Cannabis users in focus
Photo illustration by Jeffrey C. Chase | Photo by Ashley Barnas Larrimore September 10, 2026
UD epidemiology study takes closer look at medicinal, recreational use
With recreational cannabis now legal in 24 states, including Delaware, the number of users is rising. But not all cannabis users look alike or face the same health concerns.
Most published research compares cannabis users to non-users. Tarang Parekh, assistant professor of epidemiology at the University of Delaware College of Health Sciences, took a different approach, comparing medicinal cannabis users with recreational users.
In a cross-sectional study using 2018-2021 data from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS), Parekh and collaborators, including Daniel Harris, assistant professor of epidemiology, Kareem Khairy, a doctoral student in the Department of Epidemiology and Dharmi Desai, a doctoral student and mentee at George Mason University, identified patterns, demographics and health characteristics. Results were recently published in the Journal of Medicine, Surgery, and Public Health.
They found medicinal users whose average age is 49 carried a heavy health burden. Nearly half were women.
“This population had the poorest health with more arthritis, disability, obesity and chronic disease,” Parekh said.
Medicinal users also reported lower education and employment.
Recreational users were generally younger, healthier males. Despite having the highest levels of physical activity, 45% reported binge drinking.
In their analysis, Parekh also identified a third, often-overlooked group: the dual-use user. Mostly commonly between the ages of 25-34, dual users use cannabis for both medicinal and recreational purposes.
“Dual use was the most common pattern in our data, and as access to cannabis increases, this is the group to watch. Demographically, they look very different from the other populations,” Parekh said. “They also carry the heaviest burden of mental health distress and cigarette smoking.”
A Delaware snapshot
Though recreational marijuana was legalized in Delaware in 2023 and retail sales began just over a year ago, its use remains prohibited in certain places, including on University property and in public parks and spaces. Unpublished data analyzed by Parekh, drawn from Delaware's 2020–2021 BRFSS, which was conducted before the legal market opened, show similar patterns and provide a more detailed picture of cannabis use in the state. The BRFSS defines recreational use as cannabis used for non-medical purposes, regardless of its legal status.
The data show Delawareans who reported using cannabis in a month-long period weren’t just occasional users; nearly 60% used it on at least 11 days per month. Smoking was by far the most popular form of consumption at 74%, followed by edibles and vaping.
Among medicinal users, 84% have at least one chronic condition; 61% have arthritis; 49% have depression, and 42% reported struggling with their mental health for more than 10 days per month.
Nearly half of recreational users report binge drinking, compared with 42% of dual users. Among dual users, 44% also smoke cigarettes.
“The state mirrors the national pattern: recreational users who binge drink at nearly 50%, medicinal users carrying substantial chronic disease, and dual users reporting smoking and mental distress; these are the groups our health system needs to be ready for,” Parekh said.
Informing patient care
The findings highlight potential public health concerns and can help clinicians better understand what questions to ask patients about their cannabis use.
“As younger adults come into the health system, and we ask them about their cannabis use, we must also prompt them on their alcohol use,” said Parekh. “For those using both medicinally and recreationally, clinicians should probe about their mental health as well.”
For older adults using cannabis, the research raises other public health concerns.
“Older adults with multiple comorbidities could be prescribed multiple pain medications, and we must consider how those potentially interact with cannabis,” Parekh said.
But before public health policies are enacted, Parekh said significant data gaps must be addressed.
“While we have some of this data for Delawareans, to draw conclusions across the nation, we must fully understand why they use cannabis, how often, and what kind of products they’re using,” he said. “Understanding the content and concentration could lead to much different recommendations for treatment.”
Parekh said it also brings about questions on whether access to cannabis should continue to be expanded.
“If we are seeing rising mental health issues coupled with binge drinking and cigarette smoking, are we doing the right thing by expanding usage? Or do we need safeguards in place for higher-risk populations? These are the questions we should be asking,” Parekh said.
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