New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani).
Am J Psychiatry. 2024 Feb 1;181(2):144-152. doi: 10.1176/appi.ajp.20230168. Epub 2023 Nov 29.
Cannabis use disorder diagnoses are increasing among U.S. adults and are more prevalent among people with comorbid psychiatric disorders. Recent changes in cannabis laws, increasing cannabis availability, and higher-potency cannabis may have placed people with cannabis use and psychiatric disorders at disproportionately increasing risk for cannabis use disorder. The authors used Veterans Health Administration (VHA) data to examine whether trends in cannabis use disorder prevalence among VHA patients differ by whether they have psychiatric disorders.
VHA electronic health records from 2005 to 2019 (N range, 4,332,165-5,657,277) were used to identify overall and age-group-specific (<35, 35-64, and ≥65 years) trends in prevalence of cannabis use disorder diagnoses among patients with depressive, anxiety, posttraumatic stress, bipolar, or psychotic spectrum disorders and to compare these to corresponding trends among patients without any of these disorders. Given transitions in ICD coding, differences in trends were tested within two periods: 2005-2014 (ICD-9-CM) and 2016-2019 (ICD-10-CM).
Greater increases in prevalence of cannabis use disorder diagnoses were observed among patients with psychiatric disorders compared to those without (difference in prevalence change, 2005-2014: 1.91%, 95% CI=1.87-1.96; 2016-2019: 0.34%, 95% CI=0.29-0.38). Disproportionate increases in cannabis use disorder prevalence among patients with psychiatric disorders were greatest among those under age 35 between 2005 and 2014, and among those age 65 or older between 2016 and 2019. Among patients with psychiatric disorders, the greatest increases in cannabis use disorder prevalences were observed among those with bipolar and psychotic spectrum disorders.
The findings highlight disproportionately increasing disparities in risk of cannabis use disorder among VHA patients with common psychiatric disorders. Greater public health and clinical efforts are needed to monitor, prevent, and treat cannabis use disorder in this population.
美国成年人的大麻使用障碍诊断数量正在增加，并且在患有合并精神疾病的人群中更为普遍。最近大麻法律的变化、大麻供应的增加以及高浓度大麻的出现，可能使患有大麻使用障碍和精神疾病的人面临不成比例的增加风险。作者使用退伍军人健康管理局 (VHA) 的数据，研究 VHA 患者中大麻使用障碍的流行率趋势是否因他们是否患有精神疾病而有所不同。
使用 VHA 的电子健康记录（2005 年至 2019 年，N 范围为 4332165 至 5657277），确定患有抑郁、焦虑、创伤后应激、双相或精神病谱系障碍的患者中，大麻使用障碍诊断的总体和年龄组（<35 岁、35-64 岁和≥65 岁）流行率趋势，并将这些趋势与没有这些疾病的患者的相应趋势进行比较。鉴于 ICD 编码的转变，在两个时期内测试了趋势的差异：2005-2014 年（ICD-9-CM）和 2016-2019 年（ICD-10-CM）。
与没有精神疾病的患者相比，患有精神疾病的患者中大麻使用障碍诊断的流行率增加幅度更大（2005-2014 年，流行率变化差异：1.91%，95%CI=1.87-1.96；2016-2019 年，0.34%，95%CI=0.29-0.38）。2005 年至 2014 年间，年龄在 35 岁以下的患者以及 2016 年至 2019 年间年龄在 65 岁或以上的患者中，患有精神疾病的患者中大麻使用障碍流行率的不成比例增加最为明显。在患有精神疾病的患者中，双相和精神病谱系障碍患者的大麻使用障碍流行率增加幅度最大。
这些发现强调了退伍军人健康管理局患有常见精神疾病的患者中，大麻使用障碍风险不成比例地增加。需要更大的公共卫生和临床努力来监测、预防和治疗这一人群中的大麻使用障碍。
