Proximal Antecedents and Subjective Effects of Cannabis Use and their Relation to Cannabis Use Disorder: An Ecological Momentary Assessment of Medical Cannabis Users

With the growing popularity of medical cannabis, and high rates of cannabis use disorder (CUD) among medical cannabis users, it is more important than ever to accurately identify the proximal antecedents and subjective effects of medical cannabis use. Subjective antecedents and effects have been proposed as key mechanisms underlying the transition from cannabis use to CUD, but little research has examined medical cannabis users’ experiences in real-time, real-world settings. The current study of 86 young-adult medical cannabis users ages 18-30 (32.6% female) used ecological momentary assessment (EMA) to characterize the antecedents and effects of medical cannabis use, and to examine whether these antecedents and effects vary as a function of CUD severity. Higher craving, pain, and withdrawal symptoms predicted greater odds of cannabis use at the next report, and lower subjective ‘high’ predicted greater odds of cannabis use at the next report. Use of medical cannabis was associated with increases in positive affect, stimulation, relaxation, and subjective ‘high’, decreases in negative affect, withdrawal symptoms, craving, and pain, and increases in cognitive problems, psychotic-like experiences, and adverse bodily effects. Further, following cannabis use, medical users with more CUD symptoms reported greater relief from craving, attenuated increases in stimulation and relaxation, and enhanced increases in sluggishness, cognitive problems, psychotic-like symptoms, and bodily symptoms. Results suggest that medical cannabis use, like recreational use, is associated with a wide range of subjective antecedents and effects, and that relief from cannabis craving may play an important role in the maintenance of CUD among medical users.