Department of Epidemiology (in Psychiatry) (Hasin), Department of Epidemiology (Olfson, Keyes, Martins, Livne, Mannes), and Department of Psychiatry (Olfson), Columbia University, New York; New York State Psychiatric Institute, New York (Hasin, Olfson, Fink, Wall); VA Puget Sound Health Care System, Seattle (Saxon, Malte, Maynard); Department of Psychiatry and Behavioral Sciences (Saxon) and Department of Health Systems and Population Health (Maynard), University of Washington, Seattle; Department of Epidemiology, Boston University, Boston (Gradus); Department of Population Health, New York University, New York (Cerdá); San Francisco VA Health System and Division of General Internal Medicine, University of California at San Francisco (Keyhani); Department of Biostatistics (in Psychiatry), Columbia University Medical Center, New York (Wall).
Am J Psychiatry. 2022 Oct;179(10):748-757. doi: 10.1176/appi.ajp.22010034. Epub 2022 Jul 28.
In the United States, adult cannabis use has increased over time, but less information is available on time trends in cannabis use disorder. The authors used Veterans Health Administration (VHA) data to examine change over time in cannabis use disorder diagnoses among veterans, an important population subgroup, and whether such trends differ by age group (<35 years, 35-64 years, ≥65 years), sex, or race/ethnicity.
VHA electronic health records from 2005 to 2019 (range of Ns per year, 4,403,027-5,797,240) were used to identify the percentage of VHA patients seen each year with a cannabis use disorder diagnosis (ICD-9-CM, January 1, 2005-September 30, 2015; ICD-10-CM, October 1, 2015-December 31, 2019). Trends in cannabis use disorder diagnoses were examined by age and by race/ethnicity and sex within age groups. Given the transition in ICD coding, differences in trends were tested within two periods: 2005-2014 (ICD-9-CM) and 2016-2019 (ICD-10-CM).
In 2005, the percentages of VHA patients diagnosed with cannabis use disorder in the <35, 35-64, and ≥65 year age groups were 1.70%, 1.59%, and 0.03%, respectively; by 2019, the percentages had increased to 4.84%, 2.86%, and 0.74%, respectively. Although the prevalence of cannabis use disorder was consistently higher among males than females, between 2016 and 2019, the prevalence increased more among females than males in the <35 year group. Black patients had a consistently higher prevalence of cannabis use disorder than other racial/ethnic groups, and increases were greater among Black than White patients in the <35 year group in both periods.
Since 2005, diagnoses of cannabis use disorder have increased substantially among VHA patients, as they have in the general population and other patient populations. Possible explanations warranting investigation include decreasing perception of risk, changing laws, increasing cannabis potency, stressors related to growing socioeconomic inequality, and use of cannabis to self-treat pain. Clinicians and the public should be educated about the increases in cannabis use disorder in general in the United States, including among patients treated at the VHA.
在美国，成年人的大麻使用量随着时间的推移而增加，但关于大麻使用障碍的时间趋势的信息较少。作者使用退伍军人健康管理局 (VHA) 的数据，研究了退伍军人中大麻使用障碍诊断的随时间变化情况，这是一个重要的亚人群，以及这些趋势是否因年龄组（<35 岁、35-64 岁、≥65 岁）、性别或种族/族裔而异。
使用 VHA 从 2005 年到 2019 年（每年的 N 值范围，4403027-5797240）的电子健康记录，确定每年有多少 VHA 患者被诊断出患有大麻使用障碍（ICD-9-CM，2005 年 1 月 1 日至 2015 年 9 月 30 日；ICD-10-CM，2015 年 10 月 1 日至 2019 年 12 月 31 日）。通过年龄以及年龄组内的种族/族裔和性别，研究大麻使用障碍诊断的趋势。鉴于 ICD 编码的转变，在两个时期内测试了趋势差异：2005-2014 年（ICD-9-CM）和 2016-2019 年（ICD-10-CM）。
2005 年，<35 岁、35-64 岁和≥65 岁年龄组中被诊断患有大麻使用障碍的 VHA 患者比例分别为 1.70%、1.59%和 0.03%；到 2019 年，这一比例分别上升至 4.84%、2.86%和 0.74%。尽管男性中大麻使用障碍的患病率始终高于女性，但在 2016 年至 2019 年期间，女性中的患病率增长速度高于男性。黑人患者的大麻使用障碍患病率始终高于其他种族/族裔群体，在两个时期内，<35 岁年龄组中，黑人群体的患病率增长速度都快于白人。
自 2005 年以来，VHA 患者的大麻使用障碍诊断数量大幅增加，与一般人群和其他患者群体一样。值得调查的可能解释包括风险感知降低、法律变化、大麻效力增加、与不断扩大的社会经济不平等相关的压力以及使用大麻来自我治疗疼痛。在美国，包括在 VHA 接受治疗的患者在内，应向临床医生和公众宣传大麻使用障碍的普遍增加。
