Supplementary Table 1. Responses to “What do you like most about medical cannabis?” (N = 2,475) were analyzed with QSR NVivo10. Categories are in bold followed by subcategories. Number of responses is in parentheses and sample responses are listed. ______1– health benefits (892) a – pain relief/inflammation/tension (333) “The serious reduction of pain.” “Takes edge off when in pain.” “Makes pain tolerable.” “I can get relief from my pain.” “I like that it subsides my pain.” “Incredible pain relief” b – sleep/insomnia/nightmares (154) “I am able to sleep much better.” “Getting a good night’s sleep.” “It helps me sleep without crazy dreams.” c – anxiety/calm nerves/hypervigilance/panic attacks/fear (70) “It makes me less anxious.” “Help with the day to day anxiety.” “I can curb a panic attack.” d – many ailments/conditions/symptoms/issues/only one substance (63) “It helps so much with my medical issues” “The fact that it covers so many medical problems” “Relieves the current conditions” “It works for almost every ailment I have.” e – vomit/nausea/stomach/gut/constipation/Chrohns (39) “It effectively treats my nausea/vomiting” “Takes away break through intestinal pain, calms my stomach” “My Chrohn’s is in remission” f – eat/appetite/increase metabolism/weight gain (36) “Gaining back my appetite” “Weight gain” “To enjoy eating” g – improve mood/calm emotions/emotional mental symptoms/mood swings/psychoactive effects/mood stable (30) “Improves my mood” “The temporary uplift in mood.” “It is the only thing that works on intense emotions.” h – depression/suicide (25) “Eases depression” “That I am no longer suicidal.” “Makes depression more manageable.” i – PTSD/flashbacks/trauma (22) “Unparalleled relief from PTSD symptoms” “It puts a little maneuvering room between me and my PTSD.” “Eases my PTSD symptoms.” j – migraines/headaches (21) “I can control my debilitating daily migraines.” “It is a great relief from headaches.” “It’s the only thing I’ve found to prevent migraines.” k – other symptoms (18) “The way it has affected my M.S.” “It has help tremendously with my hotflashes.” “Can breathe easier” l – spasms (muscles)/relax muscles joints/restless legs/strain in back/muscular dystrophy/ spasticity/cramping (17) “My muscles can also relax and not tighten or spasm.” “and eases my restless leg syndrome.” “It relaxes my muscles and joints.” m – decrease stress (14) “I can deal with day to day stress.” “and don’t stress out much at all” “lowered stress” n – positive changes in health (9) “It had increased my overall health” “The positive health improvements “It helps me to stay well” o – arthritis (9) “Helps with my horrible arthritis.” “It eases my joint pain.” “Sincerely helps me with chronic arthritic pain, especially at night.” p – fibromyalgia/nerves (8)| “Fibromyalgia is quite painful.” “Some significant relief of fibromyalgia pain and soft tissue spasticity.” “And neuropathy that I experience daily” q – tremors/seizures/shakes (8) “Aura of seizures controlled.” “And it stop my tremors.” “I visually shake sometimes and it helps with that.” r – cancer (4) “Seems to be effective on my cancer.” “Looks like I’m a stage 4 colon cancer survivor. I don’t know how much of a part cannabis played, but I’m keeping it in the mix.” s – eyesight/glaucoma (4) “It has saved my eyesight!!” “It actually does help with eye pressure from glaucoma.” t – degenerative disk disease (2) “Also, I have a digenerating disk in my lower back, when I lay down my legs get restless from it, pot helps with that as well.” u – schizophrenia/DID (2) “In the morning, my inner voices are silent most days.” v – ADHD (2) “It helps me concentrate – ADHD.” w – blood pressure (2) “Blood pressure is down.”
2 - Product (351) a – natural/organic/pure/herbal/clean (107) “It is a natural herbal medicine.” “It is purely plant based.” “That it is a completely natural organic substance” b – not addictive/habit forming (37) “I have never had a problem with addiction to it.” “I love that it is not physically addictive.” “Not habit forming.” c – quality (control), growing conditions consistent; reliable; excellent; consistent (29) “Quality of product” “Consistant and reliable quality” “Quality control over product.” d – strains/THC CBD content/quality (27) “The different strains available for relief.” “Robust selection of strains.” “I am able to find high cbd/low thc strains” e – options, choices of delivery/application (23) “So many different ways to use it.” “There are many options available to each patient.” “The versatile delivery methods” f – safe/not harmful/not toxic/know what getting (19) “It doesn’t hurt my organs and brain.” “It is safe for your body and mind.” “I don’t feel like I’m doing ‘harm’ to my body.” g – dose (consistent/can adjust/easy) (17) “I can control dose better.” “I like how I regulate dosing by the way I feel.” “Can titrate my own dosage based on my symptomatology and current need” h – edibles (convenience/discreet); cookies (portion control; sleep; relaxed; happy; pain; sleep); CBD capsule (chronic nerve pain); pain relief better than smoking; slow/gentle onset; prevent anxiety (13) “Edible cannabis provides much more pain relief than smoked.” “I sleep much better when I eat a medible cookie.” “The edible help so much when I can not use other methods.” i - smoking (boredom; improve lung function; way I feel); water bong (straighten me out); immediate results; anxiety; sleep; stronger faster effect; control dose (12) “I enjoy the smoking process. It helps with boredom.” “More immediate results when smoking it.” “I prefer to smoke since it has a stronger, faster effect, and it’s easier to control the dose.” j – no deaths/safe/can’t OD (12) “Nearly impossible to come close to dying from an overdose.” “There have been 0 deaths associated with it” “Won’t kill me.” k – taste/smell (12) “Clean taste.” “The taste, similar to a fine cigar.” “Smell” l – consistency (9) “I always know what to expect.” “I can know exactly what I am ingesting.” “The consistency of product and selection.” m – no hangover feeling; not zonked; can function next day (8) “I don’t feel groggy when I wake up the next day.” “Can function the next day well.” “Nor do I feel bad the next day.” n – high (7) “I enjoy the high.” “The legal high.” “Getting high.” o – tinctures (clean/easy); no smell; sleep; function normally, not stoned (6) “Recently started using tinctures. Clean and easy.” “I recommend tinctures to anyone with my symptoms.” “I like the tincture – no smell.” p - topical (neuropathy); joint muscle pain; salve (chronic knee pain; leg cramps) (6) “Topical helps a lot with joint and muscle pain.” “Topical cannabis helped with neuropathy.” “I use cannabis salves for leg cramps and it’s better than anything I’ve tried over the counter.” q – long hx medical use (2) “It has a long history of medical use.” r – learning (mj/meds) (2) “I have learned a lot about cannabis and the other medications in my life” s – oil (no munchies) (2) “In oil form, I do not get the “munchies”.” t – balm (doesn’t alter perception) (1) “Like the fact that it doesn’t alter my perception, when using balm.”
3 – non health benefits (350) a – relaxation/take edge off (75) “I have always appreciated the fact that cannabis allows me to relax.” “The relaxed feeling.” “Helps relaxation.” b – active/energy/function better/do more/improve physical function/mobility/exercise (54) “I function normally.” “I love the energy I get.” “Extra energy which I need to get exercise.” c – live life/alive/life more tolerable/changed life/live semi normal life/feel like me/life back (54) “It has made me feel alive again.” “I have my life back.” “I live a normal life because of it. I look normal, I act normal.” d – redirect thoughts/mental clarity/slow down mind/mind relief/stop worry/improve state of mind (22) “It distracts me from dwelling on my problems.” “It gives my mind relief when nothing else can.” “Improvement in my state of mind.” e – mindfulness/be present/focus/balance mind spirit body/ perspective/awareness (21) “Steadys my reality giving me perspective.” “Increased awareness” “Being able to focus” f – increase QOL/wellbeing (19) “Better quality of life” “Overall sense of well being” “My quality of life is much improved” g – better person/attitude adjustment/outlook/kinder/patient/others (17) “Better kinder way of life.” “My patience and tolerance levels have increased significantly.” “Be better human being” h – happy/content/joy/bliss/euphoria (17) “How happy it makes me feel.” “Immediate euphoric feeling of release” “Able to feel joy” i – not impaired (11) “My judgment does not get impaired.” “It does not impair my thinking (even though people say it will)” “does NOT cause me to have less ability to function” j – soothing/calming/at peace/carefree (11) “It calms me down.” “I like how at peace I am with everything.” “The way it calms my body and mind.” k – social/outgoing (11) “Improve social involvement.” “Improved social life.” “I can b more social. And not hide at home.” l – motivation/outlook/uplifting/interest/hope (10) “Uplifting and motivational” “It gives me hope” “The uplifting feeling” m – can work/productive/pay bills/driving (10) “I can work and pay my bills.” “The tasks and accomplishments I can get done.” “Having a job” n – creative (7) “I do like the expansive mind/creativity element” “Increases creativity” “Creative insight” o – decrease alcohol use/smoking/drug use (7) “I have been freed of my addictions.” “Marijuana has helps me to stop drinking and come off the drugs” “It has certainly not been a gateway drug for me, rather it has helped me to NOT need other drugs/alcohol.” p – sex (4) “Increase in sexual desire and pleasure.” “I have to admit that it has improved my sex life as well.” “Great for sex”
4 – general (255) a – works (72) “Sometimes it works where everything else has not.” “How it works for me” “The fact that it actually works.” b – effective (51) “It is actually effective” “Effective long term” “It’s 100% effective” c– feel better (47) “How great I feel!!” “And generally makes me feel MUCH better.” “I feel better overall because of it” d – relief (many symptoms) (35) “The relief it brings me” “It provides REAL relief mentally, emotionally, and physically.” “Overall body relief” e – helps (with many problems) (25) “It helps me in so many ways.” “It helps a lot of people, including me.” “I had no idea that it could help so much.” f – general (18) “It is a miracle cure!” “The way it has changed my life for the better.” “The positive outcome” g – benefits (7) “The many benefits it is offering me” “The countless benefits it provides”
5 – medications (176) [rx – prescription medications] a – decrease rx meds (62) “Less medications and pills I have to put in my body.” “Not taking prescription meds.” “I am off pharmaceuticals for the most part.” b – more effective than rx (39) “It is far more effective than any prescription that I’ve been prescribed.” “It gives the most symptom relief of anything I’ve tried” “That it works better than any pharmaceutical I’ve used.” c – safer than rx (26) “replaces dangerous pharmacy drugs” “Safer than some other pain meds.” “And safer than pharmaceuticals.” d – no/reduce opiates (23) “Eliminated use of opiate pain medications.” “It has helped me drastically reduce my opiate intake.” “The ability to limit or eliminate the need for medical opiates.” e – off/reduce painkillers (14) “I don’t have to take pain pills all the time” “It helps me cut down on pain meds” “I like that I am off almost all painkillers” f – no need narcotics (5) “I use less narcotics.” “It’s reduced my need for narcotics.” “I don’t have to take narcotics.” g – no interactions with other rx (4) “Doesn’t interact with my other medications” “I cannot think of one drug it isn’t safe to mix with” h – f(x) better than when on rx (pain) (3) “Can function better than when on pain medications.” “I can function at a much higher rate than with the use of pain pills.” 6 – other (159) a – comments (71) “It has always been my best friend.” “Thank you for this wonderful plant.” “The pros demolish the cons on this argument, as far as my personal experience goes.” b – unclear (30) “The freedom.” “Gentleness.” “The truth” c – random, best but doesn’t fit into a category (28) “I feel like I am in a better state of homeostasis.” “The way it helps me through my current situation.” “Keeps me on an even keel.” d – everything (19) “Everything. While these answer may not seem serious, they are.” “What isn’t to like?” “Everything!!!” e – negative (11) “Not much.” “Currently I don’t like using it.” “You can legally buy but have to pay for the license.”
7 – side effects (se) (129) a – no se/adverse effects (48) “It doesn’t really have any side effects.” “Side effect free” “There are no life threatening side effects” b – less se than rx (47) “Less side effects than the medications I’ve previously been prescribed” “Without the side effects of chemical medicine.” “Without side affects that prescriptions often have.” c – cope with se meds/chemo (12) “It truly helped me get through the side effects of my chemo treatments.” “It makes it easier for me to tolerate the side effects of my medications.” “And helps with nausea from pills” d- < pain, with no se (12) “Pain management without side effects” “The only drug that can relieve my pain without negative side effects” “Effectively treats pain just as good as opioids, with no side effects!” e – no dangerous/harmful/scary se (7) “Lack of dangerous side effects” “no harsh side effects.” “The lack of detrimental side effects.” f - < pain without (oxy) zombie (3) “Taking care of my pain without being an oxy zombie”
8 – access (92) a – available/options exist/east to obtain (27) “That it is available if I need it.” “Happy to have this as an option.” “Easily obtained” b – grow/garden free (14) “That I am able to grow my own medicine.” “If I grow my own, it is essentially free.” “I grow my own medicine, gardening itself is therapeutic.” c – safe access – clean/legal/legitimate source (13) “That I can get it from a clean legal source.” “Being able to have safe access to the medicine I need.” “Being able to go somewhere safe to obtain it” d – dispensary (convenient/clean)/location/buy it/easy appointments (11) “Convenience of buying from dispensary” “Able to go to dispensary to purchase medication.” “Easy appointments” e – staff (welcoming/knowledgeable) (8) “Welcoming, Knowledgeable Staff. It makes a big difference.” “Staff are extremely helpful.” “Also the knowledge of the people that work there” f – prn – when needed/tailor intake (7) “I love the freedom to self medicate.” “I can tailor my intake to meet my needs in terms of symptoms.” “I can use it when need, rather than when prescribed; don’t need it, don’t use it.” g – convenient/simple (5) “Convenient” “It is convenient.” h – reasonable price (5) “It’s relatively inexpensive.” “Reasonably priced.” i – easy to use/simplicity (2) “The ease of using.”
9 – the law (44) a – legal/follow the law/not a criminal (41) “That I can now legally purchase what helps me with my conditions.” “being able to purchase it in a dignified and legal way.” “And I don’t feel like a criminal when I try to find relief.” b – less stigma (2) “Freedom to treat! Without judgment” c – taxable (1) “Taxable marijuana.”
10 – effects (27) a – quick/fast acting (15) “The immediate results” “Fast relief” “Speed of effect” b – long lasting (7) “Long lasting symptom relief” “Lasts a long time” c – wear off slowly (3) “Gently wears off” d – don’t need a lot (2) “I like that you don’t need to consume a large quantity for results.” Supplementary Table 2. Responses to “What do you like least about medical cannabis?” (N = 1,678) were analyzed with QSR NVivo10. Categories are in bold followed by subcategories. Number of responses are in parentheses and sample responses are listed. ______1 – Money (477) a – Cost (156) “Cost.” “How much it costs” “The cost is ridiculously high for a weed that grows out of the ground.” b – Price (104) “I feel that it is sorely overpriced.” “The price is tough considering my disability income.” “The price is pretty high (no pun intended)!” c – Expensive (96) “The cost can be a bit expensive, though worth it.” “How expensive some of the products are” “I don’t like how expensive it is.” d – Insurance/insurance doesn’t cover/not covered under my insurance/Medicare (58) “I would have to say I wish insurance covered this.” “That it is not covered by health insurance as other medications are.” “Things would be much easier if insurance paid for this medication.” e – Other/buying it/costs money (28) “That there is no help for low income patients.” “Not covered by workers compensation” “I’m broke because I decide to buy my medication” f – Afford/affordability/can’t afford it (15) “I don’t like that I can’t afford it.” “Cost should be affordable to someone on 800 a month.” “I think of affordability for folks who are on a very tight budget.” g– Taxes/having to pay taxes on it/taxed (10) “Taxes applied to what is classified as a prescription drug.” “And having to pay my taxes on it, not being able to claim it on my taxes.” “Not being able to take this medication off taxes as I do others by the same perscriber.” h – Certification/difficult and expensive to be certified/cost to renew (9) “That it is so difficult and expensive to be certified.” “Having to apply for the card every year.” “Having to pay for recertification every year…” i – Veteran’s Affairs (1) “The VA does not indorse it.”
2 – Effects (364) a – Smell/odor (60) “Obvious smell” “The smell offends others sometimes and is not professional.” “The odor, which makes being discreet difficult.” b – Eating/increased appetite/munchies/hungry/graze mindlessly (53) “Decrease control over eating – craving sweets!” “I have to be careful about over eating while high.” “Increases appetite too much” c – Respiratory/coughing/asthma/effects on lungs/COPD (33) “Sometimes it makes me cough” “What it does to my lungs” “Lung irritation.” d – Tired/drowsy/sleep/sluggish/lazy/lethargic (31) “Makes me tired.” “Feeling of lethargy.” “Sometimes I feel sluggish.” e – Cognitive/stupid/brain fog/dingy/confused/fuzzy (30) “It makes me somewhat loopy.” “Cognitive side effects.” “Just a bit of a fog.” f – Mouth/dry/thirsty/sores (20) “Sometimes I get dry mouth.” “Cotton mouth.” “mouth sores.” g - High/feeling high/potential to feel high (19) “I don’t like the “high” feeling.” “Potential to feel ‘high’ or intoxicated.” “The “high” took a little getting used to.” h – Memory/impairment/short term (15) “The short term memory loss can be annoying.” “Some forgetfulness.” “The effect on my memory.” i – Taste/the taste (15) “Taste of the medicine.” “The taste.” j – Productive/lazy/unmotivated/lack of motivation (11) “Takes away motivation to be productive.” “The unmotivating feeling I have at times.” “I sometimes have trouble being as productive as I’d like to be” k – Anxiety/slight anxiety/occasional anxiety/anxious feeling (10) “Occasional anxiety.” “Just when it exacerbates my anxiety.” “Due to heart rate increase, I have slight anxiety.” l – Tolerance/building tolerance/developed tolerance quickly (9) “The inability to get high after getting high a few times in a day.” “The tolerance development.” m – Head/headache/head trip/head buzz (9) “A bit of a confused and fuzzy head feeling.” “It gives me a headache.” “The head buzz.” n – General/psychotropic effects/ side effects/delivery system effects (7) “Sometimes I will have unpleasant side effects which are gradually going away.” “General psychotropic effects.” “Not knowing if I will have bad side effects.” o – Eyes/dry/red (6) “Makes my eyes red.” “Dry eyes.” p – Paranoid/paranoia/occasional paranoia (6) “I do not like that it makes me feel paranoid.” “Occasional paranoia.” q – Dizziness/sometimes dizzy/initially dizziness (5) “Can cause mild dizziness.” “Initially dizzinesss” r – Throat/harshness on my throat/irritation/lumpy feeling (4) “Irritation to my throat.” “Harshness on my throat.” s – Restless/become restless/too much energy (4) “Too much energy.” “I become restless.” t – Stoned/too stoned/stoned effect (4) “It makes me too stoned.” “I don’t necessarily like to be “stoned” all of the time.” u – Hangover/ some hangover effect/sometimes a bit of a hangover (4) “Sometimes a bit of a hangover” “Some hang over effect. Coffee seems to clean it out so it’s not really like over drinking.” v – Dependence/feeling of being dependent on a drug/severe dependence on it (4) “I have severe dependence on it and find it extremely difficult to go a day without it.” “The feeling of being dependent on a drug.” w - Other side effects/woozy feeling/heavy chest/can upset stomach (3) “Can upset stomach.” “Heavy chest.” x – Ears/ringing (1) “Ringing in ears.” y – Nausea/nausea it causes me (1) “And the nausea it causes me.”
3 – View (191) a – Stigma/negative stigma/stigma from society/fear of stigma/stigma associated with use (106) “Stigma associated with its use” “I hate the stigma attached to marijuana use” “Plus I don’t care for the stigma of marijuana among the population.” b – Others/perception from others/not more widely accepted/others notions on its use (55) “Not treated as a medication, and certain types of people don’t understand.” “Feeling like it’s frowned upon by the general society.” “Negative opinions from other people.” c – Medical/stigma from healthcare workers or doctors/not accepted by medical community (18) “The stigma that goes with medical usage…from doctors.” “Not more widely accepted by the medical community.” “That it is not accepted by the medical community as a whole.” d – Hide/secrecy from my employer/not told my PCP/hide from visitors (7) “Keeping it a secret form people outside my immediate circle.” “I don’t talk about it with my family. It’s easier that way.” “The exposure when I don’t want anyone to know I smoke pot because I’m a nurse.” e – Multiple/medical providers and law enforcement/employers and medical people (4) “Not supported by my family or many medical doctor” “How it is so frowned upon by medical providers and law enforcement.” f – Law/prejudice and misunderstanding about benefits by law makers (1) “The prejudice and misunderstanding about the benefits held by lawmakers.”
4 – Access (138) a – Access/hard to obtain/limited/run out/not enough places to purchase (33) “It can be difficult for me to obtain due to my condition and situation.” “Lack of access to what I want and need.” “Not enough places to purchase it.” b – Strain/availability/more options/more variety/quality (32) “The strains are also very limited at dispensaries.” “Not enough of each strain to help everybody” “Also strains that work well are not always available.” c – Distance/have to travel/too far (24) “The locations, so far away.” “The lack of dispensaries in close proximity (I drive over 100 miles each way).” “Access to dispensaries is a long drive.” d – Dispensary/hours/not enough dispensaries/getting appointments (20) “It can be hard to get appointments at the dispensary.” “Dispensery hours.” “Restrictive rules regarding dispensary locations.” e– Availability (13) “Lack of availability.” “The limited availability to obtain it.” “It should be more widely available.” f – Grow/how long it takes to grow/trying to grow it/not being able to grow it (8)} “I dislike how difficult it is to grown on my own.” “How long it takes to grow outdoors.” “Not being able to grow it myself.” g – Information/lack of credible information/little guidance (4)} “Lack of info I was given at the clinic” “Lack of credible sources of information.” h – Condition/qualifying conditions are limited/few disorders benefit (3) “That the qualifying conditions are so limited.” i – Source/ability to find a steady source (1) “The ability to find a steady source.”
5 – Method (119) a – Smoking/smoking it/smell from smoking/inconvenient/time (64) “Smoking. I feel smoking is not good for you but that seems to be the most effective method.” “Smoking sometimes is rough” “The feeling of smoking” b – Edibles/too earthy/inconsistent dosing/time to make/slow effects (17) “The lack of edible product that is available.” “Would prefer edibles which are expensive.” “I cannot control the effects of edibles. It’s sometimes too strong.” c – Tincture/difficult to use/taste/sleepy (12) “The strong taste of the tinctures.” “I can not afford to use the tinctures as my first way due to prices.” “Tried tincture once, but made me sleepy, so never used again.” d – Vape/preparing it/hard time using/expensive (11) “Preparing the vaporizer” “Hate the burning sensation of vaporizer, used once, never again.” “I still have a hard time using the vaporizer but its getting easier.” e – More/limited products available here/more vessels for cannabis (5) “The limited products available here.” “We need more vessels for cannabis other than smoking.” “The selection isn’t as strong as in California.” f – Seeds/not being able to buy seeds/made available to grow (3) “Not being able to buy seeds or clones.” “Seeds should be available to those that prefer to grow their own medicine.” g – Oil/costly/get too high (2) “I would buy Concentrates and Oils if they were not so costly.” “The oil makes me get too high.” h – Balm/smells (1) “Since I only use the balm, still don’t like the way it smells.” i – Glycerin/sticky/hard to dispense (1) “The glycerin is sticky and hard to dispense reliably. Makes your mouth taste like an ashtray all day.” j – Keif/buy separately after removed from flower (1) “It’s also very disappointing that I have to buy shake (kief) separately after it has been removed from the flower.” k– Topical/more options (1) “more topical options. Those work the best for me.” m – Bud/cheapest form (1) “Bud is the cheapest form, so it’s what I use but I would much rather use alternative medicines. Concentrates, edibles and tinctures.”
6 – Legal (104) a – Illegal/not federally or nationally legal/federal or government regulations/schedule 1 (83) “Federal restrictions, schedule 1 drug stupidity” “It’s still illegal.” “Legal limitations.” b – Conceal/discrete/hide/can’t use openly (21) “I can only smoke it at home legally.” “Delivery restrictions in public.” “It’s hard to medicate and not disrupt other people.”
7 – Nothing/nothing/can’t think of a thing/no problems/NA/not sure (87) “No problems whatsoever” “There is no down side to it.” “I have nothing negative to say about medical cannabis.”
8 – Miscellaneous (86) a – Other/takes time to consume/product is too dry/it’s inconvenient/it is not standardized (51) “It is limiting.” “Legislation making medical use unduly expensive” “Attempts by big corporations and cartels to control delivery and growing.” b – Positive/love it/relaxes me/happy/a big help/it’s a lifesaver (24) “I’m happy and I can deal with everyday life better.” “I love it.” “It’s a big help to me.” c – Unclear/feeling/harder to use/names/the travel (11) “Feeling” “Annual bills to change current laws” “names.”
9 – Use (58) a – Dose/control/proper dose/misdose/not accurate/inconsistent (20) “I would prefer more accurate dosing.” “Adjusting dosages with different strains.” “I really find it hard to get just the right amount to relieve my medical issues without getting too high.” b – Best/trial and error/find best dosage and type (9) “The trial and error of what will work best.” “Still trying to find the best dosage and type.” “Difficult to determine exactly what works best.” c – Effects/not long lasting/take a while to kick in/variable (8) “Effect doesn’t last long enough.” “It’s effect is variable. “It can take a while to kick in.” d – Not effective/not highly effective/no effect/doesn’t provide relief (6) “Not highly effective.” “So far it’s had no effect.” “It puts me to sleep but doesn’t help the pain.” e – Inconsistent/lack of consistency/unpredictable (5) “Product sometimes seems inconsistent.” “Lack of consistency.” “Unpredictable.” f – Strength/not strong enough/very strong (4) “Not strong enough at times.” “Some of the strains are very strong, a lot different then in the 60’s and 70’s” g – Recreational Use/banned as a recreational drug/considered a street drug (3) “That people are still using it for recreational purposes and giving those of us that use it for medicine a bad image.” “How banned it is as a recreational drug” h – Use/having to use it at all/relying on any drug (3) “Having to use it at all. That reflects on my conditions, not the substance.” “Relying on any drug.” “That I’m using pot.”
10 – Travel/difficulty traveling with it/traveling out of state/can’t take it with me on trips (22) “That I can’t travel with it like any other medication I am prescribed.” “I travel for work and I am not able to bring it out of state.” “Hassle of traveling without it.”
11 – Limit (17) a – Driving/interferes with driving/limit my ability to drive/not being able to drive (9) “It does limit my ability to drive.” “It interferes with my driving.” “Not being able to drive.” b – Work/interferes with work/makes work difficult/cannot use it at work (8) “I cannot work while using cannabis.” “Effects make work difficult.” “I can’t use it before work or if I have any important events where I need to be sober.”
12 – Job/limit employment options/risk of losing job/prevent me from being hired (15) “The fact that I would lose my job because I use.” “Prevented me from getting a job I know I could do.” “I lost my job and license because I required this relief.” ______
Medical Cannabis Patient Survey Rhode Island
You are being asked to participate in a project conducted through the Husson University School of Pharmacy by Brian Piper, PhD; by Dartmouth-Hitchcock Medical Center by Corey Burchman, MD; and by Maine Health by Stephanie Nichols, PharmD and Alexander Abess, MD that involves research. The researchers are required to receive your informed consent before you participate in this project. This project has been reviewed and approved by the Husson University Institutional Review Board (IRB) for the Protection of Human Subjects in Research. Contact the IRB at (207) 941-7049 if you have any questions about (1) the conduct of the project, (2) your rights as a research participant, or (3) a research-related injury. Any other questions about the research project should be directed to: Brian J. Piper ([email protected]) or Stephanie Nichols ([email protected]). Your participation in research is voluntary. If you refuse to participate, there are no penalties or loss of benefits or services that you are otherwise entitled to. If you decide to participate and then withdraw or skip a question, there are no penalties or loss of benefits or services. Whether or not you choose to participate in this project will have no effect on your relationship with Husson University, Dartmouth-Hitchcock Medical Center, or Maine Health, now or in the future. A basic explanation of the project is written below. After you have read this information, please indicate whether you consent at the bottom of this page.
PROJECT PURPOSE: The purpose of this online survey is to gather information about the risks and benefits of medical cannabis use. Adults that are legally authorized to use medical cannabis are being asked to participate in this study. You have been invited to participate in this study because of your relationship with a cannabis dispensary. You are receiving this invitation because you have agreed to receive emails from your dispensary.
EXPLANATION OF PROCEDURES: This study will involve answering questions about you, your health, and your use of medical cannabis.
CONFIDENTIALITY: No identifying information will be collected during this research. Information from this research will not be released to anyone outside of this research project. Your responses will not be discussed with anyone not involved in the research. Only researchers associated with the project will have access to this information. Any information from this study to be presented or published, will be in aggregate form only and individuals will not be identified.
COMPENSATION: Participation in this study is voluntary. No compensation will be awarded.
BENEFITS: The overall benefits of this research include gaining a better understanding of medical cannabis.
RISKS: This study involves minimal risk. Risks in this study are not anticipated to be any greater than those involved in day-to-day activities (working with a computer, answering questions, reading etc.).
KEY POINTS:
1. This survey is intended to learn more about the benefits and risks of medical cannabis.
2. Completion of this survey is voluntary. Information you provide in this survey is not identifiable to you and is completely anonymous.
3. Only the investigators involved in this study will have access to survey responses.
4. There will be no changes in your prescription or access to medications or medical cannabis should you decide to not participate.
5. The only benefit provided by participating in this survey is helping scientists and clinicians better understand medical cannabis.
1 6. Surveys may only be completed once, and must be completed in one session. The survey should only take about 15 minutes of time.
7. By completing this survey, you certify that you are over age 18.
8. Please answer as many questions as you feel comfortable answering.
9. Please note that in this survey, we use the term “cannabis” to mean the same as marijuana or medical marijuana.
CONSENT
* 1. Do you consent to participate in this research? Please be aware that that completion of the survey also implies consent.
Yes, I consent to participate.
No, I do not consent to participate.
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2. How old are you?
3. What is the highest level of education you have attained?
Did not complete High School
Completed High School or GED
Vocational Degree
Some College (AA, AS)
Undergraduate Degree (BA, BS)
Graduate or Professional Degree (MA, MBA, PhD, JD)
4. What is your ethnicity?
White
Black or African American
Asian
Hispanic or Latino
Native Hawaiian
Pacific Islander
American Indian
Alaska Native
Prefer not to disclose
Other (please specify)
3 5. What are your annual earnings? If hourly, 7.5/hour = $15,600, 15/hour = $31,200.
Prefer not to disclose
$0 to $9,999
$10,000 to $19,999
$20,000 to $39,999
$40,000 to $59,999
$60,000 to $99,999
$100,000 to $149,999
$150,000+
6. How would you describe your work status? Check all that apply.
Employed full time
Employed part time
Unemployed
On disability
Student
Retired
Prefer not to disclose
Other (please specify)
7. How would you describe the city or town where you live?
Population less than 50,000
Population more than 50,000 but less than 250,000
Population more than 250,000
8. What state do you live in?
Alabama
Alaska
Arizona
Arkansas
California
4 Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
5 Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington DC
West Virginia
Wisconsin
Wyoming
Other (please specify)
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9. How tall are you?
Feet
Inches
10. How much do you weigh in pounds?
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11. Who issued your medical cannabis certificate?
M.D.
D.O.
Other (please specify)
12. Was your medical cannabis certificate issued by:
Primary Care Provider who I was seeing already
Specialist who I was seeing already (e.g. Neurologist or Psychiatrist)
A new provider that I’m seeing for my qualifying condition
Other (please specify)
13. Which of the following diseases or conditions have you been diagnosed by a medical professional (physician, PA, psychologist) as having? Check all that apply.
Alzheimer's Disease
Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig's Disease)
Arthritis
Anorexia
Anxiety Disorder (Generalized or Social)
Attention Deficit Hyperactivity Disorder or Attention Deficit Disorder (ADHD or ADD)
Asthma
Autism Spectrum Disorder (Autism/Aspergers)
Bipolar Disorder (manic-depression)
Bulimia
Cancer
Cachexia
Celiac Disease
8 Chronic pain
COPD (Chronic Obstructive Pulmonary Disease)
Crohn's Disease
Dementia (non-Alzheimer's)
Depression (Major Depressive Disorder)
Diabetes
Emphysema
Fibromyalgia
Heart disease (Heart failure, Coronary Artery Disease)
High blood pressure
HIV/AIDS
Irritable Bowel Syndrome (IBS)
Kidney disease
Migraine / Chronic Headaches
Myasthenia gravis
Narcolepsy
Obsessive Compulsive Disorder (OCD)
Parkinson’s Disease
Premenstrual Dysphoric Disorder
Post-Traumatic Stress Disorder (PSTD)
Schizophrenia
Seizure disorder (epilepsy)
Sleep disorder (insomnia)
Stroke
None of the above
Prefer not to disclose
Other (please specify)
9 14. For what condition(s) did you receive a medical cannabis certificate? Check all that apply.
Intractable or chronic pain
Agitation related to Alzheimer’s Disease
Cachexia or wasting syndrome
Cancer
Glaucoma
Hepatitis C
HIV or AIDS
Muscle spasms, including but not limited to, those characteristic of Multiple Sclerosis or Crohn’s disease
Nausea (severe)
Parkinson's Disease
Seizures, including but not limited to those characteristic of epilepsy
Prefer not to disclose
Other (please specify)
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You have completed approximately 25% of the survey.
15. If you are using medical cannabis for pain, what type of pain do you have? Check all that apply.
Abdominal
Back/Neck
Cancer
Chronic pain following surgery
Menstrual pain
Neuropathic (nerve pain)
Trauma/Injury
Not applicable
Other (please specify)
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16. How long have you been certified to use medical cannabis?
Months Years
Length
17. What is your preferred delivery method?
Joint, pipe or bong
Vaporizer
Food edibles
Concentrated
Tincture
Topicals (salve or balm)
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18. How much do you use each week (for example, 3 cookies/week)?
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19. How many grams of medical cannabis do you use each day (1 oz = 28.4 g)? If you'd prefer not to disclose, enter "NA".
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20. How much money ($) do you spend on medical cannabis each week?
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21. What type of medical cannabis works best for you?
Cannabis sativa dominant strains
Cannabis indica dominant strains
Don’t know
Prefer not to disclose
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22. For the condition you were certified for, which strain(s) works best for you? If you prefer not to disclose, please feel free to skip this item.
23. Please describe other strains you use and why. If you prefer not to disclose, please feel free to skip this item.
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24. How would you describe your use of cannabis? For example, if you use medical cannabis twice a day for your symptoms but on the weekends, twice midday to relax with friends, you might choose 20% recreation/ 80% medical).
100% recreational, 0% medical
90% recreational, 10% medical
80% recreational, 20% medical
70% recreational, 30% medical
60% recreational, 40% medical
50% recreational, 50% medical
40% recreational, 60% medical
30% recreational, 70% medical
20% recreational, 80% medical
10% recreational, 90% medical
0% recreational, 100% medical
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25. How old were you when you first smoked a tobacco cigarette?
10 years or younger
11
12
13
14
15
16
17
18
19
20
21 or older
I've never smoked a cigarette
19 26. How old were you when you first used alcohol?
10 or younger
11
12
13
14
15
16
17
18
19
20
21 or older
I've never used alcohol
27. How many packs of cigarettes do you currently smoke each day?
a few cigarettes
half a pack
1
2
3
4
5
I don't smoke
20 28. How old were you when you first used marijuana recreationally?
10 or younger
11
12
13
14
15
16
17
18 or older
I've never used marijuana recreationally
29. What is your sex?
Male
Female
Prefer not to disclose
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30. How many days per week do you consume 4 or more alcoholic drinks in a single sitting?
0
1
2
3
4
5
6
7
I don't drink
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31. How many days per week do you consume 5 or more alcoholic drinks in a single sitting?
0
1
2
3
4
5
6
7
I don't drink
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You have completed about half of the survey.
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32. How effective is medical cannabis in treating your symptoms or condition(s)?
0% no relief at all
10%
20%
30%
40%
50% about half relief
60%
70%
80%
90%
100% complete relief
33. Are there any other conditions that you find are helped by cannabis? Please check all that apply.
Anxiety
Appetite stimulant
Concentration (ADD/ADHD)
Depression/mood
Other substance cravings (nicotine, alcohol, or other)
Pain
Restless legs
Sleep quality
None
Other (please specify)
25 34. Besides yourself, how many members of your house-hold are certified to receive medical cannabis?
0
1
2
3
4
Other (please specify)
35. Are you on any of the following types of medications? Please select all that apply.
ADHD medication (stimulant)
antidepressant
antipsychotic
anti-seizure medication or mood stabilizer
anxiety medication
blood pressure medication
diabetes medication
pain medication (non-prescription)
pain medication (prescription)
sleeping medication(non-prescription)
sleeping medication(prescription)
none of the above
prefer not to disclose
36. Do you regularly take opiate pain medications (such as oxycodone, hydrocodone, buprenorphine, methadone, or others)?
Yes
No
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37. Have you noticed a change in the amount of opiate medication you need for the same pain relief since you began using medical cannabis?
Yes, I need a lot more medication
Yes, I need slightly more medication
No change
Yes, I need slightly less medication
Yes, I need a lot less medication
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38. Do you regularly take medications for anxiety (such as valium, lorazepam, clonazepam, or other)?
Yes
No
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39. Have you noticed a change in the amount of prescription anxiety medication you need/use since you began using medical cannabis?
Yes, I need a lot more medication
Yes, I need slightly more medication
No change
Yes, I need slightly less medication
Yes, I need a lot less medication
40. Do you regularly take medications to help you sleep (such as ambien or benadryl)?
Yes
No
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41. Have you noticed a change in the amount of medication you need/use for sleep since you began using medical cannabis?
Yes, I need a lot more medication
Yes, I need slightly more medication
No change
Yes, I need slightly less medication
Yes, I need a lot less medication
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42. Do you regularly take medications to help you for depression (such as Celexa, Cymbalta, Effexor, Prozac, Paxil, Wellbutrin, Zoloft)?
Yes
No
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43. Have you noticed a change in the amount of medication you need/use for depression since you began using medical cannabis?
Yes, I need a lot more antidepressants
Yes, I need slightly more antidepressants
No change
Yes, I need slightly less antidepressants
Yes, I need a lot less antidepressants
44. Do you regularly consume alcohol?
yes
no
prefer not to disclose
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45. Have you notice a change in your alcohol consumption since you started medical cannabis?
Yes, I need to drink a lot more
Yes, I need to drink slightly more
No change
Yes, I need to drink slightly less
Yes, I need to drink a lot less
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Migraine
46. Do you regularly take medications for migraines or headaches?
yes
no
prefer not to disclose
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47. Since starting medical cannabis, have you noticed a change in the amount of medications you use for migraines or headaches?
Yes, I need a lot more medications
Yes, I need slightly more medications
No change
Yes, I need slightly less medications
Yes, I need a lot less medications
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48. Do you think using medical cannabis has caused any other significant change in your health conditions or medications (either better or worse)?
Yes
No
49. Please describe
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50. Does your primary care provider know about your medical cannabis use?
Yes
No
51. Do you inform healthcare providers (other specialists, pharmacists, clinics, etc.) of your medical cannabis use when providing information about other medications?
Yes
Sometimes
No
52. Who first suggested medical cannabis as an option for you?
Me (I brought it up with my doctor)
Primary Provider
Other specialist/clinician
Friend/Family
53. How would you describe the way healthcare providers, in general, treat your use of medical cannabis?
Strongly supportive
Supportive
Neutral
Unsupportive
Strongly unsupportive
54. Do you currently have any negative/unwanted side effects from medical cannabis?
Yes
No
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55. Please select any of the following side effects that were or are still bothersome to you:
Anxiety/nervousness/paranoia
Asthma or breathing problems
Changes in perception or memory problems
Chest pain
Concentration problems
Decline in motivation, productivity, or activity
Facial hair
Mood changes
Nausea/vomiting
Rapid heart beat/palpitations
Sleep changes
Weight gain that was not wanted
Other (please specify)
56. About how long have you had these side effects from cannabis?
Days: Weeks: Months
Length
57. Did side effects ever limit your use of medical cannabis?
No
Yes, but not any more
Yes, and it still is limited by side effects
38 58. Do you think you have developed a tolerance to the benefits of medical cannabis?
No
Yes, and I still use the same dose, ingestion methods, and strain
Yes, but I changed my dose, ingestion method, or strain to make it more effective
59. How long did it take for you to find the correct route/dose/frequency/strain of medical cannabis?
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You have completed approximately 75% of the survey.
60. For the condition(s) on your medical cannabis certificate, which of the following complementary and alternative medicines or techniques do you currently use?
Acupuncture
Chiropractor
Herbal/natural remedies
Massage
Reiki
Physical therapy
None
Other (please specify)
61. For the condition(s) on your medical cannabis certificate, which of the following complementary and alternative medicines or techniques did you use BEFORE medical cannabis?
Acupuncture
Chiropractor
Herbal/natural remedies
Massage
Reiki
Physical therapy
None
Other (please specify)
40 62. Had you ever used cannabis before your current medical use?
No
Yes, recreationally
Yes, self-prescribed for a medical condition
Prefer not to disclose
63. Does your spouse/partner know about your medical cannabis use?
No
Yes
Not Applicable (I don’t have a spouse or partner)
Prefer not to disclose
64. Does your immediate family know about your medical cannabis use?
No
Yes
Prefer not to disclose
65. Do your closest friends know about your medical cannabis use?
No
Yes
Prefer not to disclose
66. Does your employer know about your medical cannabis use?
No
Yes
Not applicable (I don’t have an employer)
Prefer not to disclose
67. Have you experienced any legal issues because of medical cannabis?
Yes
No
Prefer not to disclose
41 68. Have you ever suffered from alcoholism and/or drug addiction?
No
Yes- alcoholism
Yes- drug addiction
Both
Prefer not to disclose
69. Do you currently use any illegal substances (such as heroin, cocaine, bath salts, or other “street drugs”)?
Yes
No
Prefer not to disclose
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70. Which modes of delivery have you used for medical cannabis? Please choose all that apply.
Smoke – joints
Smoke – pipe
Smoke – water pipe or bong
Vaporize – whole flower
Vaporize – oils/concentrates
Eat
Drink
Tincture
Topical (on the skin)
Concentrates
71. What is the mode of delivery you use most for medical cannabis?
Smoke – joints
Smoke – pipe
Smoke – water pipe or bong
Vaporize – whole flower
Vaporize – oils/concentrates
Eat
Drink
Tincture
Topical (on the skin)
Concentrates
43 72. How frequently do you use medical cannabis?
3 or more times per day
2 times per day
Once per day
Multiple times per week
Once per week or less
73. How many members of your household use medical cannabis?
1 (just me)
2
3
4 or more
prefer not to disclose
74. Do you have any plans to stop using medical cannabis?
Yes
No
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75. What is it that you like least about medical cannabis?
76. What is it that you like most about medical cannabis?
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Thank you for completing this survey. We appreciate your participation!
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