(162) Adult Cannabis Usage Pattern in a Rural Ohio Community

Background &

Introduction: Cannabis use has increased substantially in the United States following widespread legalization; however, research has largely centered on urban populations. Rural communities, including those in Ohio and West Virginia, face unique challenges such as limited access to addiction services, underdeveloped harm reduction programs, and minimal public education regarding substance use. In West Virginia, 68.1% of trauma patients tested positive for at least one drug, with cannabis among the most common substances detected (Mansoor et al., 2023). Such trends emphasize the importance of monitoring substance use in rural populations to inform prevention and trauma management strategies. Although most cannabis research examines recreational or urban cohorts, emerging data reveal diverse motivations for use. In Alberta, Canada, 34% of women aged ≥35 reported cannabis use, primarily for medical purposes such as pain, anxiety, and sleep relief (Babyn et al., 2023). Nevertheless, neuroimaging studies indicate that tetrahydrocannabinol (THC) and THC+CBD formulations disrupt neural networks involved in executive control and memory (Ertl et al., 2024), and up to 50% of daily users develop cannabis use disorder (Saura et al., 2024). This study aimed to characterize cannabis usage patterns, perceptions, and health-related behaviors among adults in a rural Ohio community.

Methods: A cross-sectional pilot survey was conducted at Mercy Health St. Rita’s Medical Center, a rural academic hospital with an annual emergency department census of approximately 57,500 visits. Data collection occurred between June 1 and July 8, 2025. A convenience sample of 351 adult patients (≥18 years) was recruited. Participation was voluntary and anonymous, and Institutional Review Board (IRB) approval was obtained prior to study initiation. The survey instrument included questions on demographic characteristics, age of first cannabis use, routes of administration (smoking, edibles, vaping/dabbing, or other), frequency and reasons for use, perceived benefits or harms, and adverse effects experienced. Participants also reported any history of CHS or cannabis-related medical visits. Data was analyzed using descriptive statistics to summarize demographic and behavioral patterns. Chi-square (χ²) testing assessed relationships between categorical variables such as age of initiation, route of use, and perceived harm. Statistical significance was defined as p< 0.05.
Abbreviations: ED = Emergency Department; THC = tetrahydrocannabinol; CHS = Cannabinoid Hyperemesis Syndrome.

Results: Of 351 respondents, 101 (28.7%) reported cannabis use within the past 30 days. Among lifetime users, 60.3% initiated use before age 18, with the earliest reported onset of 10 years. The mean age of participants was 42.5 years (95% confidence interval 39.8 to 45.2) versus 51.8 years (95% CI, 49.2-54.5)
The most common routes of administration were smoking (58.1%; 95% confidence interval 50.1-66.1), edibles (20.5%), and vaping/dabbing (11.5). 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), closely aligning with the patterns observed among adult women using cannabis therapeutically in Alberta (Babyn et al., 2023).
Perceptions of cannabis were largely favorable: 46.7% rated cannabis as beneficial, 38.1% neutral, and 15.1% harmful. Anxiety or paranoia was reported by 6.8% (95% confidence interval 4.1-9.4), and cannabinoid hyperemesis syndrome by 4.1% of past-year users. No statistically significant differences were observed between age of initiation and perceived harm (p=0.21).
These findings parallel national data indicating rising normalization and decreased perceived risk of cannabis use, even among populations with limited access to mental health or addiction resources.

Conclusion &

Discussion: The present study demonstrates that cannabis use is highly prevalent among adults in rural Ohio, consistent with national patterns of early initiation, smoking predominance, and low perceived harm. Although cannabidiol (CBD) exhibits therapeutic promise in pain management and inflammation (Brazeau et al., 2025), unregulated and recreational use remains widespread in underserved rural areas with limited clinical oversight. Comparative data from West Virginia trauma populations, where substance positivity exceeded 68% (Mansoor et al., 2023), reinforce the broader burden of substance exposure in rural regions. Moreover, concurrent cannabis and tobacco use has been associated with greater withdrawal severity and reduced cessation success (Saura et al., 2024), a trend that may be underrecognized in these communities. Neuroimaging evidence indicates that combined tetrahydrocannabinol (THC) and CBD formulations may disrupt executive and limbic network connectivity (Ertl et al., 2024), potentially contributing to the anxiety and paranoia reported by study participants.
Overall, these findings highlight the need for targeted public health interventions that promote safe use practices, early intervention, and education regarding potential cognitive and psychiatric sequelae. Future research should expand to larger rural cohorts and incorporate qualitative analyses to inform equitable, evidence-based addiction treatment strategies.

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