Prevalence of Cannabis Use Disorder and Reasons for Use Among Adults in a US State Where Recreational Cannabis Use Is Legal

Abstract

ImportanceMedical and nonmedical cannabis use and cannabis use disorders (CUD) have increased with increasing cannabis legalization. However, the prevalence of CUD among primary care patients who use cannabis for medical or nonmedical reasons is unknown for patients in states with legal recreational use.ObjectiveTo estimate the prevalence and severity of CUD among patients who report medical use only, nonmedical use only, and both reasons for cannabis use in a state with legal recreational use.Design, Setting, and ParticipantsThis cross-sectional survey study took place at an integrated health system in Washington State. Among 108 950 adult patients who completed routine cannabis screening from March 2019 to September 2019, 5000 were selected for a confidential cannabis survey using stratified random sampling for frequency of past-year cannabis use and race and ethnicity. Among 1688 respondents, 1463 reporting past 30-day cannabis use were included in the study.ExposurePatient survey–reported reason for cannabis use in the past 30 days: medical use only, nonmedical use only, and both reasons.Main Outcomes and MeasuresPatient responses to the Composite International Diagnostic Interview-Substance Abuse Module for CUD, corresponding to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition CUD severity (0-11 symptoms) were categorized as any CUD (≥2 symptoms) and moderate to severe CUD (≥4 symptoms). Adjusted analyses were weighted for survey stratification and nonresponse for primary care population estimates and compared prevalence of CUD across reasons for cannabis use.ResultsOf 1463 included primary care patients (weighted mean [SD] age, 47.4 [16.8] years; 748 [weighted proportion, 61.9%] female) who used cannabis, 42.4% (95% CI, 31.2%-54.3%) reported medical use only, 25.1% (95% CI, 17.8%-34.2%) nonmedical use only, and 32.5% (95% CI, 25.3%-40.8%) both reasons for use. The prevalence of CUD was 21.3% (95% CI, 15.4%-28.6%) and did not vary across groups. The prevalence of moderate to severe CUD was 6.5% (95% CI, 5.0%-8.6%) and differed across groups: 1.3% (95% CI, 0.0%-2.8%) for medical use, 7.2% (95% CI, 3.9%-10.4%) for nonmedical use, and 7.5% (95% CI, 5.7%-9.4%) for both reasons for use (P = .01).Conclusions and RelevanceIn this cross-sectional study of primary care patients in a state with legal recreational cannabis use, CUD was common among patients who used cannabis. Moderate to severe CUD was more prevalent among patients who reported any nonmedical use. These results underscore the importance of assessing patient cannabis use and CUD symptoms in medical settings.

Cannabis Use Reported by Patients Receiving Primary Care in a Large Health System

“…Our study found that among the 74.8% of patients who completed cannabis screening, nearly 1 in 5 adult primary care patients reported recent cannabis use, among whom a third were at moderate to high risk for CUD. These rates are higher than those among adults in the general population; however, our results are comparable with the small number of recent studies that have estimated cannabis use within health care settings . We also found that while a minority of patients reported using cannabis for strictly medical reasons, most of those who reported cannabis use reported using it to manage a specific health symptom.…”

“…These rates are higher than those among adults in the general population; however, our results are comparable with the small number of recent studies that have estimated cannabis use within health care settings. 1 , 16 , 31 , 32 We also found that while a minority of patients reported using cannabis for strictly medical reasons, most of those who reported cannabis use reported using it to manage a specific health symptom. This aligns with another study 29 that found that this type of cannabis use is clinically underrecognized, and without specifically screening for medical cannabis use, clinicians may not ask and patients often do not disclose their use.…”

“…This aligns with another study that found that this type of cannabis use is clinically underrecognized, and without specifically screening for medical cannabis use, clinicians may not ask and patients often do not disclose their use. As one of the first health systems to routinely ask about reasons for cannabis use, including health symptoms managed with cannabis, we provide a crucial point-of-care opportunity for clinicians to understand their patients’ risk for CUD given the association between reasons for cannabis use and the risk of disordered use …”

“…As one of the first health systems to routinely ask about reasons for cannabis use, including health symptoms managed with cannabis, we provide a crucial point-of-care opportunity for clinicians to understand their patients’ risk for CUD given the association between reasons for cannabis use and the risk of disordered use. 32 …”

Benefits and risks of cannabinoids

“…Cannabis use disorders are the primary contributor that cannabis use makes to the global burden of disease 11 and could increase the risk of further adverse cannabis outcomes because characteristic symptoms involve using more cannabis than intended, and difficulty controlling or cutting down use. 9 Given that cannabis use disorders are prevalent in people who use cannabis for medical as well as non-medical purposes, 12 preventing and treating CUDs should be a key focus in clinical practice and policies designed to maximise benefits and minimise risks.…”