Addiction Recovery and Treatments Services, San Francisco VA Health Care System, San Francisco, CA, USA.
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.
BMC Psychiatry. 2023 Mar 17;23(1):177. doi: 10.1186/s12888-023-04648-5.
Cannabis is marketed as a treatment for pain. There is limited data on the prevalence of cannabis use and its correlates among Veterans prescribed opioids.
To examine the prevalence and correlates of cannabis use among Veterans prescribed opioids.
Cross-sectional study.
Veterans with a urine drug test (UDT) from Primary Care 2014-2018, in 50 states, Washington, D.C., and Puerto Rico. A total of 1,182,779 patients were identified with an opioid prescription within 90 days prior to UDT.
Annual prevalence of cannabis positive UDT by state. We used multivariable logistic regression to assess associations of demographic factors, mental health conditions, substance use disorders, and pain diagnoses with cannabis positive UDT.
Annual prevalence of cannabis positive UDT ranged from 8.5% to 9.7% during the study period, and in 2018 was 18.15% in Washington, D.C. and 10 states with legalized medical and recreational cannabis, 6.1% in Puerto Rico and 25 states with legalized medical cannabis, and 4.5% in non-legal states. Younger age, male sex, being unmarried, and marginal housing were associated with use (p < 0.001). Post-traumatic stress disorder (adjusted odds ratio [AOR] 1.17; 95% confidence interval [CI] 1.13-1.22, p < 0.001), opioid use disorder (AOR 1.14; CI 1.07-1.22, p < 0.001), alcohol use disorder or positive AUDIT-C (AOR 1.34; 95% CI 1.28-1.39, p < 0.001), smoking (AOR 2.58; 95% CI 2.49-2.66, p < 0.001), and other drug use disorders (AOR 1.15; 95% CI 1.03-1.29, p = 0.02) were associated with cannabis use. Positive UDT for amphetamines AOR 1.41; 95% CI 1.26-1.58, p < 0.001), benzodiazepines (AOR 1.41; 95% CI 1.31-1.51, p < 0.001) and cocaine (AOR 2.04; 95% CI 1.75-2.36, p < 0.001) were associated with cannabis positive UDT.
Cannabis use among Veterans prescribed opioids varied by state and by legalization status. Veterans with PTSD and substance use disorders were more likely to have cannabis positive UDT. Opioid-prescribed Veterans using cannabis may benefit from screening for these conditions, referral to treatment, and attention to opioid safety.
大麻被宣传为治疗疼痛的药物。在开处阿片类药物的退伍军人中，大麻使用的流行率及其相关因素的数据有限。
研究开处阿片类药物的退伍军人中大麻使用的流行率及其相关因素。
横断面研究。
2014 年至 2018 年期间，50 个州、华盛顿特区和波多黎各初级保健中心进行尿液药物检测（UDT）的退伍军人。共有 1182779 名患者在 UDT 前 90 天内开处了阿片类药物处方。
按州划分的大麻阳性 UDT 的年度流行率。我们使用多变量逻辑回归来评估人口统计学因素、心理健康状况、物质使用障碍和疼痛诊断与大麻阳性 UDT 的关联。
在研究期间，大麻阳性 UDT 的年度流行率范围为 8.5%至 9.7%，2018 年华盛顿特区和 10 个大麻医用和娱乐用合法化的州为 18.15%，波多黎各和 25 个医用大麻合法化的州为 6.1%，非合法化的州为 4.5%。年龄较小、男性、未婚和边缘性住房与使用相关（p<0.001）。创伤后应激障碍（调整后的优势比[OR]1.17；95%置信区间[CI]1.13-1.22，p<0.001）、阿片类药物使用障碍（OR 1.14；CI 1.07-1.22，p<0.001）、酒精使用障碍或阳性 AUDIT-C（OR 1.34；CI 1.28-1.39，p<0.001）、吸烟（OR 2.58；CI 2.49-2.66，p<0.001）和其他药物使用障碍（OR 1.15；CI 1.03-1.29，p=0.02）与大麻使用相关。安非他命阳性 UDT 的优势比（OR）为 1.41；95%置信区间（CI）为 1.26-1.58，p<0.001）、苯二氮䓬类药物（OR 1.41；CI 1.31-1.51，p<0.001）和可卡因（OR 2.04；CI 1.75-2.36，p<0.001）与大麻阳性 UDT 相关。
开处阿片类药物的退伍军人中，大麻的使用情况因州和合法化情况而异。患有创伤后应激障碍和物质使用障碍的退伍军人更有可能出现大麻阳性 UDT。使用大麻的开处阿片类药物的退伍军人可能受益于对这些疾病的筛查、转介治疗以及对阿片类药物安全性的关注。
