 2.79 *Info Reliance on State MC Program 9 37.5 111 63.1 .02 5.75 Info Reliance on Friends 19 79.2 141 79.7 .57 .003 Info Reliance on Internet 19 79.2 138 78.0 .57 .018 *Significant difference (p < .05). + Measured using Fisher’s Exact Test. Results similarly showed that experiencing barriers to MC access were significantly associated with an increase in the likelihood of IMC use (See Table 3 ). When explicitly asked in the survey, experiencing problems getting MC was associated with an increased likelihood of IMC nearly fivefold (Odds Ratio OR = 4.73, p = .001). For healthcare access (1), experiencing lack of insurance (OR = 4.86, p = .02), no MC access through pharmacies nearby (OR = 4.91, p = .04), or high cost of MC products (OR = 4.91, p = .001) were all associated with increased odds of IMC use. For program enrollment (2), increased odds of IMC use were associated with experiencing problems with state website navigation (OR = 3.47, p = .09), renewal requirements (OR = 58.7, p = .001), the renewal process (OR = 4.23, p = .023), enrollment costs (OR = 5.66, p = .001), and confidence to obtain MC products (OR = 12.5, p = .01). Regarding perception of MC use (3), experiencing problems with provider stigma (OR = 16.0 p = .026), fear of discrimination at work (OR = 6.99, p = .001), cultural perception (OR = 7.69, p = .001), and friends or family’s perception (OR = 3.32, p = .04) were associated with increased odds of using IMC. Table 3 Univariate Logistic Regression of Barriers and Contributors to MC Impact on IMC Use Variables OR SE p 95% CI *Did you ever have problems getting medicinal cannabis? 4.73 2.13 .001 [1.95, 11.4] Barriers Healthcare Provider Access *Lack of insurance coverage 4.86 3.25 .02 [1.31, 18.1] Long wait time 3.12 2.71 .19 [.57, 17.1] Program Enrollment Process *Difficulty navigating state website 3.47 2.52 .09 [.83, 14.4] *Difficulty in knowledge of renewal requirements 58.7 65.0 < .001 [6.69, 514.8] *Problems with renewal process 4.23 2.20 .03 [1.17, 15.3] *Problems with enrollment cost 5.66 3.05 .001 [1.97, 16.3] Medical Cannabis Accessibility *Provider Stigma/Bias 16.0 19.9 .03 [1.39, 183.8] *No medical cannabis near them 4.91 3.76 .04 [1.10, 22.1] Incompatible pharmacy hours 3.93 3.52 .13 [.68, 22.7] Individual Factors *Cost of MC products 4.91 2.27 .001 [1.99, 12.1] Transportation issues 2.67 .188 .17 [.67, 10.6] Not safe to keep MC products in home 3.8 4.74 .28 [.33, 43.6] *Fear of discrimination at work 6.99 3.53 < .001 [2.59, 18.8] *Lack of confidence to obtain MC products 12.5 11.8 .01 [1.97, 79.1] *Negative cultural perception of MC 7.69 4.34 < .001 [2.54, 23.2] *Negative friend/family perception 3.32 1.92 .04 [1.07, 10.3] Contributors to IMC Use Trusted Sources of MC Information Trust in MC Pharmacist .49 .34 .30 [.13, 1.88] Trust in Medical Provider .85 .57 .81 [.23, 3.13] *Trust in State MC Program .40 .18 .05 [.16, .99] Trust in Friends 1.34 .67 .56 [.50, 3.60] Trust in Internet 1.29 .58 .58 [.53, 3.12] Reliance on Sources of MC Information *Info Reliance on MC Pharmacist .35 .16 .02 [.14, .86] Info Reliance on Medical Provider 2.35 1.23 .10 [.84, 6.55] *Info Reliance on State MC Program .43 .16 .02 [.21, .88] Info Reliance on Friends .97 .52 .96 [.34, 2.78] Info Reliance on Internet 1.07 .57 .89 [.38, 3.06] Motives to IMC Use *Ensure an Adequate Supply 14.1 7.39 < .001 [5.01, 39.4] *Cost of Products 17.9 9.67 < .001 [6.21, 51.6] Difficulty obtaining a prescription 3.93 3.52 .13 [.68, 22.7] *Cost of consultation 4.07 3.03 .06 [.95, 17.5] *Improve effectiveness 35.2 40.2 .002 [3.74, 330.5] *Significant Difference (p < .10). NOTE: Variables with ≤ 1 response in any condition were not included in the analysis due to collinearity and subsequentially not included in the table. 3.3 Potential Contributors to IMC Use Participants using IMC reported differing levels of trust and information reliance than those not using IMC. These participants reported significantly lower levels of trust in the state MC Program (45.5% vs 67.4%, p = .04). Participants using IMC reported lower levels of information reliance as compared to those not using IMC on two sources: MC pharmacists (33.3% vs 58.9%, p = .01) and the state MC program (37.5% vs 63.1%, p = .02). Participants from both groups reported similar levels of trust and reliance among the other sources of information (See Table 2 ). Sources of trust and information reliance correlated with IMC use. Trusting and relying on the state MC program for information indicated a decrease in the odds of IMC use (OR = .43, p = .02). Relying on information from the MC pharmacists (OR = .35, p = .02) and the state program (OR = .43, p = .02) were similarly associated with lower odds of IMC use. 3.4 Motives to IMC Use The most cited reason for using IMC indicated by respondents was the cost of products (n = 19, 79%) and difficulty obtaining a prescription was the least common reason (n = 3, 8.3%, See Fig. 2 ). Several identified participant-reported motives increased odds of IMC use including ensuring an adequate supply (OR = 14.1, p = .001), cost of MC products (OR = 17.9, p = .001), and improving effectiveness (OR = 35.2, p = .002). We conducted a multivariate logistic regression, including all relevant factors identified from the univariate analysis in the full model, and conducted stepwise variable selection. The final model included three risk factors that potentially increased the risk of IMC use (See Table 4 ). Both concerns about accessing an adequate supply of MC (Adjusted Odds Ratio (AOR) = 6.96, p = .004) and concerns about the cost of MC products (AOR = 20.1, p < .001) were significantly associated with higher odds of IMC use, while relying on information from the state MC program was associated with lower odds of IMC use (AOR = 0.16, p = .05). Table 4 Stepwise Regression of Barriers and contributors to Illicit Medicinal Cannabis Use Barriers and Contributors AOR SE p 95% CI Ensuring an adequate supply of MC 6.96 4.70 .004 [1.85, 26.1] Cost of MC Products 20.1 13.96 < .001 [5.16, 78.4] Info Reliance on State MC Program .16 .15 .049 [.03, .99] Note: Only significant factors (p < .05) were kept in the final model. All surveyed demographic variables were included in the model but proved to be non-significant. 4. Discussion IMC use is a prevalent behavior among MC program participants, with these data demonstrating that one in ten MC patients use IMC. 3 In order to address this potentially dangerous behavior, it is critical to understand the elements that contribute to IMC use. This exploratory analysis revealed factors that may influence IMC use. Our analysis focused on barriers and contributors to accessing MC, the impact of sources of information related to IMC use, and specific motivations for IMC use. 4.1 Barriers Cost . Experiencing problems with MC product cost was shown as a main motive for IMC use, as 79.2% of participants using IMC reporting this barrier. This finding remains consistent among MC participants in other programs across the country, as participants often report that the cost of products was either an issue or unaffordable. 16 – 18 However, lowering the cost of MC may not address these product issues. Previous research showed that while price influences product choices, demand is relatively inelastic, 19 indicating that decreasing the price of MC may not lead to lower IMC use. Nonetheless, due to the impact of product price on IMC use, cost may still be a relevant issue for MC participants who use IMC. Access . The increase in IMC use was most highly associated with barriers relating to healthcare access, program enrollment experiences, and perception of MC use. Frequently reported access barriers, including problems with insurance or no MC pharmacies nearby, may indicate that many MC participants using IMC resort to these illicit products due to relative unavailability of legal MC options. Thus, future studies to assess whether increasing access to MC programs might reduce IMC use may be warranted. However, facilitating broader access to cannabis through MC programs may increase the risk of negative health effects for some individuals, especially at-risk groups such as cannabis-naive patients, older adults 20 and adolescents 21 due to the risk of unfamiliarity and long-term health consequences specific to these populations. Policies that seek to increase MC access may need to be accompanied by research measuring both the benefits and collateral harms of increasing legal access to cannabis. It is worth noting that patients who reside in states with only MC options may face different barriers than patients in states with both medical and adult-use options. Patients in states with both programs may be less incentivized to access MC because adult-use options may be cheaper or easier to access. Program participation . Experiences within program enrollment or card renewal were also found to increase the likelihood of IMC use. Our results suggested participants accessing IMC may be deterred from MC use due to program-specific issues such as understanding renewal requirements, navigating the state website, and the enrollment cost. Participants in other MC programs have reported similar issues. 16 – 18 Previous research into factors that influence switching from illicit to licit has shown that similar issues such as price, regulation, and reduced accessibility act as barriers to MC use. 22 Our sample presents similar trends while also providing further understanding of specific barrier effects and protective factors against IMC use. Stigma . Our analysis also indicated that participants’ and providers’ perceptions of MC use significantly affected IMC use. Although our results showed that participants who use IMC experienced negative cultural or familial perception of MC use at similar rates as those who did not use IMC, participants who use IMC were more influenced by these negative perceptions as fear of experiencing discrimination at work or stigma by MC providers was associated with increased IMC use. Although public sentiments about MC use across the country are generally positive 23 , if a participant is internalizing negative perceptions of use, they might forgo public purchasing, typical at a pharmacy, to avoid these negative perceptions. 24 Additionally, previous research into motives for IMC use in treating medical conditions has found that healthcare provider perceived stigma motivates IMC use. 25 Our analysis produced similar results as provider stigma was shown to be associated with increased IMC use. People who use drugs are often stigmatized by the healthcare providers treating them, 26 which can preclude discussions about the relative risks and benefits of MC with their medical providers. Instead, some participants may opt to use IMC to avoid negative public perception, shame, or stigma. Educational and stigma-reducing campaigns for healthcare providers may prove beneficial to reduce stigma surrounding MC use, thereby possibly reducing IMC use and improving care for program patients. There were a few factors presented as barriers in the survey that did not influence the likelihood of IMC use. Problems related to pharmacy customer service such as long wait times, or incompatible hours did not affect IMC use in our sample of participants. Individual factors such as transportation or home storage issues were similarly not significant in our sample. It is possible that, despite encountering these challenges, participants may not perceive the associated barriers as sufficient to instigate use of IMC. 4.2 Potential Contributors Program information . We also analyzed whether the degree to which participants relied on, or trusted different sources of information was associated with IMC use. We found that relying on information from both MC pharmacists and state MC program resources was associated with a decrease in IMC use. If participants trust and receive information from these sources, thereby possibly strengthening their connection and reliance on the MC program, they would be more likely to access legal products than IMC. 27 Connection and reliance on the program may be achieved through efficacious care and positive interactions. Notably, trust in MC pharmacists did not have a significant association with IMC use while reliance did, suggesting that information reliance may have some greater influence on behavior than trust. Participants in MC programs often rely on information from a variety of sources including the internet, friends, and family. 28 As information about cannabis is often ambiguous and illusive, 29 it is reasonable to assume that MC patients will continue to favor availability over creditability. As a result, supporting the collection and dissemination of valid and reliable cannabis research may provide a reduction in IMC use. Our final analytical model highlighted three significant influences: (1) Ensuring an adequate supply and (2) cost of MC products was associated with an increased likelihood of IMC use while (3) information reliance on state resources was correlated with decreased IMC use. Based on these results, we hypothesize that low availability and high cost of MC products may increase IMC use while reliance on state resources may attenuate use. Future studies could focus efforts on measuring patterns of MC and IMC use when MC costs are reduced or measure how cannabis knowledge affects MC adherence. 4.4 Limitations There are limitations to the study findings that should be considered. The exploratory nature study and smaller size of the current IMC group may limit the generalizability of the findings, signaling the necessity of further research into this topic. The patient-reported data also represents a small cohort in a single state, which may limit external validity. Although our sample possessed important points of possible representativeness of the overall state MC population with regards to condition, it may not be representative of other MC populations across the US or other parts of the world where cannabis use is legal, as barriers and potential contributors may differ. Moreover, further research should systematically consider illicit MC use in other jurisdictions, both within and outside the US, as well as among individuals who have not attempted to access the legal system, to better understand how these barriers and factors influence usage. Further studies should also examine how perceptions of effectiveness and quality affect IMC use. Evaluation cohorts were also created using a convenience sampling method, which could introduce potential bias to the sample. Future studies may consider probability sampling methods to control for these threats. This analysis was conducted with baseline survey data that may not accurately capture the lasting perceptions and demographics of those in the program, as these factors may shift as the program continues to grow. Additionally, the frequency of IMC use in our sample may be underrepresented due to social desirability bias. Parts of our analysis relied on variables that contained cell sizes with less than five responses. We used Fisher’s exact test as a method to compensate for small cell sizes. We also observed large confidence intervals in some of our regression analyses due to our small size. Future studies should consider larger samples to correct these errors. Additionally, correction for multiple comparisons was not undertaken for this exploratory analysis. Larger confirmatory studies should utilize such corrections to better understand the impact of these identified factors on IMC use. 30 5. Conclusion As state MC programs develop, the prevalence and clinical implications of IMC use must be considered. In this exploratory study, we identified key factors that may influence the likelihood of use IMC among participants enrolled in a MC program. Our findings suggest that barriers related to MC supply and cost may contribute to IMC use, while reliance on state program information appears to protect against this behavior. Additional factors, such as enrollment barriers and public perception may be influential in participants' decision-making processes. While this study offers valuable insights, more comprehensive research based on these preliminary findings is needed to develop effective strategies to mitigate IMC use and promote safe MC program participation. Abbreviations MC: Medical Cannabis IMC: Illicit Medicinal Cannabis OR: Odds Ratio AOR : Adjusted Odds Ratio SUBLIME : Study of Utahn’s Beliefs and Experiences with Integrative Medicine DHHS : Utah Department of Health and Human Services Declarations Data Availability Data can be made available upon reasonable request. Funding The funds to support this exploratory analysis were allocated by the Utah Department of Health, under contract #236204 titled “Utah Medical Cannabis: A Prospective Cohort Evaluation” with Dr. Gerald Cochran as Principal Investigator for the time period of 12/01/23 through 03/31/2025. The funder had no role in the design, data collection, or data analysis. The content of this analysis does not reflect the views of the funder. Author Information Authors and Affiliations Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA. Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA. Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA. Utah Department of Health and Human Services (DHHS) Center for Medical Cannabis, Salt Lake City, UT, USA. Contributions Each author made substantial contributions to the conception and creation of the work. C.R. retrieved and analyzed the data and led the creation of the manuscript. L.F., A.T.K, M.I., A.J.G, E.F. all interpreted the data and contributed to the creation of the manuscript. G.C. supervised the analysis and creation of the manuscript. Z.Y. provided assistance with statistical analysis and reporting. Corresponding Author Correspondence to Lirit Franks ( [email protected] ) Ethics Declarations Ethics Approval The University of Utah IRB approved all evaluation procedures for protocol #164305. Informed and written consent was gathered from all participants from evaluation staff. Competing Interests The authors declare no competing interests. Acknowledgements Not applicable. References Rhee TG, Rosenheck RA. Increasing Use of Cannabis for Medical Purposes, Among US, Residents, American Journal of Preventive Medicine. 2013–2020. Vol. 65,. Elsevier BV; 2023. pp. 528–33. Available from: http://dx.doi.org/10.1016/j.amepre.2023.03.005 Substance Abuse and Mental Health Services Administration. 2023 Companion infographic report: Results from the 2021, 2022, and 2023 National Surveys on Drug Use and Health. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration; 2024. Report No.: PEP24-07-020. Available from: https://www.samhsa.gov/data/report/2021-2022-2023-nsduh-infographic Hrdinova J. Ohio Medical Marijuana Control Program at Four Years: Evaluating Satisfaction and Perception. SSRN Electronic Journal. Elsevier BV; 2022. Available from: http://dx.doi.org/10.2139/ssrn.4231400 Farrelly KN, Wardell JD, Marsden E, Scarfe ML, Najdzionek P, Turna J et al. The Impact of Recreational Cannabis Legalization on Cannabis Use and Associated Outcomes: A Systematic Review. Vol. 17, Substance Abuse: Research and Treatment. SAGE Publications; 2023. p. 117822182311720. Available from: http://dx.doi.org/10.1177/11782218231172054 Mahamad S, Wadsworth E, Rynard V, Goodman S, Hammond D. Availability, retail price and potency of legal and illegal cannabis in Canada after recreational cannabis legalisation. Vol. 39, Drug and Alcohol Review. Wiley; 2020. pp. 337–46. Available from: http://dx.doi.org/10.1111/dar.13069 Jameson LE, Conrow KD, Pinkhasova DV, Boulanger HL, Ha H, Jourabchian N et al. Comparison of State-Level Regulations for Cannabis Contaminants and Implications for Public Health. Vol. 130, Environmental Health Perspectives. Environmental Health Perspectives; 2022. Available from: http://dx.doi.org/10.1289/EHP11206 Sevigny EL, Pacula RL, Heaton P. The effects of medical marijuana laws on potency. Vol. 25, International Journal of Drug Policy. Elsevier BV; 2014. pp. 308–19. Available from: http://dx.doi.org/10.1016/j.drugpo.2014.01.003 Matsuzaki M, Vu QM, Gwadz M, Delaney JAC, Kuo I, Trejo MEP et al. Perceived access and barriers to care among illicit drug users and hazardous drinkers: findings from the Seek, Test, Treat, and Retain data harmonization initiative (STTR). Vol. 18, BMC Public Health. Springer Science and Business Media LLC; 2018. Available from: http://dx.doi.org/10.1186/s12889-018-5291-2 Moallef S, Homayra F, Milloy MJ, Bird L, Nosyk B, Hayashi K. High Prevalence of Unmet Healthcare Need among People who use Illicit Drugs in a Canadian Setting with Publicly-Funded Interdisciplinary Primary Care Clinics. Vol. 42, Substance Abuse. SAGE Publications; 2021. pp. 760–6. Available from: http://dx.doi.org/10.1080/08897077.2020.1846667 King C, Collins D, Patten A, Nicolaidis C, Englander H. Trust in Hospital Physicians Among Patients With Substance Use Disorder Referred to an Addiction Consult Service: A Mixed-methods Study. Vol. 16, Journal of Addiction Medicine. Ovid Technologies (Wolters Kluwer Health); 2021. pp. 41–8. Available from: http://dx.doi.org/10.1097/ADM.0000000000000819 Thom DH, Hall MA, Pawlson LG. Measuring Patients’ Trust In Physicians When Assessing Quality Of Care. Vol. 23, Health Affairs. Health Affairs (Project Hope); 2004. pp. 124–32. Available from: http://dx.doi.org/10.1377/hlthaff.23.4.124 Shonesy BC, Williams D, Simmons D, Dorval E, Gitlow S, Gustin RM, Screening. Brief Intervention, and Referral to Treatment in a Retail Pharmacy Setting: The Pharmacist’s Role in Identifying and Addressing Risk of Substance Use Disorder. Vol. 13, Journal of Addiction Medicine. Ovid Technologies (Wolters Kluwer Health); 2019. pp. 403–7. Available from: http://dx.doi.org/10.1097/ADM.0000000000000525 Donnan J, Shogan O, Bishop L, Swab M, Najafizada M. Characteristics that influence purchase choice for cannabis products: a systematic review. Vol. 4, Journal of Cannabis Research. Springer Science and Business, Media LLC. 2022. Available from: http://dx.doi.org/10.1186/s42238-022-00117-0 Lintzeris N, Mills L, Abelev SV, Suraev A, Arnold JC, McGregor IS. Medical cannabis use in Australia: consumer experiences from the online cannabis as medicine survey 2020 (CAMS-20). Vol. 19, Harm Reduction Journal. Springer Science and Business, Media LLC. 2022. Available from: http://dx.doi.org/10.1186/s12954-022-00666-w Lintzeris N, Mills L, Suraev A, Bravo M, Arkell T, Arnold JC et al. Medical cannabis use in the Australian community following introduction of legal access: the 2018–2019 Online Cross-Sectional Cannabis as Medicine Survey (CAMS-18). Vol. 17, Harm Reduction Journal. Springer Science and Business Media LLC; 2020. Available from: http://dx.doi.org/10.1186/s12954-020-00377-0 Minnesota Department of Health: Office of Medical Cannabis. Minnesota Medical Cannabis Program: Patient Experiences from the First Program Year. Minnesota Legislative Reference Library. p. 173. 2016. https://www.health.state.mn.us/people/cannabis/docs/about/firstyearreport.pdf Sofis M, Slade LM, Boyum M. H. Examination of Experiences, Behaviors, and Outcomes of Medical Cannabis Patients and Providers in New Mexico. Cannabis Public Policy Consulting The State of New Mexico Department of Health. p. 11/22/2022. 2022. https://www.nmhealth.org/publication/view/report/7954/ Cannabis Public Policy Consulting. Maryland Medical Cannabis Patient Survey Report. Maryland Medical Cannabis Commission. 2022. https://cannabis.maryland.gov/Documents/2024%20Reports/MMCPS-22-Addendum-V5.pdf Amlung M, Reed DD, Morris V, Aston ER, Metrik J, MacKillop J. Price elasticity of illegal versus legal cannabis: a behavioral economic substitutability analysis. Vol. 114, Addiction. Wiley; 2018. pp. 112–8. Available from: http://dx.doi.org/10.1111/add.14437 Stall NM, Shi S, Malikov K, Wang S, Rochon PA, Hillmer MP, JAMA Internal Medicine. Edible Cannabis Legalization and Cannabis Poisonings in Older Adults. Vol. 184,. American Medical Association (AMA); 2024. p. 840. Available from: http://dx.doi.org/10.1001/jamainternmed.2024.1331 Croker JA, Werts M, Couch ET, Chaffee BW. Cannabis use among adolescents and emerging adults who use e-cigarettes: Findings from an online, national U.S. Sample. Vol. 140, Addictive Behaviors. Elsevier BV; 2023. p. 107620. Available from: http://dx.doi.org/10.1016/j.addbeh.2023.107620 Robertson K, Thyne M. Legalization of recreational cannabis: Facilitators and barriers to switching from an illegal to a legal source. Vol. 24, Preventive Medicine Reports. Elsevier BV; 2021. p. 101639. Available from: http://dx.doi.org/10.1016/j.pmedr.2021.101639 Khademi S, Hallinan CM, Conway M, Bonomo Y. Using Social Media Data to Investigate Public Perceptions of Cannabis as a Medicine: Narrative Review. Vol. 25, Journal of Medical Internet Research. JMIR Publications Inc.; 2023. p. e36667. Available from: http://dx.doi.org/10.2196/36667 Matthews S, Dwyer R, Snoek A, Stigma. and Self-Stigma in Addiction [Internet]. Vol. 14, Journal of Bioethical Inquiry. Springer Science and Business Media LLC; 2017. pp. 275–86. Available from: http://dx.doi.org/10.1007/s11673-017-9784-y Erridge S, Troup L, Sodergren MH. Illicit Cannabis Use to Self-Treat Chronic Health Conditions in the United Kingdom: Cross-Sectional Study [Internet]. Vol. 10, JMIR Public Health and Surveillance. JMIR Publications Inc.; 2024. pp. e57595–e57595. Available from: http://dx.doi.org/10.2196/57595 Fong C, Mateu-Gelabert P, Ciervo C, Eckhardt B, Aponte-Melendez Y, Kapadia S et al. Medical provider stigma experienced by people who use drugs (MPS-PWUD): Development and validation of a scale among people who currently inject drugs in New York City. Vol. 221, Drug and Alcohol Dependence. Elsevier BV; 2021. p. 108589. Available from: http://dx.doi.org/10.1016/j.drugalcdep.2021.108589 Weng HC. Does the physician’s emotional intelligence matter? Vol. 33, Health Care Management Review. Ovid Technologies (Wolters Kluwer Health); 2008. pp. 280–8. Available from: http://dx.doi.org/10.1097/01.HCM.0000318765.52148.b3 Boehnke KF, Smith T, Elliott MR, Wilson-Poe AR, Kruger DJ. Cannabis-related information sources among US residents: A probability-weighted nationally representative survey. Vol. 6, Journal of Cannabis Research. Springer Science and Business, Media LLC. 2024. Available from: http://dx.doi.org/10.1186/s42238-024-00249-5 The Health Effects of Cannabis and Cannabinoids. National Academies Press. 2017. Available from: http://dx.doi.org/10.17226/24625 Sarma A, Pu X, Chi Y, Brown ET, Correll M, Kay M. Odds and insights: decision quality in exploratory data analysis under uncertainty. In: Proceedings of the 2024 CHI Conference on Human Factors in Computing Systems. Association for Computing Machinery; 2024. Available from: https://doi.org/10.1145/3613904.3641995 Additional Declarations No competing interests reported. Supplementary Files AppendixA.docx Cite Share Download PDF Status: Published Journal Publication published 18 Jul, 2025 Read the published version in Journal of Cannabis Research → Version 1 posted Editorial decision: Accepted 01 May, 2025 Reviews received at journal 11 Apr, 2025 Reviewers agreed at journal 11 Apr, 2025 Reviewers invited by journal 10 Apr, 2025 Submission checks completed at journal 09 Apr, 2025 First submitted to journal 09 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5596197","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":441077898,"identity":"6b6e1580-f54b-4334-9479-3da44b4a41ff","order_by":0,"name":"Carter Reeves","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDklEQVRIiWNgGAWjYPCDigMQmrEBSBzAqQwsDQVnDkBEiNfC2EaEFv72s88ffNzDkM/P3mP48Oe8O/b8DTzmD37uYJDju5GAVYvEmXTDxhnPGCxn9pwxNubd9ixxxgEew8beMwzGkji0GDCkMTbzHGAwMLiRlibNuO1wggEDj2EDbxtD4gZcWvifMTb/AWqxv/8s/efPOYftQVoa/7Yx1OPUIgG0hQFkiwTzMQbehsOMG4BamoG2JBjg8suNZ4wzew5IGEicST4szXPscOKMw2yFs2XbJAxnnnmAPcT60xg+/DhgY8DffrDx44+aw/b87c0bPr5ts5HnO47dFphlSGxmDJFRMApGwSgYBaQCAAvxYrGv7XxBAAAAAElFTkSuQmCC","orcid":"","institution":"University of Utah Health Care","correspondingAuthor":true,"prefix":"","firstName":"Carter","middleName":"","lastName":"Reeves","suffix":""},{"id":441077903,"identity":"3200bcbb-d939-4262-8a2d-e082317b119e","order_by":1,"name":"Lirit Franks","email":"","orcid":"","institution":"University of Utah Health Care","correspondingAuthor":false,"prefix":"","firstName":"Lirit","middleName":"","lastName":"Franks","suffix":""},{"id":441077905,"identity":"620472be-d91d-4bc4-9098-017da5247432","order_by":2,"name":"A. Taylor Kelley","email":"","orcid":"","institution":"University of Utah Health Care","correspondingAuthor":false,"prefix":"","firstName":"A.","middleName":"Taylor","lastName":"Kelley","suffix":""},{"id":441077906,"identity":"b7f0a2f8-6073-4fd5-a795-704f3e1b64a6","order_by":3,"name":"Michael Incze","email":"","orcid":"","institution":"University of Utah Health Care","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Incze","suffix":""},{"id":441077907,"identity":"794e4493-ce92-45ad-862d-1fead18d7500","order_by":4,"name":"Adam J. Gordon","email":"","orcid":"","institution":"University of Utah Health Care","correspondingAuthor":false,"prefix":"","firstName":"Adam","middleName":"J.","lastName":"Gordon","suffix":""},{"id":441077908,"identity":"ef7faba9-057d-4ab4-b9fc-927065844382","order_by":5,"name":"Ziji Yu","email":"","orcid":"","institution":"University of Utah Health Care","correspondingAuthor":false,"prefix":"","firstName":"Ziji","middleName":"","lastName":"Yu","suffix":""},{"id":441077910,"identity":"604a68a3-4c38-4fb8-a6f5-7fc1b4ca5c6c","order_by":6,"name":"Eden Flake","email":"","orcid":"","institution":"University of Utah Health Care","correspondingAuthor":false,"prefix":"","firstName":"Eden","middleName":"","lastName":"Flake","suffix":""},{"id":441077912,"identity":"05765b60-df0d-494e-9f93-3af1dbeb6839","order_by":7,"name":"Gerald Cochran","email":"","orcid":"","institution":"University of Utah Health Care","correspondingAuthor":false,"prefix":"","firstName":"Gerald","middleName":"","lastName":"Cochran","suffix":""}],"badges":[],"createdAt":"2024-12-06 22:38:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5596197/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5596197/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s42238-025-00284-w","type":"published","date":"2025-07-18T16:05:41+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":80578810,"identity":"30f18dc7-5dde-4783-80f6-94863fa87c64","added_by":"auto","created_at":"2025-04-14 23:05:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":22775,"visible":true,"origin":"","legend":"\u003cp\u003eSTROBE Chart\u003c/p\u003e","description":"","filename":"floatimage125.png","url":"https://assets-eu.researchsquare.com/files/rs-5596197/v1/303374445d30066ede8aef50.png"},{"id":80578812,"identity":"44116ede-38a7-4d8c-af6c-a65f01b5fd97","added_by":"auto","created_at":"2025-04-14 23:05:33","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":14964,"visible":true,"origin":"","legend":"\u003cp\u003eReasons for IMC Use Among Participants with IMC Use\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5596197/v1/2a73519efe09870b636af11c.png"},{"id":88506142,"identity":"06001a7a-9e0c-4a65-a034-2827e9094913","added_by":"auto","created_at":"2025-08-07 07:31:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1289945,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5596197/v1/6df1ddf7-6a4f-4cf9-9d1b-8648b9323360.pdf"},{"id":80577555,"identity":"b3b26b04-5477-4648-bf5b-c147b04ca7ea","added_by":"auto","created_at":"2025-04-14 22:57:32","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15380,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixA.docx","url":"https://assets-eu.researchsquare.com/files/rs-5596197/v1/6a099bc6fbda74dc4d696d52.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Understanding Motives for Illicit Medicinal Cannabis Use: An Exploratory Analysis in a Medical Cannabis Program","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eMedical Cannabis (MC) is an increasingly common treatment for a variety of medical conditions. Over four million Americans across 38 states and the District of Colombia are registered with their state MC programs.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Individual states and districts have taken responsibility to legislate MC use and distribution for their constituents due to the current Drug Enforcement Administration Schedule I status of cannabis.\u003c/p\u003e \u003cp\u003eDespite MC being legally available in most states, cannabis remains the most used illicit substance in the United States.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Previous research has demonstrated that some patients authorized to purchase MC still utilize illicit cannabis to treat their health conditions that qualify them for the MC program, with prevalence of illicit use as high as 10%. \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e This notable prevalence of illicit cannabis use, cannabis purchased outside of a state licensed MC pharmacy, or illicit medicinal cannabis (IMC), raises concern when considering its potential health and legal consequences. Engaging in illicit cannabis use, regardless of motive, can result in legal repercussions such as incarceration\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, undesired or unpredictable side effects from illicit products with higher general THC content,\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e and a lack of reliable product information, quality, standardization, or access\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e - which all may impact treatment efficacy for participants\u0026rsquo; medical conditions.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Despite the potential negative consequences to IMC use, MC program participants still access IMC at notable rates.\u003c/p\u003e \u003cp\u003eIMC use might be explained in part by potential barriers to MC within state programs. For example, previous research suggests experiencing healthcare-related barriers may increase illicit substance use,\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e with one study reporting that 24.7% of participants using illicit substances experience unmet healthcare needs.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e These data suggest similar concerns may exist in MC programs.\u003c/p\u003e \u003cp\u003eNotwithstanding barriers to MC access, medical provider and pharmacist relationships may also influence IMC use. For example, positive provider relationships and trust have been shown to attenuate illicit substance use.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Pharmacists can also facilitate substance use treatment through screening, intervention, and referrals.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Since healthcare providers are involved in MC participants\u0026rsquo; enrollment and treatment in MC state programs, they can have a substantive impact on IMC use. Medical professionals can leverage expertise and trusting relationships with participants to recommend safer practices around cannabis use as well as alternative low-cost treatment options for chronic health conditions.\u003c/p\u003e \u003cp\u003eThese risks related to IMC use and the limited available empirical information available in the field\u0026mdash;especially related to MC program-level factors\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e \u0026mdash; underscore the need for further research into the motivations behind this behavior. Understanding why MC program participants engage in IMC use may help identify ways to reduce overall illicit cannabis use, limit health disparities, and enhance the health and safety of individuals in MC programs. This exploratory study aimed to investigate barriers and contributors to MC access and the motivations of MC program participants who use IMC.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Design, Data Source, and Participants\u003c/h2\u003e \u003cp\u003eWe conducted cross-sectional exploratory analyses of self-reported baseline variables from the Study of Utahns\u0026rsquo; Beliefs and Life Experiences with Integrative Medicine (SUBLIME). This program evaluation aimed to measure participants' reported benefit and efficacy of the MC program by assessing many factors, including variables measuring and influencing IMC use in the state of Utah. SUBLIME was a mixed-methods prospective cohort evaluation of Utah\u0026rsquo;s Medical Cannabis Program ongoing from 2023 to 2025. Notably, Utah has a medical-only cannabis program and adult use of cannabis is prohibited. Evaluation procedures were approved by the University of Utah Institutional Review Board.\u003c/p\u003e \u003cp\u003eThe SUBLIME MC cohort included adult (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;18 years old) Utah residents who were state-registered MC program participants for \u0026le;\u0026thinsp;6 months. Participants were English-speaking who were able to provide reliable contact information for themselves and two other collateral contacts. Additionally, we restricted cohort enrollment to diagnoses of one or more of the three most prevalent qualifying conditions in the state program to obtain a generalizable sample: chronic pain, post-traumatic stress disorder, or current cancer treatment. Diagnoses were self-reported and not mutually exclusive. Exclusion criteria included current incarceration, pregnancy, and/or mania or psychosis within the past month to protect vulnerable populations and increase data accuracy.\u003c/p\u003e \u003cp\u003eTo recruit cohort participants, we distributed recruitment material at MC pharmacies, advertised on social media platforms (Facebook, Twitter, LinkedIn, Instagram), and attached recruitment material in the Utah Department of Health and Human Services (DHHS) Center for Medical Cannabis monthly newsletter. Our team contacted eligible prospective participants to provide details regarding evaluation participation, and for those eligible and interested, to request written informed consent to participate. After enrollment, a link to an online survey was emailed to participants at three time points: baseline, 6-months post-enrollment, and 12-months post-enrollment. Study data were collected and managed using Research Electronic Data Capture (REDCap), a secure web-based application.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Assessments\u003c/h2\u003e \u003cp\u003eWe assessed baseline survey data regarding physical health, mental health, and MC program experience using multiple survey instruments that specifically assessed potential barriers and potential contributors to IMC use: 1) the Cannabis as Medicine Survey (CAMS) and 2) Patient Experiences Survey.\u003c/p\u003e \u003cp\u003e \u003cb\u003eCannabis use.\u003c/b\u003e The CAMS is a common measure to assess participant cannabis usage.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e The CAMS consisted of questions assessing the age of first access to cannabis, weekly medicinal cannabis cost, prescriber qualifications, pharmacy, reasons for discontinuing MC, barriers to MC access, and IMC use. We specifically employed participant responses to the MC access items in our current analysis as previous research has indicated that healthcare-related barriers may increase the risk of illicit substance use.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Participants were asked, \u0026ldquo;Did you ever have problems getting medicinal cannabis?\u0026rdquo;. If participants indicated that they did, they were prompted to choose from a set of barriers relating to healthcare provider access, program enrollment process, MC product access, and individual factors largely related to perception and cost (See \u003cb\u003eAppendix A\u003c/b\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eTrust and reliance.\u003c/b\u003e The Patient Experiences Survey assessed program satisfaction factors such as distance to the pharmacy, referral source, program application, pharmacy experience, product variety, program accessibility, program efficacy, and varying MC information sources. The survey also asked participants to report on levels of trust and reliance on MC information sources. Trust and reliance on various sources of MC information have been previously identified as potential contributors that may influence IMC use\u003csup\u003e\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Trust items asked participants to rate how much they trusted people/entities to address questions/concerns about MC use on a 5-point Likert scale from \u0026ldquo;Strongly distrust\u0026rdquo; to \u0026ldquo;Strongly trust\u0026rdquo;. Reliance items asked participants to report where they receive their MC information from amongst the included entities. Responses included \u0026ldquo;No to little information,\u0026rdquo; \u0026ldquo;Some information,\u0026rdquo; or \u0026ldquo;Majority of information.\u0026rdquo; Trust refers to participants indicating that they either trust or strongly trust the information source and reliance refers to where participants indicated they receive the majority of their information regarding MC.\u003c/p\u003e \u003cp\u003e \u003cb\u003eDemographics.\u003c/b\u003e In addition, demographic information including age, sex, employment status, qualifying medical condition, educational background, marital status, ethnicity, and race were collected.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Analyses\u003c/h2\u003e \u003cp\u003eThis exploratory analysis was designed to be hypothesis-generating in nature. Analysis included utilizing descriptive statistics to characterize the analytical cohort. The \u0026ldquo;IMC use\u0026rdquo; group included participants who indicated IMC use at least once in the previous 12 months, with plans to continue in the future. The \u0026ldquo;no IMC use\u0026rdquo; group included participants who indicated no IMC use in the previous 12 months with no plans for future use or no IMC lifetime use. Participants who used IMC more than 12 months ago were also included in the \u0026ldquo;no IMC use\u0026rdquo; group. We described survey responses for \u0026ldquo;IMC use\u0026rdquo; and \u0026ldquo;no IMC use\u0026rdquo; participants using measures of motivation and behavior for IMC use gathered in the survey.\u003c/p\u003e \u003cp\u003eChi-squared analysis was employed to determine if there were any group differences among reported barriers/contributors to MC access. Fisher\u0026rsquo;s exact test was used to compensate for cell counts less than five. Univariate logistic regression was then used to identify associations between barriers/contributors and current IMC use, using p\u0026thinsp;\u0026lt;\u0026thinsp;.10 as the statistical significance cutoff. This cutoff was chosen to aid the exploratory nature of the project analysis. Once possibly associated factors were identified, a stepwise multivariate logistic regression was employed to identify important risk factors that were associated with an influence in IMC use. In the final stepwise model, factors were considered statistically significant and retained if p\u0026thinsp;\u0026lt;\u0026thinsp;.05. All data cleaning and statistical analysis were conducted using STATA 18.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.1 IMC Participants Characteristics\u003c/h2\u003e \u003cp\u003eAmong 273 MC program participants screened, 47 also met exclusion criteria, leaving 227 enrolled in the evaluation cohort. There were 16 enrolled participants who did not complete the survey, primarily because they did not complete the survey within the given timeframe (n\u0026thinsp;=\u0026thinsp;7). 211 participants completed the baseline survey (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In our sample, 11.9% (n\u0026thinsp;=\u0026thinsp;24) of participants reported IMC use. These participants were mostly white (83.3%) and male (58.3%). and slightly older (40.5 vs 38.7 years of age) than those who did not report IMC use. Chronic pain condition is reported higher in participants indicating IMC use than those not reporting IMC use (87.5% vs. 75.9%). There were no differences between groups for any demographic variables (P\u0026rsquo;s\u0026thinsp;\u0026gt;\u0026thinsp;.05; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics of Patients with and without IMC use.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline Characteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eIMC Use (n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eNo IMC Use (n\u0026thinsp;=\u0026thinsp;187)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ex̅\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ex̅\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e%\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e%\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hispanic/Latino\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic Pain*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePTSD*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;High School Educ.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNote: P\u0026rsquo;s\u0026thinsp;\u0026gt;\u0026thinsp;.05 for comparisons between IMC and No IMC for all characteristics.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e*Qualifying conditions were not mutually exclusive.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Barriers\u003c/h2\u003e \u003cp\u003eParticipants accessing IMC reported problems getting MC at a greater rate than those who did not access IMC (54.2% vs 20.2%, p\u0026thinsp;=\u0026thinsp;.002; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e). There were specific barriers that were experienced at higher rates among participants with IMC use versus participants without IMC use. These statistically significant barriers (p\u0026rsquo;s\u0026thinsp;\u0026lt;\u0026thinsp;.10) were categorized into three groups based on observed commonalities: (1) healthcare access, (2) program enrollment, and (3) perception of MC use.\u003c/p\u003e \u003cp\u003eRegarding healthcare access (1), participants using IMC reported a greater proportion of lack of health insurance to access MC (16.7% vs. 3.9%, p\u0026thinsp;=\u0026thinsp;.03) and greater problems with the cost of MC products (45.8% vs 15.4%, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Concerning experiences with program enrollment (2), participants using IMC reported greater problems compared to those without IMC with renewal requirements (25.0% vs 0.6%, p\u0026thinsp;=\u0026thinsp;.04), enrollment costs (29.2% vs 7.1%, p\u0026thinsp;=\u0026thinsp;.003), the renewal process (16.7% vs. 4.4%, p\u0026thinsp;=\u0026thinsp;.04), and confidence to obtain MC products (12.5% vs 1.7%, p\u0026thinsp;=\u0026thinsp;.02), respectively. Regarding perceptions of MC use (3), participants using IMC reported higher rates compared to those without IMC of provider stigma (8.3% vs 0.6%, p\u0026thinsp;=\u0026thinsp;.04) and fear of discrimination at work (37.5% vs. 8.8%, p\u0026thinsp;=\u0026thinsp;.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChi-Squared Analysis of Contributors and Barriers to Illicit Medical Cannabis Use\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eIMC Use\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eNo IMC Use\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eΧ\u0026sup2;\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Did you ever have problems getting medicinal cannabis?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBarriers\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealthcare Provider Access\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003e+\u003c/sup\u003eIncompatible insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*\u003csup\u003e+\u003c/sup\u003eLack of insurance coverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003e+\u003c/sup\u003eLong wait time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003e+\u003c/sup\u003eNo MC-authorized provider available\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProgram Enrollment Process\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003e+\u003c/sup\u003eDifficulty navigating state website\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003e*+\u003c/sup\u003eDifficulty in knowledge of renewal requirements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e38.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*\u003csup\u003e+\u003c/sup\u003eProblems with renewal process\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Problems with enrollment cost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedical Cannabis Accessibility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*\u003csup\u003e+\u003c/sup\u003eProvider Stigma/Bias\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003e+\u003c/sup\u003eNo medical cannabis near them\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003e+\u003c/sup\u003eIncompatible pharmacy hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndividual Factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Cost of MC products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003e+\u003c/sup\u003eTransportation issues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003e+\u003c/sup\u003eCaregiver responsibilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003e+\u003c/sup\u003eNot safe to keep cannabis products in my home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Fear of discrimination at work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*\u003csup\u003e+\u003c/sup\u003eLack of confidence to obtain MC products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative cultural perception of MC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative friend/family perception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eContributors to IMC Use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTrusted Sources of MC Information\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrust in MC Pharmacist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrust in Medical Provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Trust in State MC Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrust in Friends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrust in Internet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReliance on Sources of MC Information\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Info Reliance on MC Pharmacist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e58.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfo Reliance on Medical Provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Info Reliance on State MC Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfo Reliance on Friends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfo Reliance on Internet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003e*Significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;.05).\u003c/em\u003e \u003csup\u003e\u003cem\u003e+\u003c/em\u003e\u003c/sup\u003e\u003cem\u003eMeasured using Fisher\u0026rsquo;s Exact Test.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eResults similarly showed that experiencing barriers to MC access were significantly associated with an increase in the likelihood of IMC use (See Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e). When explicitly asked in the survey, experiencing problems getting MC was associated with an increased likelihood of IMC nearly fivefold (Odds Ratio OR\u0026thinsp;=\u0026thinsp;4.73, p\u0026thinsp;=\u0026thinsp;.001). For healthcare access (1), experiencing lack of insurance (OR\u0026thinsp;=\u0026thinsp;4.86, p\u0026thinsp;=\u0026thinsp;.02), no MC access through pharmacies nearby (OR\u0026thinsp;=\u0026thinsp;4.91, p\u0026thinsp;=\u0026thinsp;.04), or high cost of MC products (OR\u0026thinsp;=\u0026thinsp;4.91, p\u0026thinsp;=\u0026thinsp;.001) were all associated with increased odds of IMC use. For program enrollment (2), increased odds of IMC use were associated with experiencing problems with state website navigation (OR\u0026thinsp;=\u0026thinsp;3.47, p\u0026thinsp;=\u0026thinsp;.09), renewal requirements (OR\u0026thinsp;=\u0026thinsp;58.7, p\u0026thinsp;=\u0026thinsp;.001), the renewal process (OR\u0026thinsp;=\u0026thinsp;4.23, p\u0026thinsp;=\u0026thinsp;.023), enrollment costs (OR\u0026thinsp;=\u0026thinsp;5.66, p\u0026thinsp;=\u0026thinsp;.001), and confidence to obtain MC products (OR\u0026thinsp;=\u0026thinsp;12.5, p\u0026thinsp;=\u0026thinsp;.01). Regarding perception of MC use (3), experiencing problems with provider stigma (OR\u0026thinsp;=\u0026thinsp;16.0 p\u0026thinsp;=\u0026thinsp;.026), fear of discrimination at work (OR\u0026thinsp;=\u0026thinsp;6.99, p\u0026thinsp;=\u0026thinsp;.001), cultural perception (OR\u0026thinsp;=\u0026thinsp;7.69, p\u0026thinsp;=\u0026thinsp;.001), and friends or family\u0026rsquo;s perception (OR\u0026thinsp;=\u0026thinsp;3.32, p\u0026thinsp;=\u0026thinsp;.04) were associated with increased odds of using IMC.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate Logistic Regression of Barriers and Contributors to MC Impact on IMC Use\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Did you ever have problems getting medicinal cannabis?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[1.95, 11.4]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBarriers\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealthcare Provider Access\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Lack of insurance coverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[1.31, 18.1]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLong wait time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[.57, 17.1]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProgram Enrollment Process\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Difficulty navigating state website\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[.83, 14.4]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Difficulty in knowledge of renewal requirements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[6.69, 514.8]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Problems with renewal process\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[1.17, 15.3]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Problems with enrollment cost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[1.97, 16.3]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedical Cannabis Accessibility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Provider Stigma/Bias\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[1.39, 183.8]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*No medical cannabis near them\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[1.10, 22.1]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncompatible pharmacy hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[.68, 22.7]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndividual Factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Cost of MC products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[1.99, 12.1]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransportation issues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[.67, 10.6]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot safe to keep MC products in home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[.33, 43.6]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Fear of discrimination at work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[2.59, 18.8]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Lack of confidence to obtain MC products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[1.97, 79.1]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Negative cultural perception of MC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[2.54, 23.2]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Negative friend/family perception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[1.07, 10.3]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eContributors to IMC Use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTrusted Sources of MC Information\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrust in MC Pharmacist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[.13, 1.88]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrust in Medical Provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[.23, 3.13]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Trust in State MC Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[.16, .99]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrust in Friends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[.50, 3.60]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrust in Internet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[.53, 3.12]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReliance on Sources of MC Information\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Info Reliance on MC Pharmacist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[.14, .86]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfo Reliance on Medical Provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[.84, 6.55]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Info Reliance on State MC Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[.21, .88]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfo Reliance on Friends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[.34, 2.78]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfo Reliance on Internet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[.38, 3.06]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMotives to IMC Use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Ensure an Adequate Supply\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[5.01, 39.4]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Cost of Products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[6.21, 51.6]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifficulty obtaining a prescription\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[.68, 22.7]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Cost of consultation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[.95, 17.5]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Improve effectiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[3.74, 330.5]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003e*Significant Difference (p\u0026thinsp;\u0026lt;\u0026thinsp;.10). NOTE: Variables with \u0026le;\u0026thinsp;1 response in any condition were not included in the analysis due to collinearity and subsequentially not included in the table.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Potential Contributors to IMC Use\u003c/h2\u003e \u003cp\u003eParticipants using IMC reported differing levels of trust and information reliance than those not using IMC. These participants reported significantly lower levels of trust in the state MC Program (45.5% vs 67.4%, p\u0026thinsp;=\u0026thinsp;.04). Participants using IMC reported lower levels of information reliance as compared to those not using IMC on two sources: MC pharmacists (33.3% vs 58.9%, p\u0026thinsp;=\u0026thinsp;.01) and the state MC program (37.5% vs 63.1%, p\u0026thinsp;=\u0026thinsp;.02). Participants from both groups reported similar levels of trust and reliance among the other sources of information (See Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSources of trust and information reliance correlated with IMC use. Trusting and relying on the state MC program for information indicated a decrease in the odds of IMC use (OR\u0026thinsp;=\u0026thinsp;.43, p\u0026thinsp;=\u0026thinsp;.02). Relying on information from the MC pharmacists (OR\u0026thinsp;=\u0026thinsp;.35, p\u0026thinsp;=\u0026thinsp;.02) and the state program (OR\u0026thinsp;=\u0026thinsp;.43, p\u0026thinsp;=\u0026thinsp;.02) were similarly associated with lower odds of IMC use.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Motives to IMC Use\u003c/h2\u003e \u003cp\u003eThe most cited reason for using IMC indicated by respondents was the cost of products (n\u0026thinsp;=\u0026thinsp;19, 79%) and difficulty obtaining a prescription was the least common reason (n\u0026thinsp;=\u0026thinsp;3, 8.3%, See Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Several identified participant-reported motives increased odds of IMC use including ensuring an adequate supply (OR\u0026thinsp;=\u0026thinsp;14.1, p\u0026thinsp;=\u0026thinsp;.001), cost of MC products (OR\u0026thinsp;=\u0026thinsp;17.9, p\u0026thinsp;=\u0026thinsp;.001), and improving effectiveness (OR\u0026thinsp;=\u0026thinsp;35.2, p\u0026thinsp;=\u0026thinsp;.002).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWe conducted a multivariate logistic regression, including all relevant factors identified from the univariate analysis in the full model, and conducted stepwise variable selection. The final model included three risk factors that potentially increased the risk of IMC use (See Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Both concerns about accessing an adequate supply of MC (Adjusted Odds Ratio (AOR)\u0026thinsp;=\u0026thinsp;6.96, p\u0026thinsp;=\u0026thinsp;.004) and concerns about the cost of MC products (AOR\u0026thinsp;=\u0026thinsp;20.1, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) were significantly associated with higher odds of IMC use, while relying on information from the state MC program was associated with lower odds of IMC use (AOR\u0026thinsp;=\u0026thinsp;0.16, p\u0026thinsp;=\u0026thinsp;.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStepwise Regression of Barriers and contributors to Illicit Medicinal Cannabis Use\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarriers and Contributors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eAOR\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnsuring an adequate supply of MC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[1.85, 26.1]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCost of MC Products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[5.16, 78.4]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfo Reliance on State MC Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[.03, .99]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eNote: Only significant factors (p\u0026thinsp;\u0026lt;\u0026thinsp;.05) were kept in the final model. All surveyed demographic variables were included in the model but proved to be non-significant.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIMC use is a prevalent behavior among MC program participants, with these data demonstrating that one in ten MC patients use IMC.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e In order to address this potentially dangerous behavior, it is critical to understand the elements that contribute to IMC use. This exploratory analysis revealed factors that may influence IMC use. Our analysis focused on barriers and contributors to accessing MC, the impact of sources of information related to IMC use, and specific motivations for IMC use.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Barriers\u003c/h2\u003e \u003cp\u003e \u003cb\u003eCost\u003c/b\u003e. Experiencing problems with MC product cost was shown as a main motive for IMC use, as 79.2% of participants using IMC reporting this barrier. This finding remains consistent among MC participants in other programs across the country, as participants often report that the cost of products was either an issue or unaffordable.\u003csup\u003e\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e However, lowering the cost of MC may not address these product issues. Previous research showed that while price influences product choices, demand is relatively inelastic,\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e indicating that decreasing the price of MC may not lead to lower IMC use. Nonetheless, due to the impact of product price on IMC use, cost may still be a relevant issue for MC participants who use IMC.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAccess\u003c/b\u003e. The increase in IMC use was most highly associated with barriers relating to healthcare access, program enrollment experiences, and perception of MC use. Frequently reported access barriers, including problems with insurance or no MC pharmacies nearby, may indicate that many MC participants using IMC resort to these illicit products due to relative unavailability of legal MC options. Thus, future studies to assess whether increasing access to MC programs might reduce IMC use may be warranted. However, facilitating broader access to cannabis through MC programs may increase the risk of negative health effects for some individuals, especially at-risk groups such as cannabis-naive patients, older adults\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e and adolescents\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e due to the risk of unfamiliarity and long-term health consequences specific to these populations. Policies that seek to increase MC access may need to be accompanied by research measuring both the benefits and collateral harms of increasing legal access to cannabis. It is worth noting that patients who reside in states with only MC options may face different barriers than patients in states with both medical and adult-use options. Patients in states with both programs may be less incentivized to access MC because adult-use options may be cheaper or easier to access.\u003c/p\u003e \u003cp\u003e \u003cb\u003eProgram participation\u003c/b\u003e. Experiences within program enrollment or card renewal were also found to increase the likelihood of IMC use. Our results suggested participants accessing IMC may be deterred from MC use due to program-specific issues such as understanding renewal requirements, navigating the state website, and the enrollment cost. Participants in other MC programs have reported similar issues.\u003csup\u003e\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Previous research into factors that influence switching from illicit to licit has shown that similar issues such as price, regulation, and reduced accessibility act as barriers to MC use.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e Our sample presents similar trends while also providing further understanding of specific barrier effects and protective factors against IMC use.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStigma\u003c/b\u003e. Our analysis also indicated that participants\u0026rsquo; and providers\u0026rsquo; perceptions of MC use significantly affected IMC use. Although our results showed that participants who use IMC experienced negative cultural or familial perception of MC use at similar rates as those who did not use IMC, participants who use IMC were more influenced by these negative perceptions as fear of experiencing discrimination at work or stigma by MC providers was associated with increased IMC use. Although public sentiments about MC use across the country are generally positive\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e, if a participant is internalizing negative perceptions of use, they might forgo public purchasing, typical at a pharmacy, to avoid these negative perceptions.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAdditionally, previous research into motives for IMC use in treating medical conditions has found that healthcare provider perceived stigma motivates IMC use.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Our analysis produced similar results as provider stigma was shown to be associated with increased IMC use. People who use drugs are often stigmatized by the healthcare providers treating them,\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e which can preclude discussions about the relative risks and benefits of MC with their medical providers. Instead, some participants may opt to use IMC to avoid negative public perception, shame, or stigma. Educational and stigma-reducing campaigns for healthcare providers may prove beneficial to reduce stigma surrounding MC use, thereby possibly reducing IMC use and improving care for program patients.\u003c/p\u003e \u003cp\u003eThere were a few factors presented as barriers in the survey that did not influence the likelihood of IMC use. Problems related to pharmacy customer service such as long wait times, or incompatible hours did not affect IMC use in our sample of participants. Individual factors such as transportation or home storage issues were similarly not significant in our sample. It is possible that, despite encountering these challenges, participants may not perceive the associated barriers as sufficient to instigate use of IMC.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Potential Contributors\u003c/h2\u003e \u003cp\u003e \u003cb\u003eProgram information\u003c/b\u003e. We also analyzed whether the degree to which participants relied on, or trusted different sources of information was associated with IMC use. We found that relying on information from both MC pharmacists and state MC program resources was associated with a decrease in IMC use. If participants trust and receive information from these sources, thereby possibly strengthening their connection and reliance on the MC program, they would be more likely to access legal products than IMC.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Connection and reliance on the program may be achieved through efficacious care and positive interactions.\u003c/p\u003e \u003cp\u003eNotably, trust in MC pharmacists did not have a significant association with IMC use while reliance did, suggesting that information reliance may have some greater influence on behavior than trust. Participants in MC programs often rely on information from a variety of sources including the internet, friends, and family.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e As information about cannabis is often ambiguous and illusive,\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e it is reasonable to assume that MC patients will continue to favor availability over creditability. As a result, supporting the collection and dissemination of valid and reliable cannabis research may provide a reduction in IMC use.\u003c/p\u003e \u003cp\u003eOur final analytical model highlighted three significant influences: (1) Ensuring an adequate supply and (2) cost of MC products was associated with an increased likelihood of IMC use while (3) information reliance on state resources was correlated with decreased IMC use. Based on these results, we hypothesize that low availability and high cost of MC products may increase IMC use while reliance on state resources may attenuate use. Future studies could focus efforts on measuring patterns of MC and IMC use when MC costs are reduced or measure how cannabis knowledge affects MC adherence.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Limitations\u003c/h2\u003e \u003cp\u003eThere are limitations to the study findings that should be considered. The exploratory nature study and smaller size of the current IMC group may limit the generalizability of the findings, signaling the necessity of further research into this topic. The patient-reported data also represents a small cohort in a single state, which may limit external validity. Although our sample possessed important points of possible representativeness of the overall state MC population with regards to condition, it may not be representative of other MC populations across the US or other parts of the world where cannabis use is legal, as barriers and potential contributors may differ. Moreover, further research should systematically consider illicit MC use in other jurisdictions, both within and outside the US, as well as among individuals who have not attempted to access the legal system, to better understand how these barriers and factors influence usage. Further studies should also examine how perceptions of effectiveness and quality affect IMC use.\u003c/p\u003e \u003cp\u003eEvaluation cohorts were also created using a convenience sampling method, which could introduce potential bias to the sample. Future studies may consider probability sampling methods to control for these threats. This analysis was conducted with baseline survey data that may not accurately capture the lasting perceptions and demographics of those in the program, as these factors may shift as the program continues to grow. Additionally, the frequency of IMC use in our sample may be underrepresented due to social desirability bias. Parts of our analysis relied on variables that contained cell sizes with less than five responses. We used Fisher\u0026rsquo;s exact test as a method to compensate for small cell sizes. We also observed large confidence intervals in some of our regression analyses due to our small size. Future studies should consider larger samples to correct these errors. Additionally, correction for multiple comparisons was not undertaken for this exploratory analysis. Larger confirmatory studies should utilize such corrections to better understand the impact of these identified factors on IMC use.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eAs state MC programs develop, the prevalence and clinical implications of IMC use must be considered. In this exploratory study, we identified key factors that may influence the likelihood of use IMC among participants enrolled in a MC program. Our findings suggest that barriers related to MC supply and cost may contribute to IMC use, while reliance on state program information appears to protect against this behavior. Additional factors, such as enrollment barriers and public perception may be influential in participants' decision-making processes. While this study offers valuable insights, more comprehensive research based on these preliminary findings is needed to develop effective strategies to mitigate IMC use and promote safe MC program participation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMC:\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eMedical Cannabis\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eIMC:\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eIllicit Medicinal Cannabis\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eOR:\u003c/em\u003e\u003c/strong\u003e Odds Ratio\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAOR\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Adjusted Odds Ratio\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSUBLIME\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Study of Utahn\u0026rsquo;s Beliefs and Experiences with Integrative Medicine\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDHHS\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Utah Department of Health and Human Services\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData can be made available upon reasonable request.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe funds to support this exploratory analysis were allocated by the Utah Department of Health, under contract #236204 titled \u0026ldquo;Utah Medical Cannabis: A Prospective Cohort Evaluation\u0026rdquo; with Dr. Gerald Cochran as Principal Investigator for the time period of 12/01/23 through 03/31/2025. The funder had no role in the design, data collection, or data analysis. The content of this analysis does not reflect the views of the funder.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors and Affiliations\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProgram for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.\u003c/p\u003e\n\u003cp\u003eDivision of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.\u003c/p\u003e\n\u003cp\u003eInformatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.\u003c/p\u003e\n\u003cp\u003eUtah Department of Health and Human Services (DHHS) Center for Medical Cannabis, Salt Lake City, UT, USA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eContributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEach author made substantial contributions to the conception and creation of the work. C.R. retrieved and analyzed the data and led the creation of the manuscript. L.F., A.T.K, M.I., A.J.G, E.F. all interpreted the data and contributed to the creation of the manuscript. G.C. supervised the analysis and creation of the manuscript. Z.Y. provided assistance with statistical analysis and reporting.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCorresponding Author\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to Lirit Franks ([email protected]\u003c/a\u003e)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics Approval\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe University of Utah IRB approved all evaluation procedures for protocol #164305. Informed and written consent was gathered from all participants from evaluation staff.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting Interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRhee TG, Rosenheck RA. Increasing Use of Cannabis for Medical Purposes, Among US, Residents, American Journal of Preventive Medicine. 2013\u0026ndash;2020. Vol. 65,. Elsevier BV; 2023. pp. 528\u0026ndash;33. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1016/j.amepre.2023.03.005\u003c/span\u003e\u003cspan address=\"10.1016/j.amepre.2023.03.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSubstance Abuse and Mental Health Services Administration. 2023 Companion infographic report: Results from the 2021, 2022, and 2023 National Surveys on Drug Use and Health. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration; 2024. Report No.: PEP24-07-020. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.samhsa.gov/data/report/2021-2022-2023-nsduh-infographic\u003c/span\u003e\u003cspan address=\"https://www.samhsa.gov/data/report/2021-2022-2023-nsduh-infographic\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHrdinova J. Ohio Medical Marijuana Control Program at Four Years: Evaluating Satisfaction and Perception. SSRN Electronic Journal. Elsevier BV; 2022. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.2139/ssrn.4231400\u003c/span\u003e\u003cspan address=\"10.2139/ssrn.4231400\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarrelly KN, Wardell JD, Marsden E, Scarfe ML, Najdzionek P, Turna J et al. The Impact of Recreational Cannabis Legalization on Cannabis Use and Associated Outcomes: A Systematic Review. Vol. 17, Substance Abuse: Research and Treatment. SAGE Publications; 2023. p. 117822182311720. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1177/11782218231172054\u003c/span\u003e\u003cspan address=\"10.1177/11782218231172054\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMahamad S, Wadsworth E, Rynard V, Goodman S, Hammond D. Availability, retail price and potency of legal and illegal cannabis in Canada after recreational cannabis legalisation. Vol. 39, Drug and Alcohol Review. Wiley; 2020. pp. 337\u0026ndash;46. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1111/dar.13069\u003c/span\u003e\u003cspan address=\"10.1111/dar.13069\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJameson LE, Conrow KD, Pinkhasova DV, Boulanger HL, Ha H, Jourabchian N et al. Comparison of State-Level Regulations for Cannabis Contaminants and Implications for Public Health. Vol. 130, Environmental Health Perspectives. Environmental Health Perspectives; 2022. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1289/EHP11206\u003c/span\u003e\u003cspan address=\"10.1289/EHP11206\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSevigny EL, Pacula RL, Heaton P. The effects of medical marijuana laws on potency. Vol. 25, International Journal of Drug Policy. Elsevier BV; 2014. pp. 308\u0026ndash;19. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1016/j.drugpo.2014.01.003\u003c/span\u003e\u003cspan address=\"10.1016/j.drugpo.2014.01.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatsuzaki M, Vu QM, Gwadz M, Delaney JAC, Kuo I, Trejo MEP et al. Perceived access and barriers to care among illicit drug users and hazardous drinkers: findings from the Seek, Test, Treat, and Retain data harmonization initiative (STTR). Vol. 18, BMC Public Health. Springer Science and Business Media LLC; 2018. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1186/s12889-018-5291-2\u003c/span\u003e\u003cspan address=\"10.1186/s12889-018-5291-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoallef S, Homayra F, Milloy MJ, Bird L, Nosyk B, Hayashi K. High Prevalence of Unmet Healthcare Need among People who use Illicit Drugs in a Canadian Setting with Publicly-Funded Interdisciplinary Primary Care Clinics. Vol. 42, Substance Abuse. SAGE Publications; 2021. pp. 760\u0026ndash;6. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1080/08897077.2020.1846667\u003c/span\u003e\u003cspan address=\"10.1080/08897077.2020.1846667\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKing C, Collins D, Patten A, Nicolaidis C, Englander H. Trust in Hospital Physicians Among Patients With Substance Use Disorder Referred to an Addiction Consult Service: A Mixed-methods Study. Vol. 16, Journal of Addiction Medicine. Ovid Technologies (Wolters Kluwer Health); 2021. pp. 41\u0026ndash;8. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1097/ADM.0000000000000819\u003c/span\u003e\u003cspan address=\"10.1097/ADM.0000000000000819\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThom DH, Hall MA, Pawlson LG. Measuring Patients\u0026rsquo; Trust In Physicians When Assessing Quality Of Care. Vol. 23, Health Affairs. Health Affairs (Project Hope); 2004. pp. 124\u0026ndash;32. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1377/hlthaff.23.4.124\u003c/span\u003e\u003cspan address=\"10.1377/hlthaff.23.4.124\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShonesy BC, Williams D, Simmons D, Dorval E, Gitlow S, Gustin RM, Screening. Brief Intervention, and Referral to Treatment in a Retail Pharmacy Setting: The Pharmacist\u0026rsquo;s Role in Identifying and Addressing Risk of Substance Use Disorder. Vol. 13, Journal of Addiction Medicine. Ovid Technologies (Wolters Kluwer Health); 2019. pp. 403\u0026ndash;7. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1097/ADM.0000000000000525\u003c/span\u003e\u003cspan address=\"10.1097/ADM.0000000000000525\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDonnan J, Shogan O, Bishop L, Swab M, Najafizada M. Characteristics that influence purchase choice for cannabis products: a systematic review. Vol. 4, Journal of Cannabis Research. Springer Science and Business, Media LLC. 2022. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1186/s42238-022-00117-0\u003c/span\u003e\u003cspan address=\"10.1186/s42238-022-00117-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLintzeris N, Mills L, Abelev SV, Suraev A, Arnold JC, McGregor IS. Medical cannabis use in Australia: consumer experiences from the online cannabis as medicine survey 2020 (CAMS-20). Vol. 19, Harm Reduction Journal. Springer Science and Business, Media LLC. 2022. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1186/s12954-022-00666-w\u003c/span\u003e\u003cspan address=\"10.1186/s12954-022-00666-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLintzeris N, Mills L, Suraev A, Bravo M, Arkell T, Arnold JC et al. Medical cannabis use in the Australian community following introduction of legal access: the 2018\u0026ndash;2019 Online Cross-Sectional Cannabis as Medicine Survey (CAMS-18). Vol. 17, Harm Reduction Journal. Springer Science and Business Media LLC; 2020. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1186/s12954-020-00377-0\u003c/span\u003e\u003cspan address=\"10.1186/s12954-020-00377-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinnesota Department of Health: Office of Medical Cannabis. Minnesota Medical Cannabis Program: Patient Experiences from the First Program Year. Minnesota Legislative Reference Library. p. 173. 2016. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.health.state.mn.us/people/cannabis/docs/about/firstyearreport.pdf\u003c/span\u003e\u003cspan address=\"https://www.health.state.mn.us/people/cannabis/docs/about/firstyearreport.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSofis M, Slade LM, Boyum M. H. Examination of Experiences, Behaviors, and Outcomes of Medical Cannabis Patients and Providers in New Mexico. Cannabis Public Policy Consulting The State of New Mexico Department of Health. p. 11/22/2022. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nmhealth.org/publication/view/report/7954/\u003c/span\u003e\u003cspan address=\"https://www.nmhealth.org/publication/view/report/7954/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCannabis Public Policy Consulting. Maryland Medical Cannabis Patient Survey Report. Maryland Medical Cannabis Commission. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://cannabis.maryland.gov/Documents/2024%20Reports/MMCPS-22-Addendum-V5.pdf\u003c/span\u003e\u003cspan address=\"https://cannabis.maryland.gov/Documents/2024%20Reports/MMCPS-22-Addendum-V5.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmlung M, Reed DD, Morris V, Aston ER, Metrik J, MacKillop J. Price elasticity of illegal versus legal cannabis: a behavioral economic substitutability analysis. Vol. 114, Addiction. Wiley; 2018. pp. 112\u0026ndash;8. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1111/add.14437\u003c/span\u003e\u003cspan address=\"10.1111/add.14437\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStall NM, Shi S, Malikov K, Wang S, Rochon PA, Hillmer MP, JAMA Internal Medicine. Edible Cannabis Legalization and Cannabis Poisonings in Older Adults. Vol. 184,. American Medical Association (AMA); 2024. p. 840. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1001/jamainternmed.2024.1331\u003c/span\u003e\u003cspan address=\"10.1001/jamainternmed.2024.1331\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCroker JA, Werts M, Couch ET, Chaffee BW. Cannabis use among adolescents and emerging adults who use e-cigarettes: Findings from an online, national U.S. Sample. Vol. 140, Addictive Behaviors. Elsevier BV; 2023. p. 107620. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1016/j.addbeh.2023.107620\u003c/span\u003e\u003cspan address=\"10.1016/j.addbeh.2023.107620\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRobertson K, Thyne M. Legalization of recreational cannabis: Facilitators and barriers to switching from an illegal to a legal source. Vol. 24, Preventive Medicine Reports. Elsevier BV; 2021. p. 101639. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1016/j.pmedr.2021.101639\u003c/span\u003e\u003cspan address=\"10.1016/j.pmedr.2021.101639\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhademi S, Hallinan CM, Conway M, Bonomo Y. Using Social Media Data to Investigate Public Perceptions of Cannabis as a Medicine: Narrative Review. Vol. 25, Journal of Medical Internet Research. JMIR Publications Inc.; 2023. p. e36667. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.2196/36667\u003c/span\u003e\u003cspan address=\"10.2196/36667\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatthews S, Dwyer R, Snoek A, Stigma. and Self-Stigma in Addiction [Internet]. Vol. 14, Journal of Bioethical Inquiry. Springer Science and Business Media LLC; 2017. pp. 275\u0026ndash;86. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1007/s11673-017-9784-y\u003c/span\u003e\u003cspan address=\"10.1007/s11673-017-9784-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErridge S, Troup L, Sodergren MH. Illicit Cannabis Use to Self-Treat Chronic Health Conditions in the United Kingdom: Cross-Sectional Study [Internet]. Vol. 10, JMIR Public Health and Surveillance. JMIR Publications Inc.; 2024. pp. e57595\u0026ndash;e57595. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.2196/57595\u003c/span\u003e\u003cspan address=\"10.2196/57595\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFong C, Mateu-Gelabert P, Ciervo C, Eckhardt B, Aponte-Melendez Y, Kapadia S et al. Medical provider stigma experienced by people who use drugs (MPS-PWUD): Development and validation of a scale among people who currently inject drugs in New York City. Vol. 221, Drug and Alcohol Dependence. Elsevier BV; 2021. p. 108589. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1016/j.drugalcdep.2021.108589\u003c/span\u003e\u003cspan address=\"10.1016/j.drugalcdep.2021.108589\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeng HC. Does the physician\u0026rsquo;s emotional intelligence matter? Vol. 33, Health Care Management Review. Ovid Technologies (Wolters Kluwer Health); 2008. pp. 280\u0026ndash;8. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1097/01.HCM.0000318765.52148.b3\u003c/span\u003e\u003cspan address=\"10.1097/01.HCM.0000318765.52148.b3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoehnke KF, Smith T, Elliott MR, Wilson-Poe AR, Kruger DJ. Cannabis-related information sources among US residents: A probability-weighted nationally representative survey. Vol. 6, Journal of Cannabis Research. Springer Science and Business, Media LLC. 2024. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1186/s42238-024-00249-5\u003c/span\u003e\u003cspan address=\"10.1186/s42238-024-00249-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe Health Effects of Cannabis and Cannabinoids. National Academies Press. 2017. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.17226/24625\u003c/span\u003e\u003cspan address=\"10.17226/24625\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarma A, Pu X, Chi Y, Brown ET, Correll M, Kay M. Odds and insights: decision quality in exploratory data analysis under uncertainty. In: Proceedings of the 2024 CHI Conference on Human Factors in Computing Systems. Association for Computing Machinery; 2024. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1145/3613904.3641995\u003c/span\u003e\u003cspan address=\"10.1145/3613904.3641995\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cannabis-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcan","sideBox":"Learn more about [Journal of Cannabis Research](https://jcannabisresearch.biomedcentral.com/)","snPcode":"42238","submissionUrl":"https://submission.springernature.com/new-submission/42238/3","title":"Journal of Cannabis Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Medical Cannabis, Marijuana, Illicit Use, Barriers, Contributors, Motives","lastPublishedDoi":"10.21203/rs.3.rs-5596197/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5596197/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMedical Cannabis (MC) is authorized in numerous state-legislated programs to treat approved medical conditions. Notwithstanding MC access, some participants continue to use cannabis purchased outside of a state licensed MC pharmacy, otherwise known as illicit medicinal cannabis (IMC), to treat their medical conditions. Identifying barriers and contributors to MC use and motives for IMC use can promote safety, improve program design, and inform future research efforts.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis exploratory analysis utilized baseline survey data from a convenience sample-based prospective cohort evaluation of newly registered (\u0026lt;\u0026thinsp;6 months) adult participants in Utah\u0026rsquo;s MC program who had been diagnosed with chronic pain, post-traumatic stress disorder, and/or cancer. Participants completed surveys assessing physical and mental health, program experience, and barriers and contributors to MC access. We employed descriptive analysis, chi-squared analysis, and logistic regression to identify factors influencing IMC use.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 273 MC program participants screened for eligibility, 227 were enrolled in the cohort evaluation, and 211 participants completed the baseline survey. Approximately 1 in 10 survey respondents (N\u0026thinsp;=\u0026thinsp;24, 11.9%) reported IMC use within the past two weeks. Participants accessing IMC were 40.5 years old, 58.3% male, 70.8% employed, and 87.5% white. Participants using IMC reported barriers to MC, including product cost (n\u0026thinsp;=\u0026thinsp;19, 79%) and assurance of adequate supply (n\u0026thinsp;=\u0026thinsp;11, 45.8%) as the most common motives for IMC use. Participants who reported experiencing MC access barriers were significantly more likely to report IMC use than those reporting no barriers (Odds Ratio (OR)\u0026thinsp;=\u0026thinsp;4.73, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Participants using IMC reported lower levels of trust in (p\u0026thinsp;\u0026lt;\u0026thinsp;0.04) and reliance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.02) upon the state program and less reliance on MC pharmacists (p\u0026rsquo;s\u0026thinsp;\u0026lt;\u0026thinsp;0.01). However, participants who relied on the state program for MC information were less likely to report IMC use (Adjusted Odds Ratio AOR\u0026thinsp;=\u0026thinsp;0.16, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn a state MC program, barriers related to MC access and cost indicated a significant increase in the likelihood of IMC use, while reliance on the state program for MC information indicated a significant decrease in the likelihood of IMC use. Future research can explore how increasing affordable access to MC and availability of reliable information may affect IMC use.\u003c/p\u003e","manuscriptTitle":"Understanding Motives for Illicit Medicinal Cannabis Use: An Exploratory Analysis in a Medical Cannabis Program","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-14 22:57:28","doi":"10.21203/rs.3.rs-5596197/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2025-05-01T21:02:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-11T14:02:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"332016924069357892950506497555097537365","date":"2025-04-11T13:41:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-10T09:30:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-09T10:02:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cannabis Research","date":"2025-04-09T04:18:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cannabis-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcan","sideBox":"Learn more about [Journal of Cannabis Research](https://jcannabisresearch.biomedcentral.com/)","snPcode":"42238","submissionUrl":"https://submission.springernature.com/new-submission/42238/3","title":"Journal of Cannabis Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9c79bfd2-731a-460f-87b4-8a513315c200","owner":[],"postedDate":"April 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-07T07:19:11+00:00","versionOfRecord":{"articleIdentity":"rs-5596197","link":"https://doi.org/10.1186/s42238-025-00284-w","journal":{"identity":"journal-of-cannabis-research","isVorOnly":false,"title":"Journal of Cannabis Research"},"publishedOn":"2025-07-18 16:05:41","publishedOnDateReadable":"July 18th, 2025"},"versionCreatedAt":"2025-04-14 22:57:28","video":"","vorDoi":"10.1186/s42238-025-00284-w","vorDoiUrl":"https://doi.org/10.1186/s42238-025-00284-w","workflowStages":[]},"version":"v1","identity":"rs-5596197","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5596197","identity":"rs-5596197","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}