







































Children and Teenagers 
ISSN 2576-3709 (Print) ISSN 2576-3717 (Online) 

Vol. 6, No. 2, 2023 
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1 
 

Original Paper 

Are Younger Medical Cannabis Users at Risk? Comparing 

Patterns of Use and Mental Health in Younger and Older 

Medical Cannabis Dispensary Users 
Lindsay A. Lo1, Caroline A. MacCallum2,3, Jade C. Yau4, William J. Panenka5,6, & Alasdair M. Barr4,6* 

Running title: Cannabis abuse characteristics 
1 Department of Public Health Sciences, Dalla Lana School of Public Health, University of Toronto ON, 

Canada 
2 Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, 

Canada 
3 Faculty of Pharmaceutical Sciences, UBC, Vancouver, BC, Canada 
4 Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, 2176 

Health Sciences Mall, Vancouver, BC, V6T1Z3 
5 Department of Psychiatry, UBC, Vancouver, BC, Canada  
6 British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, 

Canada 
* Dr. Alasdair M. Barr, Department of Anesthesiology, Pharmacology & Therapeutics, University of 

British Columbia, 2176 Health Sciences Mall, Vancouver, BC, V6T1Z3; British Columbia Mental 

Health and Substance Use Services Research Institute, Vancouver, BC, Canada 

 

Received: February 18, 2023      Accepted: March 5, 2023     Online Published: March 20, 2023 

doi:10.22158/ct.v6n2p1                             URL: http://dx.doi.org/10.22158/ct.v6n2p1 

 

Abstract 

While there has been a considerable amount of research on recreational cannabis use in youth to date, 

much less is known about patterns of medical cannabis use in youth. Adult medical versus recreational 

cannabis users may differ in how they use the product on important factors such as dose, frequency and 

route of ingestion, and so it is important to understand whether adolescents and young adults differ in 

how they use medical cannabis compared to adults, and if this increases risk of impaired mental health. 

In the present study, one hundred members of a community cannabis dispensary who endorsed 

cannabis use for medical purposes were assessed for major psychiatric disorders, and completed 

questionnaires related to stress, depression, sleep and somatic symptoms. Detailed information about 



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cannabis use was collected. In the sample, 35% were aged 19-24 years old, and 24% were aged 25-30 

(categorized as youth/young adults). In comparison to the older medical cannabis users, there were 

unexpectedly few differences, both in mental health status as well as pattern of medical cannabis use. 

These findings contrast with those of recreational cannabis users, and indicate that medical cannabis 

in youth may be as effective and well-tolerated as in older adults. 

Keywords 

cannabis, dispensary, mental health, teenagers, youth 

 

1. Introduction 

Young people often perceive cannabis as harmless (Pacek et al., 2015). This may be even more true for 

individuals using cannabis for medical purposes. However, there is a growing body of research 

associating younger age of cannabis use with a host of issues including worsening anxiety, depression, 

psychosis, social dysfunction, and increased risk of substance misuse (Crean et al., 2011; Gicas et al., 

2020; Gobbi et al., 2019; Jacobson et al., 2019; Nocon et al., 2006; Urbanoski et al., 2005). Although 

much of the literature focuses on adolescents under the age of 19, the world health organization 

categorizes young people as individuals between the ages of 10 and 24 (World Health Organization, 

2011). This encompasses a notable period of young adulthood between the ages of 19 to 24 years of 

age. Accordingly, brain development has been shown to continue until at least 25 years of age (Johnson 

et al., 2009). While a great deal of attention has been given to investigating the impacts of cannabis use 

in adolescents, the literature for young adults is less comprehensive. Furthermore, the majority of 

evidence comes from studies where cannabis was used recreationally, whose subjects tend to have 

different goals and patterns of use from medical cannabis users (Eadie et al., 2021; Lo, MacCallum, 

Yau, & Barr, 2022; Turna et al., 2020). As such, it is not yet clear if cannabis-related risks identified in 

adolescents specifically using medical cannabis persist into young adulthood, or if these risks are even 

present in medical users.  

The endocannabinoid system is an important substrate of brain development (Goldstein Ferber et al., 

2021; Schonhofen et al., 2018). It has been shown to regulate the activity of local neurons and larger 

brain pathways, such as corticolimbic circuitry, impacting the regulation of stress, anxiety and 

depression (Hill et al., 2007; Meyer et al., 2018). Although most neurodevelopment occurs before the 

age of 18, the fine-tuning of neural pathways continues into the mid-'20s (Hurd, 2020). This is 

especially pronounced in the prefrontal cortex (PFC), a brain region crucial for higher cognitive 

function and emotional regulation (Jones & Graff-Radford, 2021). This has led to concerns about the 

impact cannabis may have on mental health. Though the directionality of associations has not yet been 

established, some evidence links earlier cannabis use with anxiety, depression, and bipolar disorder 

(Degenhardt et al., 2003; Gobbi et al., 2019; Lo, MacCallum, Yau, Panenka, et al., 2022; Lowe et al., 

2019; Moore et al., 2007). The strongest evidence regarding risk has been associated with early age of 



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initiation and frequent use of high Δ9-tetrahydrocannabinol (THC) products (Gobbi et al., 2019; 

Murray et al., 2017). The recent rise in popularity medical cannabis, coupled with societal views that it 

is a “safe” alternative, may lead to an underestimated risk of potential harms. Therefore, there is a 

pressing need to evaluate both patterns of use and mental health status in young people using cannabis 

for medical purposes. Furthermore, there is a need to evaluate if patterns of use and associated risks 

differ from older aged groups to inform policy, healthcare practices and possible areas of intervention.  

The aim of this study was therefore to investigate cannabis use patterns and associated mental health in 

young people (aged 19-24) using cannabis with medical intent. The primary research question is 

whether younger cannabis users are at a greater risk for adverse mental health outcomes compared to 

older users. Secondary investigations aimed to assess if cannabis use patterns differ between age groups, 

as these may help explain any potential differences in mental health outcomes. This information could 

be used to help evaluate risks associated with medical cannabis use in young people and provide details 

on where, or if, potential interventions are needed. 

 

2. Method 

2.1 Study Population 

Study ethics were approved by the Behavioural Research Ethics Board of the institutional review board 

(protocol H16-01830). A sample of participants (n = 100) was recruited in 2018 from Evergreen 

Cannabis Society compassion club, a cannabis dispensary in Vancouver, Canada. Participants had a 

membership to the cannabis dispensary and reported using cannabis for medical purposes, however, 

most were not under the direct care of a healthcare provider. Participants were 19 years or older and 

able to give informed consent. The study took approximately four hours to complete per subject and 

consisted of self-report questionnaires and the Mini-International Neuropsychiatric Interview (MINI) 

version 6, conducted by a trained research associate as previously (Alexander et al., 2019; Barr et al., 

2011; Zhou et al., 2019). Participants were provided an honorarium for their time. No subjects were 

excluded, and none withdrew. 

2.2 Measures 

Demographic information was collected including age, gender, ethnicity, and education level. 

Self-reported information on cannabis use patterns were collected, such as preference in chemovar 

(strain), route of consumption, frequency of use, amount of use, and negative experiences of any 

severity associated with cannabis use. Individuals were able to select multiple preferences for each 

measure. Validated self-report questionnaires were used to collect information on well-being and 

mental health. The Perceived Stress Scale 10 (PSS10) was used to rate perceived stress by collecting 

information on life unpredictability, lack of control, and stress overload as rated by participants (Cohen 

et al., 1983). Depressive symptoms and attitudes within the last two weeks were captured using the 

Beck Depression Inventory-II (BDI-II) (Beck et al., 1961). The Patient Health Questionnaire 15 



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(PHQ-15) was used to assess the severity of somatic symptoms (Kroenke et al., 2002). Finally, the 

Patient Reported Outcomes Measurement Information System (PROMIS) sleep disturbance scale was 

used to assess sleep disturbance within the last seven days (Buysse et al., 2010). To determine whether 

participants met criteria for the psychiatric diagnoses of major depressive disorder (MDD), general 

anxiety disorder (GAD), or bipolar disorder (BD, either type I, II, or Not Otherwise Specified (NOS)), 

the MINI version 6 was administered. The MINI is a structured clinical interview for psychiatric 

diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) 

and the International Classification of Diseases, 10th edition (ICD-10) (Sheehan et al., 1998). 

2.3 Data Analysis 

All analyses were completed using the Statistical Package for the Social Sciences (SPSS) software 

version 27 (SPSS Inc., Armonk, USA). The Shapiro-Wilk test of normality was used to check if 

continuous variables were normally distributed. Continuous measures were compared using an 

Analysis of Variance (ANOVA) or Kruskal-Wallace test, if non-parametric. Associations between 

categorical variables were assessed using the Chi-square test of independence or 

Fisher-Freeman-Halton Exact Test, if cell count assumptions were violated. 

 

3. Result  

3.1 Demographics 

The sample consisted of the following age groups; 19-24 (n = 35), 25-30 (n = 24), 31-40 (n = 19), and 

41+ (n = 22). “Young people” were represented in the 19-24 age group, while “young adults” 

encompassed the 19-24 and 25-30 age groups. Fifty nine percent of the sample was under the age of 30. 

The majority of the participants were Caucasian / white (66%) and had at least a college degree (51%). 

3.2 Mental Health Scales 

There were relatively few differences between mental health status among age groups (Table 1). Young 

people (19-24) did not significantly differ from any of the other age groups for PSS-10 scores (F(3, 95) 

= .883, p = .453), BDI-II scores (H(3) = 4.818, p = .186), or PHQ-15 scores (H(3) = 3.813, p = .282). 

Overall, most participants endorsed “moderate” or greater levels of perceived stress via the PSS10 

(62%). The PHQ-15 scale showed 74% of the sample ranked as having minimal or low somatic 

symptoms. Only 17% of the sample had depressive symptomatology ranked worse than “normal” on 

the BDI. Thirty four percent of the sample had a standardized PROMIS sleep disturbance score over 50, 

indicating above-average sleep disturbance.  

 

 

 

 

 



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Table 1. Associations between Age Group and Mental Health Outcomes 

 Age group, n (%) P-value  

 19-24 (n=35) 25-30 (n=24) 31-40 (n=19) 41+ (n=22)  

PSS-10     .453 

Mean 16.77 (SD 5.8) 16.63 (SD 5.7) 13.89 (SD 7) 16.09 (SD 7.8)  

Median 17.00 (IQR = 

12.00 – 21.00) 

15.00 (IQR = 

13.00 – 22.25) 

12.50 (IQR = 

9.50 – 18.50) 

15.50 (IQR = 

9.75 – 21.25)  

 

BDI-II     .186 

Mean 7.4 (SD 6.7) 8.83 (SD 7) 5.32 (SD 6.4) 8.77 (SD 7.6)  

Median 6.00 (IQR = 

2.00 – 9.00) 

6.00 (2.00 – 

9.00) 

3.00 (0 – 9.00) 4.00 (IQR = 

3.00 – 8.00)  

 

PHQ-15     .282 

Mean 6.29 (SD 3.8) 5.71 (SD 3.9) 5.11 (SD 3.5) 7.9 (SD 5.2)  

Median 6.00 (IQR = 

3.00 – 9.00) 

4.50 (IQR = 

3.00 – 7.75) 

4.00 (IQR = 

3.00 – 8.00) 

7.00 (IQR = 

3.00 – 11.25)  

 

PROMIS Sleep 

Disturbance 

    .490 

Mean 46.08 (SD 7.21) 45.84 (SD 9.18) 45.49 (SD 8.09) 46.60 (8.546)  

Median 45.50 (IQR = 

41.40 – 51.20) 

42.90 (IQR = 

39.80 – 54.75) 

45.50 (IQR = 

39.80 – 53.30) 

50.10 (IQR = 

42.52 – 54.80) 

 

Psychiatric diagnoses      

Cannabis dependence 

or abuse 

9 (25.7) 11 (45.8) 6 (31.6) 4 (18.2) .203 

Alcohol dependence or 

abuse  

10 (28.6) 5 (20.8) 5 (26.3) 5 (22.7) .910 

GAD current 6 (17.1) 6 (25.0) 2 (10.5) 2 (9.1) .443 

MDD current 3 (8.6) 0 (0) 0 (0) 0 (0) .286 

MDD past 16 (45.7) 5 (20.8) 6 (31.6) 6 (27.3) .211 

BD current 0 (0) 1 (4.2) 0 (0) 1 (4.5) .420 

BD past 17 (48.6) 10 (41.7) 2 (10.5) 5 (22.7) .020 

Abbreviations: PSS-10 = Perceived Stress Scale 10, BDI-II = Beck Depression Inventory-II, PHQ-15 = 

Patient Health Questionnaire 15, PROMIS sleep = Patient Reported Outcomes Measurement 

Information System sleep disturbance scale, GAD = Generalized anxiety disorder, MDD = Major 

depressive disorder, BD = Bipolar disorder 

 
 



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Age group and psychiatric diagnoses were not significantly associated with any of the investigated 

conditions, except for meeting criteria for a prior diagnosis of bipolar disorder (type I, II, or NOS), X2 

(3, N=100) = 9.852, p = .02. The age groups under 30 had a significantly higher incidence of a lifetime 

diagnosis compared to the over 30 age groups. 

3.3 Patterns of Use 

Several differences were found between age groups and conditions used for, but general patterns of 

cannabis use remained similar across age groups (Table 2). There was a significant relationship 

between age and use for depression (X2 (3, N=100) = 3.427, p = .036), with the under 30 age groups 

reporting most frequent use (19-24 = 54.5%, 25-30 = 62.5%). Young people also reported significantly 

more use for sleep issues (71.4%) than any other age group, X2 (3, N=100) = 9.221, p = .026. The 

proportion of subjects who reported use for anxiety did not significantly differ between age groups X2 

(3, N=100) = 3.427, p = .330, but was the highest reported condition for cannabis use among all age 

groups. 

The 19-24 age group was not found to significantly differ in preference for almost all other use pattern 

variables. The two exceptions were having less preference for tinctures (Fisher- Freeman-Halton Exact 

Test, p = .035), compared to the over 30 age groups, and more preference for high CBD low THC 

chemovars compared to the 31-40 age group (X2 (3, N=100) = 7.330, p = .033). Young people were not 

more likely to prefer high or pure THC chemovars than other age groups (X2 (3, N=100) = 1.961, p 

= .581).  

 

Table 2. Cannabis Use Patterns across Age Groups 

 Age group, n (%) P-value 

 19-24 

(n=35) 

25-30 

(n=24) 

31-40 (n=19) 41+ (n=22)  

Condition using for       

Anxiety/ Stress 28 (80) 21(87.5) 13 (68.4) 15 (68.2) .330 

Depression  19 (54.3) 15 (62.5) 4 (21.1) 9 (40.9) .036 

Sleep Issues  25 (71.4) 13 (54.2) 7 (13.3) 8 (15.1) .026 

Amount     .958 

1g or less 13 (37.1) 7 (29.2) 6 (31.6) 6 (27.3)  

3.5g 14 (40.0) 11 (45.8) 6 (31.6) 8 (36.4)  

7g or more 8 (22.9) 6 (25.0) 7 (36.9) 8 (36.4)  

Frequency of use     .533 

Non-daily 10 (28.6) 9 (37.5) 5 (26.3) 6 (27.3)  

1x/day 11 (31.4) 5 (20.8) 2 (10.5) 7 (31.8)  

≥ 2x/day 14 (40.0) 10 (41.7) 12 (63.2) 9 (40.9)  



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Preferred Consumption forms      

Smoking 27 (77.1) 19 (79.2) 13 (68.4) 12 (54.5) .224 

Vaporization 13 (37.1) 9 (37.5) 9 (47.4) 11 (50.0) .719 

Edibles 8 (22.9) 5 (20.8) 2 (10.5) 5 (22.7) .753 

Tinctures 3 (8.6) 1 (4.2) 4 (21.1) 7 (31.8) .035 

Capsules 6 (17.1) 2 (8.3) 5 (26.3) 4 (18.2) .476 

Only prefer smoking 14 (40) 10 (41.7) 6 (31.6) 4 (18.2) .297 

Preferred Chemovar      

Pure THC 9 (25.7) 2 (8.3) 4 (21.1) 5 (22.7) .385 

High THC low CBD 12 (34.3) 9 (37.5) 8 (42.1) 7 (31.8) .913 

Equal THC and CBD 10 (28.6) 7 (29.2) 9 (47.4) 9 (40.9) .468 

Pure CBD 8 (22.9) 3 (12.5) 2 (10.5) 5 (27.8) .598 

High CBD low THC 10 (28.6) 7 (29.2) 0 (0) 4 (18.2) .033 

Prefer pure or high THC only 10 (28.6) 8 (33.3) 9 (47.4) 8 (36.4) .581 

Prefer pure or high CBD only 7 (20) 3 (12.5) 1 (5.3) 2 (9.1) .494 

Negative adverse events      

Experienced negative adverse events 22 (62.9) 15 (62.5) 9 (47.4) 8 (38.1) .233 

 
4. Discussion 

Currently, there is a lack of literature available on the patterns of medical cannabis use in young 

adulthood, compared to adolescents. The current study aimed to assess mental health status and 

patterns of use in young people using medical cannabis, and to compare these findings to older age 

groups. The conditions medical cannabis was reported as being used for differed between age groups, 

with the young adult age groups reporting greater use for depression and sleep issues. Interestingly, 

however, young people did not appear to have worse scores on validated scales or a greater occurrence 

of psychiatric diagnoses (Table 1). The one exception to this was a greater amount of past BD 

diagnoses in the under 30 age groups. Further, young people had use patterns similar to older age 

groups (Table 2). In all, there were relatively few differences between age groups for most measures of 

mental health and patterns of use.  

The lack of difference between age groups on indicators of mental health and psychiatric diagnoses is a 

reassuring, but a somewhat unexpected finding. The literature from recreational studies has shown that 

frequent cannabis use, as would be seen in this sample, may be associated with increased risk of 

depression (Degenhardt et al., 2003; Moore et al., 2007). Further, earlier age of regular use has been 

associated with elevated risk for poor mental health outcomes and substance dependence (Degenhardt 

et al., 2003; Eadie et al., 2021; Gicas et al., 2020; Gobbi et al., 2019; MacCallum, Eadie, et al., 2021; 

McGee et al., 2000). Sleep disturbance has also been found to moderate a relationship between 



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depressive symptoms and problematic cannabis use, in addition to being associated with stress and 

higher levels of anxiety in young adults (Babson et al., 2017; Manzar et al., 2021). Some evidence 

suggests there may also be an association between earlier cannabis use and worsening BD symptoms 

(Bally et al., 2014). Even though a greater proportion of young people self-reported using cannabis for 

depression and sleep issues, outcomes from the validated scales and assessment measures showed no 

significant differences. As such, it appears younger individuals were not at a greater risk for adverse 

mental health outcomes. Most of the sample had Beck Depression Inventory and PROMIS sleep 

disturbance scale scores within normal ranges. Furthermore, there was low incidence of current MDD 

and BD, including in young people. This is a promising finding, as it suggests that young people over 

the age of 19 may not face the same risks that were found for adolescent users below the age of 19. 

Additionally, this may also reflect a difference in intent of use, compared to recreational-use 

populations, such that use patterns are unlikely to invoke adverse mental health outcomes. One related 

finding of interest was that, although there were very low rates of current BD, there was a significantly 

higher proportion of past BD diagnoses in the under 30 age groups. This may indicate that young 

people are seeking out medical cannabis to help control symptoms. A similar trend was seen for MDD, 

although it was consistent across age groups. While these findings should not be inferred as causal, this 

may indicate that medical cannabis was helpful in improving symptoms. Overall, our findings suggest 

that young people using medical cannabis (age 19-24) are not at a greater risk of adverse mental health 

outcomes compared to older adults. 

The similarity of cannabis use patterns across age groups was also an unexpected finding. Older adults 

have been reported to perceive cannabis as having a greater risk of harm compared to young people 

(Okaneku et al., 2015; Pacek et al., 2015). Accordingly, we expected there to be differences in how 

cannabis was being used between the younger and older age groups. The similarity observed may 

partly explain why there were minimal differences for mental health outcomes. Many cannabis-related 

harms are THC dose dependent (MacCallum, Lo, et al., 2021). As such, differences in factors, such as 

chemovar and frequency, impact risk of harm. Hence, those with similar patterns of use may have 

similar risks. In contrast to our study, (Haug et al., 2017) found that younger users reported a higher 

quantity of use, and older users reported more preference for oral formulations. Differences may be due 

to different age groupings, as (Haug et al., 2017) used categories of 18-30, 31-50, and 51-74. Their 

larger sample size (n = 217) also contained more individuals in older age categories, which may have 

increased statistical power to detect subtle differences. Despite these contrasting findings, one notable 

similarity was the common preference for smoked cannabis. Smoking cannabis is a known respiratory 

harm (Hoffmann & Weber, 2010; National Academies of Sciences et al., 2017; Tashkin, 2014). This is a 

particular concern for young people and young adults who may continue to smoke throughout their 

lifetime. Our findings support the need for a greater emphasis on education and diversion away from 

smoking cannabis.  



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Finally, although not significantly different across age groups, this sample showed high rates of current 

problematic cannabis (30%) and alcohol (25%) use. This is particularly concerning for the younger age 

groups. It should be noted that currently available measures for cannabis misuse have not been 

validated for medical cannabis populations. Nevertheless, consideration is still warranted. This finding 

is consistent with previous studies suggesting an elevated risk for co-use of cannabis and alcohol 

(Metrik et al., 2018; Yurasek et al., 2017). This also may imply that increased vigilance for problematic 

cannabis use and co-use with alcohol is needed. One important distinction within this sample, however, 

is that although participants reported use for medical purposes, most were not government-authorized 

medical cannabis users. As such, findings from this study are more relevant to self-guided medical 

cannabis users, obtaining cannabis from a dispensary, than authorized cannabis users under the care of 

a healthcare professional. 

 

5. Limitations 

Generalization to broader populations may be limited as the sample was obtained from an affluent 

neighbourhood and generally had higher levels of education. Additionally, although sample participants 

reported use for medical purposes, few had guidance from a healthcare professional as authorized 

medical cannabis patients do. Therefore, generalizations between this population and government 

authorized medical cannabis patients under the care of a healthcare professional should be made with 

caution. Finally, the present assessments, while comprehensive, did not address all areas of mental 

health—such as pain, where both preclinical and clinical evidence for benefits of cannabis have been 

reported (Duarte et al., 2021; Legare et al., 2022; MacCallum, Eadie et al., 2021; Rouhollahi et al., 

2020; Ware et al., 2015). 

 

6. Conclusion 

This investigation of patterns of use and mental health outcomes in a sample of cannabis dispensary 

users revealed that young people and adults did not have significantly different patterns of use. More 

importantly, it does not appear that young people had an elevated incidence of adverse mental health 

outcomes. This serves as a starting point to better evaluate differences in use and risk factors between 

younger and older medical cannabis users. Further, it illustrates potential differences between those 

using with a recreational vs. medical intent. Despite this, more research is needed to provide stronger 

evidence and guidance for potential risk factors for adverse mental health outcomes, particularly in 

younger age groups. In the future, larger sample sizes would better help clarify associations between 

age groups, use patterns, and mental health outcomes. Additionally, comparisons between 

self-medicating cannabis users and medical cannabis patients authorized by a licensed healthcare 

professional should be investigated. 

 



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Acknowledgement 

Funding support by the Canadian Centre on Substance Abuse. 

 

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