Changes in marijuana use and associated attitudes and health behaviors among patients in HIV care in the U.S. in the post-legalization era: a qualitative study

We sought to understand the impact that state-level marijuana policy changes had on marijuana use behaviors among people with HIV (PWH), including patterns of use (e.g., frequency, modality), access, goals for use, use of other substances, and perceived health effects. We conducted 1:1 interviews at 3 U.S. HIV clinics with PWH aged ≥18 reporting weekly or more marijuana use; 2 clinics were in states that legalized recreational marijuana use. We coded interviews based on sub-topic areas of clinical interest. Among PWH (n=29, 80% cisgender male; mean age=50; 66% non-white), one-third reported increased use of marijuana products since legalization in their state, primarily related to exploring products for therapeutic needs. In legalized states, PWH reported easier product access. The most-cited therapeutic goals for use included relaxation/sleep (66%), appetite stimulation (41%), stress/anxiety relief (31%), and pain relief (28%), among others. Additionally, some reported marijuana helped maintain sobriety from other substances. In legalized settings, increased product diversity and attribute labeling facilitated decision-making, allowing individuals to tailor use to specific goals. Concern over the long-term impact of smoking marijuana was limited to respiratory effects, with no concerns regarding potential cognitive impacts of use, or effects from using edible formulations. Among a sample of PWH who use marijuana, the broad variety and availability of products following legalization increased use for a third of participants from affected states and was consistently described as offering a means for facilitating decision-making for targeted therapeutic use, including as an aid for sleep, anxiety, appetite, and pain, as well as minimization of craving alcohol and ‘harder’ substances. While the short-term benefits of using marijuana were clearly described, concern over long-term health effects was limited.