Demographics

4117 individual applicants were seen on as many as four occasions between November 2001 and June 30, 2007. All were seeking a physicians' approval of their use of cannabis; 3187 (77.4%), were male, ranging in age from 16 to 91 when first seen (median age 31). 930 (22.6%) were female, ranging in age from 16 to 89, with a median age of 36. The median age of the entire population was 32, reflecting both the smaller number of females and their somewhat greater age when first seen.

Table 1 shows race/ethnicity for the entire population. Analysis by year-of-birth (Table 2) reveals more Asians and Hispanics among the younger applicants, reflecting the two groups that have been immigrating to California in the greatest numbers in recent years. Analysis by both age and race also revealed other differences.

Table 1 Race/ethnicity of entire population (N = 3515). As subsequently shown by a more searching analysis, the composition of the applicant population has been changing steadily. Full size table

Table 2 Cohort analysis of race/ethnicity (N = 3185). Analysis of racial composition by year of birth cohorts also shows that the applicant population has reflected immigration trends. Full size table

Tables 3 and 4 summarize educational and occupational histories; Table 5 provides data on applicants who were unemployed when first seen. Overall, this population exhibited lower High School drop out rates and higher percentage of graduates than national averages. The percentages earning Bachelors' degrees and Doctorates are nearly identical to the national average, but only about one half as many had earned Masters' degrees.

Table 3 Highest Education Attainment over 25, Applicants compared to US Population (N = 936). In general, cannabis applicants compared favourably with national averages. Full size table

Table 4 Occupational divisions for employment for applicants and US population (N = 2092). The two groups are quite similar with the exception of Construction and Extraction, Office and Administrative Support, which are gender specific professions. Full size table

Table 5 Non-occupational divisions for applicants and US population (N = 494) The two groups are quite similar except for the relative scarcity of retirees in the applicant population. Full size table

Their occupations resembled US averages in some employment areas and were quite different in others (Table 4); in terms of non-occupational divisions (Table 5), a much smaller percentage are retirees, a finding that reflects both their relative youth and the paucity of applicants born before 1946.

Although the extremes of applicant age ranged from 16 to 91, only 3 were under 18 when first seen. The great majority (84.16%) were between 21 and 60, a finding further emphasized when the population is examined by year of birth (Table 6), a perspective that also discloses how few (4.53%) had been born before 1946. The overall male female ratio was nearly four to one (Table 7); however when examined as year of birth cohorts, it varies from over 5:1 for the youngest applicants to almost 3:1 for the oldest. Nearly 70% were Caucasians and 16% were Black, with sizable numbers of Hispanics and Asians (Table 1).

Table 6 Distribution by year of birth cohorts (N = 3946). This further emphasizes that one's birth cohort determines what drugs one can try during adolescence. Full size table

Table 7 Birth cohorts and gender (N = 3906). Although women were outnumbered by men in each cohort, there were significant differences noted with age. Full size table

Initiation and use of cannabis

An overwhelming majority (87.9%) of 3038 applicants queried about the details of their cannabis initiation had tried it before the age of 19, usually in the company of older siblings, cousins or peers. After subtracting those born before 1946, the percentage of applicants who had tried marijuana before the age of twenty went up to 90%. Some became regular users almost immediately, while others remained sporadic users for years (that interval was estimated by asking them when they first began to "buy their own").

Amounts and patterns of cannabis use

Essentially all applicants queried about their current use were consuming inhaled cannabis on a regular basis in amounts that varied considerably, but tended to remain stable over time. The range is from less than one sixteenth ounce per week to over one ounce, with about 70% estimating they consume between 1/8 and 1/4 oz./week. Almost 90% acknowledge daily, or near daily ("six days a week") use, with about 10% insisting their use is far less frequent, in the range of two to five days/week.

Mode of cannabis use

There was a decided preference for inhaled cannabis. Most had not tried edibles until their own recommendation, or that of a friend, gave them access to edibles from a club or dispensary. Only 50 of 830 (6%) questioned about edibles were using them on a regular basis. The reasons given were that edible effects were more difficult to control and more likely to be undesirable and/or prolonged.

Initiation and use of tobacco and alcohol

One of the more significant patterns revealed by comparing average initiation ages for cannabis, alcohol and tobacco within the context of birth cohorts was that the oldest Baby Boomers had tried cannabis at a considerably later age than their younger successors. By 1975, less than ten years after the "Summer of Love," in 1967, cannabis was being initiated by over half of all American adolescents at close to the same average ages they also were trying alcohol and tobacco (Table 8, Figure 1).

Table 8 Average initiation ages for entry level agents (N = 2498). This table is depicted by Figure 1 and emphasizes the rapid fall in age at initiation of cannabis after it first became available in high schools. Full size table

Figure 1 Average initiation age tobacco, alcohol and cannabis. Those born before 1940 were fewest in number; they had also tried cannabis at the oldest average age. Baby Boomers born after 1946 were the first large cohort, and their successors were still younger when they tried cannabis. The 61–65 cohort initiated cannabis, alcohol, and tobacco at essentially the same average age. Full size image

Essentially all applicants also admitted to trying alcohol. Nearly two thirds (64.3%) of the 1226 specifically queried about alcohol blackouts had experienced at least one and 6.26% admitted to four or more. Of 1214 applicants asked to compare their current alcohol consumption with their previous lifetime peak, 130 (10.7%) claimed to be abstinent, 341 (28%) said they were drinking less than 5% of their lifetime peaks, and an overwhelming 1058 (87%) claimed to be drinking less than half as much. Most of those who noted little change from their lifetime peaks had been moderate drinkers to begin with. This is evidence that once cannabis was established as their drug of choice, this population's subsequent alcohol consumption diminished; both collectively, and as individuals, a finding that clearly deserves further evaluation.

A history of cigarette initiation, later followed by chronic use, was prevalent in this population. 2559 of 2741 (96.4%) applicants, when asked if they had ever tried inhaling a cigarette, had done so; of 1324 who were specifically queried about their lifetime cigarette use, 872 (65.8%) had become daily smokers for some length of time. Although all but four of those still smoking claim they want to quit, only 316 (36.2%) of all smokers (23.9% of respondents) had been able to do so by the time of the interview. Most who are still smoking have reduced their daily cigarette consumption; a majority relate temporary increases in their daily cigarette use to "stress." Thus the impact of daily cannabis use on cigarette consumption, although less impressive than is the case with alcohol, also seems significant and worthy of further exploration.

Other drug initiations

When examined from the standpoint of both year of birth (YOB) cohorts and admitted initiations of other illegal agents (Table 9, Figure 2) noticeable and consistent differences are revealed: whites in every age cohort had consistently tried all other illegal agents more frequently than other racial groups (Table 10).

Table 9 Initiation rates for other illegal drugs by YOB cohorts (N = 2364). With the exception of "magic mushrooms," and ecstasy (a psychedelic made illegal in 1988), initiation rates for all Schedule One drugs have declined since 1975. Full size table

Table 10 Initiations of other illegal drugs by race (N=2400). Although race seems related to initiation rates throughout, this shows that drug initiations by all aces trying cannabis have been falling proportionately as the adolescent market matured. Full size table

Figure 2 Other illegal drugs tried by 10 year cohort analysis. Interestingly, while all cohorts sampled other illegal drugs aggressively during adolescence, the rates at which they've done so have fallen progressively. Note also the striking generational differences in peyote/mescaline initiations by older cohorts and ecstasy by younger ones. Full size image

Further cohort analysis of this population's adolescent interest in other illegal drugs, plus its nearly universal initiation of alcohol and tobacco, suggest that while race (Table 10), and generation (Table 9) exert significant influences, gender merely parallels ethnicity (Table 11).

Table 11 Initiations of Other Illegal Drugs by Gender (N=2464). Similarly, although women consistently tried all agents somewhat less often than men, the close parallels and internal consistency suggests the data are reliable. Full size table

Despite such differences (Tables 9 &10), all cohorts and racial groups have shown steady downward trends in their initiation of all other illegal drugs, with the interesting exception of psychedelic mushrooms (psilocybin) and, perhaps, ecstasy (MDMA).