Findings from a Survey of
Medical Marijuana Users in Los
Angeles County
Christine E. Grella, Ph.D.
UCLA Integrated Substance Abuse Programs
June 8, 2013
Supported by LA County Department of Public Health, Substance Abuse
Prevention and Control (SAPC)
Brief History of Medical Marijuana Policy

1996: Prop 215, the Compassionate Use Act, was
passed in California allowing adults with a doctor's
recommendation to possess and cultivate marijuana for
personal medicinal use – the first in the U.S.

The state law is in conflict with Federal regulations
because marijuana is classified as a Schedule 1
substance (1970 Federal Controlled Substances Act)

Subsequent legislative changes to the law and judicial
decisions resulted in the growth of an extensive system
of collective and cooperative dispensaries.

2007: LA passed a moratorium on licensing new
dispensaries (caped at 187); yet estimates were that
unregulated dispensaries numbered in the thousands.
Medical Marijuana Dispensaries
in Los Angeles County
Brief History of Medical Marijuana Policy

2009: The City Council imposed stricter
regulations for obtaining land use permits for
dispensaries, yet this ordinance was overturned
and numerous challenges have been filed to the
legality of efforts to regulate the dispensaries.

2010: A ballot initiative in California to legalize
sales of marijuana to adults failed.

2011: The governor authorized a reduction in
criminal sanctions for possession of small
amounts of marijuana for personal use.
Brief History of Medical Marijuana Policy

2011-12: The U.S. Attorney General began an
aggressive process of shutting down selected
dispensaries, stating that they were “significant
commercial operations” that were de facto drug
distribution centers in violation of Federal law.

At present: MM is legal in 18 states plus the District
of Columbia and marijuana distribution is legal
Colorado and Washington.



U.S. Attorney General will issue a ruling on how they intend
to treat Colorado and Washington laws.
In May, Calif. Supreme Court upheld a lower court ruling
that municipalities may ban dispensaries (since there is no
way to “regulate” an illegal entity).
On May 21, Proposition D passed in LA, which restricts
dispensaries to the original 135 and increases taxes.
Epidemiological study: who are
users of medical marijuana?
Background

There is a lack of scientific data on the
individuals who use MM

Critical questions pertaining to important
public health issues, such as:
 Reasons for using MM and patterns of use
 How does access to the dispensaries
influence initiation and patterns of use
 Do consumers distribute marijuana obtained
from the dispensaries to others
Background

No clear distinction between medical and

It is unclear whether individuals who use MM
perceive its use to be primarily “medicinal” (i.e., to
treat specific health problems or to alleviate side
effects of medication or other treatments),
primarily “recreational” or non-therapeutic (i.e., to
alter mood, to get “high,” to socialize), or as both.

Nor is there a good understanding of the
relationships among dose and frequency of use,
clinical diagnosis of dependence, and health
outcomes and social functioning.
recreational use of marijuana in the literature.
Two phase study supported by
SAPC


Focus groups with 30 MM consumers
Survey of MM users using a clusterbased sample of dispensaries

Qualitative observations of the dispensaries
Focus Group Methods
(N =30)
Individuals were recruited by posting fliers at
dispensaries


Each group focused on different region of
the county (e.g., Hollywood, Venice Beach,
Westside)

5 groups were held at ISAP in the evening

Participants were paid $50 for participating

Food was provided!
Focus Group Findings
(N = 30)

Nearly all participants had a history of marijuana use
prior to receiving their MM recommendation, usually
initiating use in adolescence and often with family.

My mother has been smoking cannabis since she was 14
years old. My mom would smoke in the house . . . she never
talked about it, it seemed like school wanted to make it
worse than it actually was and I didn’t actually feel there
was anything wrong with it.

I’ve been smoking over 40 years, my son probably picked it
up behind me.

My parents smoked when I was a kid and, yes, I was
exposed to it at a very young age and I didn’t start smoking
until much later. . . I avoided [it] for a long time.
Focus Group Findings

Some individuals had ceased marijuana use for
a period, only to resume use at a later date.
Others had used continuously, but had
recognized [or redefined] its medical benefits
after years of use:

[As an adolescent, I used marijuana] with friends, going
out to a concert or some event, party. But recently . . . I
got MM for anxiety and depression and now it’s not
necessarily recreational it’s more for relaxation and to
deal with the anxiety and depression . . . I smoke it at
home a lot by myself.
Focus Group Findings

Most reported sleep problems, anxiety, depression, or chronic
pain as their primary reason for use, although some had
serious chronic health problems related to a serious accident,
illness, or mental disorder.

I’ve been smoking weed since I was ten years old or something,
but medicinally I got it for chronic pain.

I originally started using when I was 9 years old and that was just
because of like friends and stuff, they were using it . . . as I
started getting older, I started realizing more things that I needed
it for because of back problems, sleeping problems, I’ve always
had insomnia as a little kid too.

As a teenager I probably was self-medicating through marijuana
as an alleviant for the conditions I was experiencing because I
really wasn’t comfortable with pharmaceuticals.
Focus Group Findings

Participants preferred MM over prescription meds:

I was taking all the [Rx] medications, I was shaking constantly
and I was taking, you’re not going to believe this, [but] I was
taking a medication [for] a side effect to counteract a side
effect.

I tried prescription medication . . . and I don’t like the way that
they make me feel when I wake up, I feel groggy.

Although I was previously smoking marijuana before I started
going to dispensaries, last year, after a car accident, I had a lot
of back problems.

I was looking for something to ease the pain that wasn’t ‘crazy
pills.’ I thought it helped a lot - I was never a person that was
really into taking the pain pills that they would offer you like
Vicodin . . . I thought it was the best for me.
Focus Group Findings

Participants felt that dispensaries counteract the
highly stigmatized image of marijuana users that
is pervasive in society, stemming from years of
fear-based prevention messages.

They appreciated being treated with respect and
compassion for their problems and they
identified as “patients.”

They strongly preferred the safety of obtaining
MM from the dispensaries rather than “from a
dealer” or “on the streets,” and supported
regulating MM to ensure product safety.
Focus Group Findings

Participants varied in whether they perceived any problems
related to MM use.

I would think, wow, am I a drug addict, even though it’s just marijuana
and that’s bothered me . . . There’s plenty of times where I thought,
well I’m using it just like a crutch, I just kind of like regular[ly] use, not
just the accident, just basically, I just like to smoke.

I am still dealing with the addiction issue because I smoke everyday.
I’m habitual and I am aware that when I need to stop, I stop. But it is
really easy not to stop . . . it’s around me everywhere all the time.

In high school it was around, I just chose not to do it . . . I know that if
I had smoked in high school it honestly would have affected my ability
to perform academically and [now] I see it has affected my brother.

I see what it can do basically at a young age, just like alcohol. It’s just
some things you shouldn’t do before you’re mature enough to handle
the effects of what it will do to you.
Survey Methods

Lists of MM dispensaries were compiled (e.g.,
city attorney’s list, web sites, official registered
sites, trade publications) and cross-checked

MM dispensaries were randomly sampled
within Service Area (SA)

Number of surveys to be completed was
proportionate to the number of dispensaries
documented in that SA; goal = 200 surveys

Brief survey (5-8 min) was designed in
collaboration with SAPC
Methods

Survey teams approached the selected
dispensaries and requested their
participation in the survey

4 SA’s (Antelope Valley, South LA, East LA, San
Gabriel Valley) had very low density of
dispensaries and were dropped from the sampling
frame

Surveys were completed in: Westside, South
Bay, Downtown/Hollywood, and San Fernando
Valley
Methods

Days and times of site visits to dispensaries
were varied to maximize sampling variability.

182 client and 29 staff surveys were completed

65 refusals to participate, mostly younger
males who said they were “too busy”

Individuals were paid with a $10 voucher of
their choice for participating

Descriptive analyses conducted by age and
other subject characteristics
Medical Marijuana Dispensaries:
Survey Participation (N=40)
Closed
(n = 9)
Refused
(n = 19)
Agreed
(n = 12)
Survey Findings: Socio-demographics
(N = 182)



74% were male – consistent with population data
Age range: 17 - 63, Mean = 28.4 (sd = 5.3)
Race/ethnicity







44%
26%
13%
6%
11%
White
Hispanic
African American
Asian/Pacific Islander
Other
Most had some college education; 32% were
currently students
45% were employed full-time and 24% part-time
History of Marijuana Use

Age of first marijuana use: range = 8 –
42; median = 15

Ave duration of MM use was about 2.5
years.

Primary condition for MM use was evenly
split between physical health and mental
health conditions; no difference by age
group.

Nearly all (91%) believed that use of MM
has helped them “very much.”
Recent Use of Other Substances

21% used illicit drugs in past 30 days

46% met criteria for risky alcohol use
on at least one day in past 30

5 or more drinks in one sitting (for men);
4 or more (for women)

44% smoked cigarettes

Few respondents had ever received
drug treatment (n=5) or believed they
needed it (n=2)
Other Substance Use in Past 30 Days
Heroin
1.2
Club drugs
3
Amphetamines
3
Rx Stimulants
3.6
Cocaine/Crack
5.4
Rx Painkillers
6.6
Psychedelics
7.2
0
5
10
15
Percent
20
25
30
MM Use Patterns



Ave no. of dispensaries visit/mo = 2.7
Ave no. of days visit dispensary/mo =
12.2; median = 9.5
Ave no. of days use MM/mo = 23.8;
range = 3 – 31; median = 29
What Factors are Most Important in
Deciding Which Dispensary to Use
Staff Recommendation
25
Safety of Product
32
Variety of Product
36
Environment/Atmosphere
38
Price/Sales Incentives
47
Staff Knowledge
51
Staff Friendliness
54
Quality of Product
68
Location/Convenience
73
0
10
20
30
40
Percent
50
60
70
80
Other Sources Where they
Obtain Marijuana
29
30
25
20
20
15
15
14
13
10
5
0
Family or
Friends
Delivery
Service
Homegrown
Plants
Other
Dealer
How many of your friends use MJ?
40
36
35
16% have bought marijuana
at a dispensary for friends
or family who do not have a
MM recommendation
30
20
16
11
10
2
0
All
Most
Some
Few
None
Use of MM in Place of Other Drugs
70
58
60
41
50
40
30
30
20
10
0
Rx drugs
Alcohol
Illicit Drugs
Psychological Symptoms in Past Year
70
55
60
50
38
40
30
24
30
20
3
10
0
Insomnia, sleep
Anxious,
problems,
nervous, tense,
restless sleep
scared,
panicked
Distressed and
upset by past
memory
Sad, blue,
depressed,
lonely, or
hopeless
Suicidal
thoughts
Comparisons by Age



Younger individuals (< 30) were more
likely to be male and Hispanic
Younger individuals had higher rates of
tobacco use (51% vs. 33%, p < .05), but
no difference in risky alcohol use
Older individuals were more likely to
report psychiatric symptoms (76% vs.
59%, p < .05)
Patterns of MM Use by Age

Younger users:
 Visit dispensaries on more days/month:
14.1 vs. 8.8 days (p < .01)
 Go to more dispensaries per month:
2.95 vs. 2.2 (p = .08)
 Are more likely to use MM 4 or more
times/day: 23.5% vs. 14.5%
 Are more likely to use with others and
to have friends who use MM
Do you primarily use MM alone, with
others, or both?
70
59
54
60
Percent
50
39
40
Younger
26
30
Older
15
20
7
10
0
Both alone &
w/others
P < .001
Use by self
Use w/others
How many of your friends use MJ?
70
60
43
Percent
50
40
40
32
30
20
Younger
28
25
Older
14
9
5
10
2 2
0
All
P < .001
Most
Some
Few
None
Summary

Distinct profiles of MM users by age:




Younger users have higher rates of tobacco use, visit
dispensaries more often, use on more days, use more
frequently, and are more likely to have friends who
use marijuana and to use with others – but are no
more likely to divert MM to others.
Older users rate their health more poorly overall and
have more psychiatric symptoms.
Yet overall few (< 10%) rated their health as
“fair” or “poor”
Over half use MM in place of prescription drugs
Conclusions




There was no indication that individuals
initiated marijuana use by obtaining it from
the dispensaries
Most obtained marijuana from other sources
(in addition to the dispensaries)
Most affiliate with others who also use MM –
although use among younger adults is more
socially embedded
Location/convenience was most often cited
reason for selecting a given dispensary,
although individuals typically went to two or
more dispensaries per month