Kaiser Permanente Washington Health Research Institute, Seattle.
Department of Health Systems and Population Health, University of Washington, Seattle.
JAMA Netw Open. 2023 Aug 1;6(8):e2328934. doi: 10.1001/jamanetworkopen.2023.28934.
Medical 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.
To 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 PARTICIPANTS: This 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.
Patient survey-reported reason for cannabis use in the past 30 days: medical use only, nonmedical use only, and both reasons.
Patient 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.
Of 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).
In 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.
随着大麻合法化的不断推进，医疗和非医疗用大麻的使用以及大麻使用障碍（CUD）的发生率都有所增加。然而，对于在有合法娱乐性使用大麻的州中，因医疗或非医疗原因使用大麻的初级保健患者中 CUD 的患病率尚不清楚。
评估在一个有合法娱乐性使用大麻的州中，报告仅因医疗原因、仅因非医疗原因或同时因这两种原因使用大麻的患者中 CUD 的患病率和严重程度。
设计、地点和参与者：这项横断面调查研究在华盛顿州的一个综合医疗系统中进行。在 2019 年 3 月至 9 月期间接受常规大麻筛查的 108950 名成年患者中，采用分层随机抽样方法，根据过去一年中大麻使用的频率和种族与民族，选择了 5000 名患者进行机密性的大麻调查。在 1688 名受访者中，有 1463 名报告过去 30 天内使用过大麻，被纳入了本研究。
患者在过去 30 天内使用大麻的报告原因：仅因医疗原因、仅因非医疗原因，以及两者兼有。
患者对国际诊断访谈-物质滥用模块（用于 CUD）的回答，与《精神障碍诊断与统计手册》第 5 版 CUD 严重程度（0-11 个症状）相对应，分为存在任何 CUD（≥2 个症状）和中重度 CUD（≥4 个症状）。调整后的分析考虑了调查分层和初级保健人群估计的非应答情况，并比较了不同原因使用大麻的 CUD 患病率。
在 1463 名纳入的初级保健患者（加权平均[SD]年龄，47.4[16.8]岁；748[加权比例，61.9%]为女性）中，42.4%（95%CI，31.2%-54.3%）报告仅因医疗原因使用大麻，25.1%（95%CI，17.8%-34.2%）报告仅因非医疗原因使用大麻，32.5%（95%CI，25.3%-40.8%）报告同时有这两个原因。CUD 的患病率为 21.3%（95%CI，15.4%-28.6%），且在各组之间无差异。中重度 CUD 的患病率为 6.5%（95%CI，5.0%-8.6%），且在各组之间有所不同：因医疗原因使用的患病率为 1.3%（95%CI，0.0%-2.8%），因非医疗原因使用的患病率为 7.2%（95%CI，3.9%-10.4%），同时因这两个原因使用的患病率为 7.5%（95%CI，5.7%-9.4%）（P=0.01）。
在这项对有合法娱乐性使用大麻的州中初级保健患者的横断面研究中，CUD 在使用大麻的患者中很常见。报告有任何非医疗用途的患者中，中重度 CUD 的患病率更高。这些结果强调了在医疗环境中评估患者大麻使用情况和 CUD 症状的重要性。
