Correlates of Using Medically-Authorized Cannabis in a Large Cohort of People Living with HIV Who Use Cannabis

Many people living with HIV (PLWH) use cannabis to manage symptoms, but a large proportion do so without medical cannabis authorization and use cannabis obtained outside the medical stream. In jurisdictions where non-medical cannabis use is legal, PLWH who hold medical cannabis authorization may represent a unique subgroup; yet, research on the correlates of using medical cannabis (authorized by a healthcare provider) in the context of non-medical cannabis legalization is lacking. Thus, this study examined the cannabis- and health-related correlates of medical cannabis use among PLWH in Ontario, Canada, where non-medical cannabis is legal. PLWH (N = 868; 85.37% men, mean age 51.34 years [SD = 12.25]) who were enrolled in the Ontario HIV Treatment Network Cohort Study in 2022 and who reported past-year cannabis use completed an assessment of sociodemographic characteristics, HIV-related variables, cannabis and other substance use, and health-related quality of life. Relatively few participants (n = 122; 14.06%) reported any medical cannabis use, with most (n = 746; 85.94%) reporting exclusive use of non-medical cannabis. Logistic regression analyses showed that greater HIV symptom distress, poorer physical-health-related quality of life, more frequent cannabis use, and using smokeless forms of cannabis were each uniquely associated with increased likelihood of using medical cannabis relative to exclusively using non-medical cannabis. Results suggest that even in jurisdictions where non-medical cannabis is legal, a subset of PLWH continue to access cannabis through the medical stream, and these individuals report distinct patterns of cannabis use and poorer physical health. Findings may inform cannabis policy and clinical care for PLWH who use cannabis.