Race and income affect access to medicinal cannabis, finds US study

Black and African American cancer patients, as well as those on lower incomes, were less likely to get medical certification for cannabis to manage their symptoms.

Cannabis use is an increasingly frequent alternative for patients trying to manage the pain, anxiety and sleep disruption that can accompany a cancer diagnosis and its subsequent treatment.

However, to date very little research has been conducted that explores who has access to cannabis and what barriers might exist.

This study, funded by the National Cancer Institute (NCI), examines how non-medical factors, such as where people are born, live and work, along with the various social forces that shape daily life, come into play. 

The findings published in the journal Cannabis suggest race and income are both associated with determining which patients have access to cannabis, where they get it from and in what form.

Rebecca Ashare, PhD, associate professor of psychology in the UB College of Arts and Sciences, and the study’s first author, said in a press release: “This is sadly yet another way in which systemic factors like racism and inequitable distribution of income impacts whether patients have the same access for managing cancer-related symptoms,”

“Given racial disparities in both cancer pain management and symptom burden suggested in previous research, it will be essential to identify possible barriers to access if we’re to avoid widening these already existing health disparities in cancer care.”

Race and those on lower income less likely to get legal access to cannabis

For the research, Ashare and Salimah Meghani, PhD, a professor in the University of Pennsylvania School of Nursing, co-led an anonymous survey, for five months in 2021, of cancer patients over the age of 18 at a large NCI designated cancer centre in Pennsylvania. 

In 2016, the state made medical cannabis available to its residents with a cancer diagnosis or other approved ‘serious medical condition’.

Although nearly 43% of the study’s randomly selected 352 participants received medical certification for cannabis, those who identified as Black/African American were significantly less likely to be certified compared to the group’s white participants. 

They were also more likely to report using cannabis in forms associated with adverse health outcomes, like varieties intended to be smoked or vaporised.

“We don’t know why patients who identified as Black/African American were less likely to be certified, but it’s possible that the sense of untrustworthiness in health care created by structural racism makes it less likely for these patients to be willing to participate in a state-wide registry,” says Ashare, who at the time of the research was a faculty member in the Department of Psychiatry at the Perelman School of Medicine at the University of Pennsylvania.

“But without that certification, it’s possible that patients are turning to unlicensed sellers for cannabis that are less likely to sell products with lower-risk profiles, such as edible formulations.

“Lower income patients were also likely to rely on these sources, using a product that is likely more harmful, not only because of its form, but due to the absence of any regulation or monitoring.”

Research on cannabis lags behind

Ashare stresses, however, that what’s important is that these findings, or any potential explanations, go well beyond the arena of personal choices.

“This is not about choice; this is not about blaming patients; this is not about telling people to stop smoking cannabis,” she says.

“This is about highlighting systemic factors that make it difficult − if not impossible − for the people who may need it the most to have access to safer options to manage their cancer-related symptoms.

“This is another example of the same cascading systemic factors surfacing with cannabis access that we know are already creating health care disparities more broadly.”

Understanding the benefits and harms of cannabis use is critical as the research catches up, Ashare adds: “The research is far behind the ways in which patients are using cannabis. And though our study was done in one particular state, there is some emerging evidence that the rates of use were consistent across the country.”

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