(218) Estimation of Daily Delta-9-Tetrahydrocannabinol Doses Among Participants in Florida's Medical Marijuana Use Registry: A Study on Trends and Patterns in Medical Cannabis Utilization

Background: Medicinal cannabis (MC) utilization is increasing, yet evidence for its use is scarce. Real-world evidence can address this gap, though challenges, such as incomplete information for doses of active agents (e.g., delta-9-tetrahydrocannabinol (THC)) exist. Florida's Medical Marijuana Use Registry (FMMUR) collects statewide patient dispensing data, yet its granularity of dosing data has not been investigated.

Objectives: To estimate and describe THC daily doses per order (DDO) in FMMUR by time, patient characteristics and administration route.

Methods: We used FMMUR data (2018/01-2022/06) covering patient demographics, qualifying conditions (QC), and MC dispensing data.
Dispensing records were categorized by route (e.g., oral vs. inhaled). For each order we divided the THC amount dispensed by days of supply (DOS) to calculate DDO in mg. Dispensed THC amount in orals was directly available, while in smokables, it was standardized to 25%. DOS were estimated through days between dispenses or from last dispensing date to order end date.
We stratified DDO by age groups and QC, focusing on orders with a single QC. Median and interquartile ranges (IQR) of DDO were calculated.
To explore trends, we analyzed DDO within the first 6 months of available data (2018/01-2018/06 for oral products, 2019/7-2019/12 for inhalable) and the last 6 months (2022/1-2022/6).

Results: We identified 993,387 qualified MC patients, totaling 4,235,290 oral and 13,244,438 inhalable MC orders.
Oral median DDO decreased from 27.4 mg (IQR: 12.8-60.7 mg) in early 2018 to 13.4 (IQR: 5.6-31.6) in early 2022. The highest median DDO was observed in patients aged 0-17 years (17.8, IQR: 7.9-39.3) and the lowest in those >74 years (14.3, IQR: 7.0-29.3). Chronic nonmalignant pain (CNP) and Parkinson’s disease had the highest (21.9, IQR: 10.4-47.9) and lowest (14.3, IQR: 6.8-29.6) median DDO respectively.
Inhalable median DDO increased from 117.6 mg (IQR: 51.2-235.8 mg) in late 2019 to 212.1 (IQR: 100.2-362.8) in early 2022. Patients aged 18-24 years had the highest median DDO (221.5, IQR: 109.4-372.0), with the lowest in those < 18 years (51.9, IQR: 21.7-112.0). Post-traumatic stress disorder (PTSD) patients had the highest median DDO (208.8, IQR: 100.3-354.4), with CNP the lowest (87.5, IQR: 36.5-188.7).

Conclusions: Utilizing a novel registry, we estimated THC DDO in Florida's MC patients, observing a decrease in oral and increase in inhalable DDO. Adolescents recorded the highest oral, and young adults the highest inhalable DDO. Results indicate a discordance between real-world and clinical trial doses, especially for inhalable MC among PTSD patients. Limitations such as estimating DOS need to be considered. Further research is needed to investigate these differences and their clinical implications.