(222) Medically-attended cannabis-related disorders among U.S. Medicare beneficiaries, 2017–2022

Background: An increasing number of US states and territories have enacted laws allowing medical and both medical and adult use of marijuana (cannabis).

Objectives: To describe trends in medical encounters with cannabis-related disorders among US Medicare beneficiaries during 2017–2022, by Medicare population and state/territory legal status.

Methods: We used Medicare enrollment records, Fee-for-Service (FFS) claims, and Advantage (MA) encounter data, yearly from 2017 to 2022, to conduct a descriptive study among beneficiaries aged 18-64 years with disability ( < 65 years) or aged ≥65 years continuously enrolled in FFS (Parts A, B) or MA (Parts A, B, C) for ≥183 days prior to the first day of the calendar year and through the full calendar year or death. We excluded long-term nursing home residents and those on dialysis. We identified healthcare encounters with cannabis-related disorders using ICD-10-CM diagnosis codes (F12x). We defined state/territory cannabis legalization status (illegal, medical, recreational and medical) as the status established by law at the beginning of each calendar year in the beneficiaries’ state of residence. We computed annual encounter rates per 10,000 beneficiaries with 95% CI, estimated the average annual change in rates, and assessed statistical significance using Mann-Kendall tests, by Medicare population and cannabis legal status.

Results: The study included 10,247,953 beneficiaries < 65 years and 56,624,432 aged ≥65 years. From 2017 to 2022, annual encounter rates for cannabis-related disorders per 10,000 among beneficiaries < 65 years increased from 274.8 (95% CI, 273.6, 276.0) to 373.7 (95% CI, 372.3, 375.2) and from 15.9 (95% CI, 15.8, 16.0) to 39.3 (95% CI, 39.1, 39.5) among beneficiaries aged ≥65 years. The average annual increase in rates was 17.1 (95% CI, 11.0, 23.2; p-value: 0.02) in beneficiaries < 65 years and 4.3 (95% CI, 3.3-5.3; p-value: 0.01) in those aged ≥65 years. In 2022, in both those aged < 65 and ≥65 years, respectively, rates were greatest in states/territories with recreational and medical use legalization [413.6 (95% CI: 411.0, 416.1); 45.4 (95% CI, 45.1, 45.7)], followed by those with medical use legalization [402.1 (95% CI: 399.4, 404.8); 41.5 (95% CI: 41.2, 41.8)], and with states/territories where cannabis use was illegal having the lowest rates [307.3 (95% CI: 304.8, 309.9); 27.7 (95% CI, 27.4, 28.0)].

Conclusions: We observed increasing trends in encounters with cannabis-related disorders among Medicare beneficiaries during 2017–2022. Although subject to limitations, data suggest that the observed rates are associated with state cannabis legalization status.

Disclaimer: The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement, by FDA, CMS, or the US Government.