06 Sep In States With Medical Marijuana Laws, Marijuana Use Highest Among Bisexual Women
MedicalResearch.com Interview with:
Morgan Philbin, PhD MHS
Department of Sociomedical Sciences
Columbia University School of Public Health
MedicalResearch.com: What is the background for this study?
Response: Marijuana is the most frequently used substance in the United States (US) after alcohol and tobacco. In 2017, 15.3% of the US population ages 18 and up reported past-year marijuana use (MU) and 9.9% past month use. Individuals who identify as lesbian, gay, or bisexual (LGB), also report higher levels of marijuana use and marijuana use disorder than their heterosexual counterparts. Researchers have begun to explore potentially modifiable factors, such as state-level marijuana policies, that affect marijuana use and related outcomes at the population-level and within subgroups—though as of yet not among sexual minority populations.
We therefore examined whether LGB individuals living in states with medical marijuana laws (MMLs) have higher levels of marijuana use and marijuana use disorder compared to LGB individuals in states without MMLs.
MedicalResearch.com: What are the main findings?
Response: This study used data from 126,463 adults 18 and older in the 2015-2017 National Survey on Drug Use and Health and found significant differences in marijuana use outcomes by sexual identity, particularly among LGB individuals. Past-year marijuana use was 10% among heterosexual women, 26% among gay/lesbian women and 40% among bisexual women. Daily marijuana use was seven times higher among bisexual women (10%) compared to heterosexual women (1.5%), and nearly twice as high compared to lesbians (6%). Past-year marijuana use for medical reasons was reported by 1% of heterosexual women, 5% of lesbian/gay women and 5.5% of bisexual women.
There were also differences in marijuana use outcomes by state medical marijuana law status. Lesbian women in MML states had higher daily marijuana use (6.5% versus 4%) compared to those in non-MML states. They also reported twice as much marijuana use for medical reasons (3% versus 1.5%) than gay/lesbian women in states without MMLs. Bisexual women in MML states reported higher past-year marijuana use (46% versus 34%), and more than double medical marijuana use (7% versus 3%) than bisexual women in non-MML states.
The difference in policy effects of medical marijuana laws for bisexual women compared to heterosexual women may be a result of the high levels of stigma faced by bisexual women. While not examined in this study, higher marijuana use could lead to self-medication with medical marijuana even in states without MMLs if LGB adults are in part using marijuana to alleviate sexual minority stress.
MedicalResearch.com: What should readers take away from your report?
Response: This study represents an important contribution to the literature on the structural determinants of substance use for LGB individuals, by demonstrating that lesbian and bisexual women living in MML states have higher levels of marijuana use than those in non- medical marijuana law states. This study builds on previous work that has demonstrated that policies might ‘spill over’ or have different effects on already marginalized groups. Specifically, our results suggest that MMLs may differentially impact marijuana use for LGB individuals—particularly bisexual women. As MMLs and recreational marijuana laws continue to change at the state level, it is increasingly important to understand the relationship between these laws and marijuana outcomes for LGB individuals. This highlights the need for policy makers in states that are enacting medical marijuana laws to consider how the passage of these policies may have potential differential impacts on LGB populations, ultimately promoting the development of more health-promoting policies for all.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: While we knew whether somebody lived in an medical marijuana law state, due to data limitations we were unable to discern the exact state in which they live. Future research should therefore explore this same relationship with state-level identifiers so the model can control for state-specific factors (e.g., attitudes toward LGB individuals) and other state-level policies that might influence this relationship. In addition, now that we know this association between MMLs and marijuana use outcomes differ among LGB populations, future work should explore the potential pathways that might explain these differences (e.g., perceived availability and knowledge). Future work could also explore whether this relationship changes based on how sexual orientation is determined: for this study we used identity, but research could also use attraction or behavior. Next steps could also include exploring this relationship with recreation marijuana laws and marijuana use among LGB individuals to see if the same patterns emerge. Lastly, future research should examine whether LBG individuals’ use of other substances may vary by residence in medical marijuana law states (e.g., opioid use and stimulant use), and whether these findings vary by gender and age.
This research was funded by the National Institutes on Drug Abuse
Morgan M Philbin, Pia M Mauro, Emily R Greene, Silvia S Martins. State-level marijuana policies and marijuana use and marijuana use disorder among a nationally representative sample of adults in the United States, 2015-2017: Sexual identity and gender matter. Drug and Alcohol Dependence, 2019; 204: 107506 DOI: 10.1016/j.drugalcdep.2019.06.009
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