Adult Cannabis Use Pattern in a Rural Ohio Community

Cannabis legalization has increased use nationwide, yet data from rural populations remain limited. Understanding patterns, perceived harm, and self-reported adverse effects are relevant to Emergency Department (ED) practice. Rural data allows identification of disparities and informs practice among ED providers. This study aimed to characterize self-reported cannabis use among adult ED patients in a rural Ohio community.

We conducted a cross-sectional pilot survey in a rural academic ED with an annual census of 57,500 visits. Between May 27 and July 29, 2025, a convenience sample of 351 adults was recruited. The survey assessed cannabis use history, age of initiation, routes of use, perceived harm, and self-reported adverse effects. Descriptive statistics summarized results, including characteristics of past year users, lifetime users, and nonusers. Chi-square testing evaluated associations of categorical variables with outcomes (p<0.05).

Among 351 respondents, 224 (63.8%) reported lifetime cannabis use, 148 (42.1%) past-year use, and 101 (28.7%) past-30-day use. Among lifetime users, 60.3% initiated use before age 18, with earliest onset at 10 years. Nonusers were defined as both lifetime nonusers and those with use more than one year ago. Past-year users were more often male (54.1%) and younger than nonusers, with a mean age of 42.5 years (95% confidence interval 39.8 to 45.2) versus 51.8 years (95% CI, 49.2-54.5). Top reported motivations for use were recreational at 50.6% (95% CI, 42.6- 58.7), pain relief at 44.5% (95% CI, 36.6-52.6), anxiety at 43.2% (95% CI, 35.2-51.2), and insomnia at 42.5% (95% CI, 34.6-50.6). Smoking was the most common route (58.1%; 95% CI 50.1-66.1). Anxiety or paranoia was reported by 6.8% (95% CI 4.1-9.4), and cannabinoid hyperemesis syndrome by 4.1% of past-year users. Cannabis was perceived as beneficial by 46.7%, neutral by 38.1%, and harmful by 15.1%. Age of initiation was not associated with perceived harm (p=0.21).

Cannabis use among ED patients in this rural Ohio community reflects national patterns, including early initiation, smoking as the primary route, and generally favorable perceptions. Low perceived harm and infrequent self-reported adverse effects may contribute to continued use. These findings highlight the importance of ED-based screening, papatient education, and further rural-focused research.