27 Apr Declines and pronounced state-level disparities in tetrahydrocannabinol (THC) prescribing to Medicare patients

Dr. Edward Liu

MedicalResearch.com Interview with:
Edward Liu, MD
Geisinger College of Health Sciences
Scranton, PA 18509

Medicalresearch.com: What is the background for this study?

Response: Prescription drugs have high levels of uniformity that plant-based products cannot achieve.  Given the liberalization of state-laws regarding medical marijuana¹ over the past three-decades and increasing evidence of evidence of cannabis for conditions like chronic pain,² we were interested in the use of the prescription formulation of delta(Δ)9-tetrahydrocannabinol (THC).  A prior pharmacoepidemiology report found that prescription THC (dronabinol) to Medicaid patients decreased from 2016 to 2020. There were also pronounced state-level disparities in prescribing with a 130-fold difference when correcting for population between the highest and lowest states.

There was no research on this topic among Medicare patients. To address this gap, we obtained prescription numbers nationally and at a state level from 2014 to 2019 for Medicare Part D patients.

Medicalresearch.com: What did you find?

Response: The total number of dronabinol prescriptions decreased (-9.1%) from 2014 to 2019. There was an eightfold state-level variation in prescribing in 2019 and a fivefold variation in 2014. Perhaps more importantly though was how uncommon dronabinol was ever prescribed. Across the US, there were only 3,267 prescriptions in 2014 and 2,969 in 2019. The number of unique patients receiving dronabinol could be much smaller as one person could receive twelve 30-day prescriptions in a single-year.  Primary care was responsible for over half of dronabinol use. Dronabinol prescriptions did not differ between states that did versus did not have a medical marijuana program.

Medicalresearch.com: What should readers take away from this report?

Response: Although dronabinol is US Food and Drug Administration approved for treatment of both chemotherapy-associated nausea and vomiting unresponsive to conventional anti-emetics and acquired immunodeficiency syndrome (AIDS)-associated anorexia, its use is rare among Medicare patients. Together, these findings raise the possibility that dronabinol is more used in research² than in medical practice.

Citation:

DeSalve D, Liu E, et al. Geographical disparities and medical specialty differences in dronabinol prescribing in Medicare. Guthrie Clinic Medical Journal 2026; 78(1): https://utppublishing.com/doi/10.3138/guthrie-2025-0006

References

1. Stains EL, Kennalley AL, Tian M, Boehnke KF, Kraus CK, Piper BJ. Medical cannabis in the United States: comparing 2017 and 2024 state qualifying conditions to the 2017 National Academies of Sciences Report. Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 2025; 9(2):100590.
2. National Academies of Sciences, Medicine, Medicine Division, Board on Population Health, Public Health Practice, Committee on the Health Effects of Marijuana, An Evidence Review, Research Agenda. The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research.
3. Liu EY, McCall KL, Piper BJ. Pronounced state-level disparities in prescription of cannabinoids to Medicaid patients. Medical Cannabis and Cannabinoids. 2023;6(1):58-65.

Last Updated on April 27, 2026 by Marie Benz MD FAAD