Table of Contents
- Who Uses Cannabis Medically in Australia — and Who Uses It for Both?
- Why This Matters
- Clinical Summary
- Dr. Caplan’s Take
- Clinical Perspective
- What Kind of Evidence Is This
- How This Fits With the Broader Literature
- Common Misreadings
- Bottom Line
- Frequently Asked Questions
- How many Australians use cannabis for both medical and recreational reasons?
- Does this study prove that cannabis is effective for chronic pain?
- Are dual-use consumers getting their cannabis from doctors?
- Should people who use cannabis recreationally and medically be concerned about health risks?
- What does this mean for Australia’s medicinal cannabis regulations?
Who Uses Cannabis Medically in Australia — and Who Uses It for Both?
New national survey data reveal that dual-use cannabis consumers, those reporting both medical and recreational motivations, are a distinct and growing group in Australia, raising important questions about whether existing medicinal cannabis policy frameworks can adequately account for overlapping patterns of use.
Why This Matters
Australia’s medicinal cannabis prescribing landscape has expanded dramatically in recent years, with the Therapeutic Goods Administration approving hundreds of thousands of prescriptions annually. Yet the policy architecture still treats medical and recreational cannabis use as neatly separable categories. Understanding who actually uses cannabis, and why, is essential for designing regulation that reflects real-world consumption patterns. This nationally representative dataset arrives at a moment when the gap between clinical access and population-level use patterns is widening, making the question of dual-use both timely and consequential for clinicians, regulators, and patients.
Clinical Summary
Cannabis use in Australia spans a spectrum from strictly recreational to strictly medical, but a substantial proportion of users occupy an intermediate space. Using data from the 2022/2023 Australian National Drug Strategy Household Survey (NDSHS), Chiu and colleagues published a brief report analyzing 21,663 respondents drawn through stratified, multistage random sampling of Australian residents aged 14 and older. The study employed multinomial logistic regression to compare three mutually exclusive motive categories: recreational-only, medical-only, and dual-use. The mechanistic rationale for separating these groups lies in the observation that medical motivations, particularly for chronic pain, may drive fundamentally different consumption behaviors, source preferences, and risk profiles compared with recreational motivations alone.
The survey estimated that 8.6% of respondents used cannabis recreationally only, 1.9% for dual purposes, and 1.0% for medical purposes only. Chronic pain emerged as the strongest clinical correlate of both medical-only use (relative risk ratio 8.10, p less than 0.001) and dual-use (RRR 5.17, p less than 0.001) relative to recreational-only use. Obtaining cannabis via prescription was strongly associated with medical-only motives over dual-use motives (RRR 10.55), suggesting that formal prescribing channels predominantly serve strictly medical users while many dual-use consumers obtain cannabis through other means. Key limitations include the cross-sectional design, which prevents causal inference, self-reported motives and diagnoses that may introduce classification bias, and a 43.9% response rate that raises non-response concerns. The authors emphasize that research on harms associated with dual-use should be prioritized as prescribing access broadens.
Dr. Caplan’s Take
This study confirms something I see regularly in clinical practice: the line between medical and recreational cannabis use is often blurry, and patients themselves may not draw that line where we expect them to. The finding that dual-use consumers outnumber medical-only users nearly two to one is striking, and it should give pause to anyone who assumes that prescribing frameworks alone define the medical cannabis landscape. The chronic pain signal is unsurprising given prescribing trends, but it reinforces that pain remains the primary clinical driver of cannabis-motivated use regardless of whether it occurs inside or outside formal medical channels.
In practice, I approach patients who report cannabis use for symptom management with curiosity rather than assumption. I ask about their sources, their dosing patterns, and whether their use has shifted over time from recreational to therapeutic or vice versa. This study does not change prescribing decisions directly, but it does underscore the need for honest, nonjudgmental conversations about how patients actually use cannabis, not just how policy assumes they do.
Clinical Perspective
This study sits early in the research arc for understanding dual-use as a distinct behavioral category. It builds on prior NDSHS analyses that used a simpler binary classification and extends them by demonstrating that dual-use consumers differ meaningfully from both recreational-only and medical-only users in their clinical profiles and consumption frequency. The evidence supports the conclusion that dual-use is not a trivial edge case but a population-level phenomenon that current policy does not adequately address. However, the cross-sectional design means we cannot determine whether medical motivations developed before, during, or after recreational use, a critical gap for informing clinical guidance.
From a safety standpoint, the finding that greater frequency of cannabis use is more strongly associated with dual-use than recreational-only motives warrants clinical attention. Higher frequency use carries known risks including cannabis use disorder, cognitive effects, and drug interactions, particularly with sedatives, anticoagulants, and CYP-metabolized medications. Clinicians prescribing medicinal cannabis should routinely ask about concurrent non-prescribed cannabis use, as the dual-use pattern may alter both the risk profile and the therapeutic window. One actionable step is to incorporate a structured question about recreational cannabis use into every medicinal cannabis review consultation.
What Kind of Evidence Is This
This is a cross-sectional epidemiological brief report using weighted survey data from Australia’s primary national drug surveillance instrument, the NDSHS. Cross-sectional studies occupy the descriptive tier of the evidence hierarchy, capable of establishing prevalence estimates and identifying associations but unable to demonstrate causation or temporal ordering. The single most important inference constraint is that we cannot determine whether reported health conditions preceded, followed, or merely co-occurred with cannabis use motives, making it impossible to conclude that any specific condition drives cannabis use.
How This Fits With the Broader Literature
This study extends prior work by Chiu and colleagues using the 2019 NDSHS, which first explored medical motivations for cannabis use in Australia but relied on a binary classification. The current analysis introduces the three-category framework and confirms that the dual-use group is both larger and distinct from medical-only users. Internationally, findings align with large U.S. survey data showing substantial overlap between medical and recreational cannabis use, including work from the National Survey on Drug Use and Health, where dual-use prevalence similarly exceeds medical-only use in jurisdictions with medical cannabis programs.
The chronic pain finding is consistent with both Australian Therapeutic Goods Administration prescribing data and international cohort studies identifying pain as the leading self-reported reason for medicinal cannabis use. However, the strong association between prescription source and medical-only (but not dual-use) motives is a relatively novel contribution, suggesting that Australia’s regulated prescribing pathway may be functioning as intended for a specific subset of users while leaving dual-use consumers largely outside its reach.
Common Misreadings
The most likely overinterpretation is to conclude that dual-use cannabis consumers are self-medicating effectively and therefore represent unmet demand for medicinal cannabis prescriptions. The cross-sectional design cannot establish whether these individuals’ medical motivations reflect genuine therapeutic benefit, placebo response, or retrospective justification for existing recreational use. Similarly, the strong association between chronic pain and medically motivated use should not be read as evidence that cannabis is an effective pain treatment in this population. The study measures motives, not outcomes, and the absence of clinical confirmation of self-reported diagnoses adds further uncertainty to any claims about therapeutic appropriateness.
Bottom Line
This nationally representative survey establishes that dual-use cannabis consumers outnumber medical-only users in Australia and represent a distinct group with higher consumption frequency and strong chronic pain associations. It does not establish whether dual-use reflects genuine therapeutic need, nor whether these consumers benefit from or are harmed by their use patterns. For clinical practice today, the main takeaway is that the binary medical-versus-recreational framework does not reflect population reality, and clinicians should proactively explore overlapping motivations in patients who use cannabis.
Frequently Asked Questions
How many Australians use cannabis for both medical and recreational reasons?
According to the 2022/2023 National Drug Strategy Household Survey, approximately 1.9% of respondents reported dual-use cannabis consumption, meaning they used cannabis for both medical and recreational purposes in the past 12 months. This is roughly double the 1.0% who reported using cannabis for medical reasons only, suggesting that the dual-use pattern is more common than many assume.
Does this study prove that cannabis is effective for chronic pain?
No. The study found that chronic pain was the health condition most strongly associated with medically motivated cannabis use, but it measured self-reported motives, not treatment outcomes. It cannot tell us whether cannabis actually reduced pain in these individuals. Separate clinical trials are needed to evaluate efficacy, and existing trial evidence for cannabis and chronic pain remains mixed and condition-dependent.
Are dual-use consumers getting their cannabis from doctors?
The data suggest that most dual-use consumers are not obtaining cannabis through formal prescribing channels. The study found that having a prescription source was strongly associated with medical-only use (relative risk ratio of 10.55 compared with dual-use), indicating that prescription pathways predominantly serve those who use cannabis strictly for medical reasons. Many dual-use consumers likely obtain their cannabis through informal or illicit channels.
Should people who use cannabis recreationally and medically be concerned about health risks?
The study found that dual-use consumers tended to use cannabis more frequently than recreational-only users. Higher frequency of cannabis use is independently associated with increased risk of cannabis use disorder, cognitive impairment, and respiratory issues if smoked. If you are using cannabis for a health condition alongside recreational use, discussing this openly with a healthcare provider can help identify potential risks and explore whether a supervised, dosage-controlled approach might be more appropriate.
What does this mean for Australia’s medicinal cannabis regulations?
The study highlights a policy gap. Australia’s current medicinal cannabis framework is built around a clear distinction between medical and recreational use, but population data show that nearly twice as many people occupy the overlapping category as the strictly medical one. The authors recommend that future policy and research address dual-use as its own category rather
