{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:41:39Z","timestamp":1787064099030,"version":"build-2736575974"},"reference-count":24,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2024,4,2]],"date-time":"2024-04-02T00:00:00Z","timestamp":1712016000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Cannabis &amp; Cannabinoid Research"],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Florida\u2019s medical cannabis (marijuana) program is among the largest in the United States. Smokable cannabis forms were not legally available in this program until 2019, and five years after other forms of cannabis were available. This study assessed changes in \u0394-9 tetrahydrocannabinol (THC) dispensed per patient following legalization of smokable cannabis in Florida.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>This quasi-experimental study used data from the Florida Department of Health Office of Medical Marijuana Use Reports on THC dispensing from April 6, 2018, through March 13, 2020. Certified medical cannabis user during the study period was included. The exposure was the dispensed amount of THC from legalized smokable forms of medical cannabis (statute identified as SB182), effective as of March 2019. Changes in level and trend of average milligram (mg) of dispensed THC per certified patient with 95% confidence intervals (CIs), before and after SB182, were calculated by fitting a generalized least squares linear model and allowing a 17-week phase-in period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The number of certified patients increased by 24.8% from 197,107 (March 22, 2019) to 246,079 (July 19, 2019) and to 325,868 by March 13, 2020. Assuming that a 20% THC concentration in smokable products, there was a significant level increase in the mean weekly dispensed THC amount per certified patient of 138.45 mg (95% CI: 102.69\u2013174.20), translating to a 42.18% increase (95% CI: 33.14\u201350.28), from the pre-policy period. We noted a continuous increase of 5.62 mg per certified patient per week (95% CI: 4.35\u20136.89) throughout the 35 weeks following the policy, when compared with the period before. Assuming 10% THC concentration in smokable products, we observed a significant level increase of 35.10 mg (95% CI: 5.31\u201364.88), corresponding to an increase of 10.70% (95% CI: 1.70\u201318.89), and a trend increase of 2.23 mg per certified patient per week (95% CI: 1.18\u20133.29).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>The expansion of the Florida medical cannabis program to include smokable cannabis forms was associated with a significant increase in the mean amount of weekly dispensed THC per certified patient. Findings suggest that the dispensed amount of THC after legalization of smokable medical cannabis far exceeds the maximum recommended daily dose, based on extrapolation from oral cannabis product dosing recommendations from one expert consensus statement, raising questions about the safety, and need for consumer education.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/can.2024.0073","type":"journal-article","created":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T21:30:36Z","timestamp":1728336636000},"page":"207-212","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Legalization of Smokable Medical Cannabis and Changes in the Dispensed Amount of \u0394-9 Tetrahydrocannabinol Per Patient"],"prefix":"10.1177","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1244-1423","authenticated-orcid":false,"given":"Sebastian","family":"Jugl","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA."},{"name":"Center for Drug Evaluation &amp; Safety (CoDES), Gainesville, Florida, USA."},{"name":"Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1101-3603","authenticated-orcid":false,"given":"Ruba","family":"Sajdeya","sequence":"additional","affiliation":[{"name":"Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA."},{"name":"Department of Epidemiology, University of Florida, Gainesville, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Buhlmann","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics Shared Resource, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7770-3754","authenticated-orcid":false,"given":"Robert L.","family":"Cook","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Florida, Gainesville, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua D.","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA."},{"name":"Center for Drug Evaluation &amp; Safety (CoDES), Gainesville, Florida, USA."},{"name":"Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Almut G.","family":"Winterstein","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA."},{"name":"Center for Drug Evaluation &amp; Safety (CoDES), Gainesville, Florida, USA."},{"name":"Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA."},{"name":"Department of Epidemiology, University of Florida, Gainesville, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0020-8720","authenticated-orcid":false,"given":"Amie J.","family":"Goodin","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA."},{"name":"Center for Drug Evaluation &amp; Safety (CoDES), Gainesville, Florida, USA."},{"name":"Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,4,2]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2018.01.016"},{"key":"e_1_3_5_3_2","article-title":"Young adult medical cannabis patients in Florida: Gender differences in characteristics of use, experiences at dispensaries, and association with health-related problems","author":"Lorenzo E","year":"2023","unstructured":"Lorenzo E, , McClean C, , Ford JA. Young adult medical cannabis patients in Florida: Gender differences in characteristics of use, experiences at dispensaries, and association with health-related problems. J Drug Issues, 2023; doi: 10.1177\/00220426231189486","journal-title":"J Drug Issues"},{"key":"e_1_3_5_4_2","unstructured":"National Conference of State Legislatures. State Medical Cannabis Laws. n.d. Available from: https:\/\/www.ncsl.org\/health\/state-medical-cannabis-laws [Last accessed: Feburary25 2024]."},{"key":"e_1_3_5_5_2","unstructured":"Florida Department of Health Office of Medical Marijuana Use. Weekly highlights 2024\u2014office of medical Marijuana use updates. 2024. Available from: https:\/\/knowthefactsmmj.com\/2024\/01\/05\/2024-ommu-updates\/ [Last accessed: Feburary25 2024]."},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.7326\/M22-0217"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-200342040-00003"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.1980.181"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-7643-9923-8_29"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/psyp.13955"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1159\/000526731"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1089\/can.2020.0003"},{"key":"e_1_3_5_13_2","unstructured":"Florida Department of Health Office of Medical Marijuana Use. Weekly updates\u2014office of medical marijuana use. 2018. Available from: https:\/\/knowthefactsmmj.com\/about\/weekly-updates\/ [Last accessed: Feburary25 2024]."},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0230167"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/s42238-021-00073-1"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2008.03329.x"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11916-015-0524-x"},{"key":"e_1_3_5_18_2","unstructured":"U.S. Food and Drug Administration. Label for Marinol (dronabinol). 2017. Available from: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2017\/018651s029lbl.pdf [Last accessed: August21 2024]."},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-021-00247-4"},{"key":"e_1_3_5_20_2","volume-title":"The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research","year":"2017","unstructured":"National academies of sciences, medicine division, board on population health, public health practice, committee on the health effects of marijuana, an evidence review, research agenda. In: The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. National Academies Press: Washington (DC); 2017."},{"key":"e_1_3_5_21_2","unstructured":"Florida Department of Health Office of Medical Marijuana Use. Patients information\u2014office of medical marijuana use updates. 2024. Available from: https:\/\/knowthefactsmmj.com\/patients\/#steps-to-treatment [Last accessed: April29 2024]."},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2011-200375"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000899"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1159\/000512342"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-021-01235-8"}],"container-title":["Cannabis &amp; Cannabinoid Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/can.2024.0073","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/can.2024.0073","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/can.2024.0073","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T14:13:52Z","timestamp":1777385632000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/can.2024.0073"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,2]]},"references-count":24,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,4,1]]}},"alternative-id":["10.1089\/can.2024.0073"],"URL":"https:\/\/doi.org\/10.1089\/can.2024.0073","relation":{},"ISSN":["2578-5125","2378-8763"],"issn-type":[{"value":"2578-5125","type":"print"},{"value":"2378-8763","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,2]]}}}