Factors associated with cannabis use disorder among Australians using prescribed and illicitly-sourced medical cannabis.

Background: People who use cannabis medically do so more frequently than those who use nonmedically, potentially placing them at higher risk of cannabis use disorder (CUD). Prescription involves receiving guidance from doctors how best to administer medication; however, it remains unknown whether prescribed medical cannabis is associated with reduced incidence of CUD compared to illicit. Methods: Data came from a 2022-23 online anonymous cross-sectional survey of Australians who had used medical cannabis. We examined differences between respondents who use Prescribed medical cannabis and respondents who use Illicit medical cannabis in demographic characteristics, patterns of use, and odds of meeting DSM-5 criteria for Any-CUD (≥2/11 criteria) and Moderate-Severe-CUD (≥4/11). Bayesian penalised regression models were used to identify the most important factors associated with CUD. Results: Of 1796 respondents, 43 % met Any- and 17 % Moderate-Severe CUD criteria. In bivariate analyses, respondents who sourced illicit medical cannabis were more likely to meet criteria for Any CUD (53 % vs 41 %, OR=1.6 [CI: 1.3, 2.0]) and Moderate-Severe CUD (25 % vs 15 %, OR=2.0 [CI: 1.5, 2.6]) than those who were prescribed; however, with other factors controlled for, age, frequency-of-use, mental health, THC content, route of administration, and proportion of medical vs nonmedical cannabis use were more important correlates than whether medical cannabis was prescribed or illicitly sourced. Conclusions: CUD is common amongst people who use medical cannabis. While CUD was less prevalent among people who obtained it on prescription than those who obtained it illicitly, other factors such as the concomitant use of cannabis for nonmedical reasons were a more important correlate with CUD.