Assessing Clinical Characteristics among Children Using Medical Marijuana in Florida Medicaid

Nicole E. Smolinski, PharmD, PhD
University of Florida

Co-authors: Matthew R. Muschett¹, Andrew T. Chamberlin¹, Yanning Wang¹, Jeevan Jyot¹, Md Mahmudul Hasan¹, Almut G. Winterstein^1
1University of Florida

Background: Medical marijuana (MMJ) was approved in Florida in 2017 for all ages including children. Comparison of clinical diagnoses and listed qualifying conditions has not been previously described among children.

Objective: To describe clinical diagnoses among pediatric MMJ users in Florida Medicaid.

Methods: Within the Medical Marijuana Outcomes Research Repository (MEMORY), we linked children age 1 and 17 years with MMJ certifications from 2017-2025 to Florida Medicaid claims data. We required 1 year of continuous medical and prescription coverage in Medicaid prior to certification. Among linked patients, we described the most common chronic clinical conditions listed on in in- and outpatient encounter claims using Clinical Classification Software Refined (CCSR) categories in the year before certification. Condition prevalences were further stratified by qualifying medical condition on the MMJ certification. Finally, we conducted latent class analysis to group patients based on clinical characteristics.

Results: We identified 1,465 MMJ pediatric patients with an MMJ certification linked to Florida Medicaid. The most common qualifying conditions were post-traumatic stress disorder (PTSD, 24.2%), epilepsy (19.3%), chronic nonmalignant pain (10.0%), and other similar conditions not specified (13.2%). The most common clinical diagnoses on medical encounters were autism spectrum disorder (37.5%), learning disorder (29.4%), any pain condition (28.5%), attention-deficit hyperactivity disorder (27.5%), any seizure disorder (25.5%), anxiety (23.3%), and epilepsy (21.9%). We were able to identify a potential indication based on approved conditions for medical marijuana across US MMJ programs for 82.9% of all patients. Latent class analysis identified four groups of patients based on their clinical history: seizure conditions (12.3%), mental health + pain (16.0%), autism spectrum disorder (33.3%), and miscellaneous (38.4%). Among pediatric patients qualified for PTSD or similar, the latent class analysis identified 4 groups: ASD + ADHD (29.7%), Mental Health + Pain (11.8%), Mental Health (11.9), and miscellaneous (46.6%).

Conclusion: In Florida, the number of children certified for MMJ use is small. Among Medicaid pediatric patients qualified for MMJ in Florida, we identified a variety of potential indications for use beyond those listed on the certification. Autism spectrum disorder, pain, epilepsy, and anxiety were most common diagnoses among pediatric MMJ users.