A new study finds that cannabis use disorder is prevalent among adults who use cannabis for medical or nonmedical reasons in Washington state, where recreational cannabis use is legal.
The research shows that over 20% of primary care patients who reported cannabis use met criteria for cannabis use disorder, with over 6% having moderate to severe disorder.
Patients using cannabis solely for nonmedical purposes were most at risk.
Key facts:
- Over 20% of primary care patients who used cannabis had some form of cannabis use disorder
- 6% had moderate to severe cannabis use disorder
- Patients using cannabis only for nonmedical reasons had the highest rates of moderate-severe disorder (7%)
- 13% of patients using cannabis solely for medical reasons met criteria for mild CUD.
Source: JAMA Netw Open 2023
What is cannabis use disorder?
Cannabis use disorder (CUD) is a diagnosable mental health condition involving problematic use of cannabis.
The key symptoms include:
- Using more cannabis than originally intended
- Being unable to cut back on use
- Spending significant time obtaining, using, or recovering from cannabis
- Cravings and urges to use cannabis
- Failure to fulfill major role obligations due to cannabis use
- Continuing use despite cannabis-related social or interpersonal problems
- Giving up important activities due to cannabis use
- Using cannabis in physically hazardous situations
- Continuing use despite cannabis-related physical or psychological problems
- Tolerance (needing more cannabis to achieve the same effect)
- Withdrawal symptoms after stopping use
CUD is diagnosed when a person exhibits at least two of these symptoms.
The more symptoms present, the more severe the disorder.
Having 2-3 symptoms constitutes mild CUD, 4-5 symptoms is moderate, and 6 or more is severe.
Cannabis use increasing with legalization
Cannabis use has steadily risen across the United States as more states legalize its medical and recreational use.
Currently 38 states allow medical cannabis and 23 states plus Washington DC have legalized recreational cannabis for adults 21 and older.
With increased use, rates of cannabis use disorder have also climbed.
It’s estimated that 17% of all cannabis users nationwide have CUD.
But less is known about how common CUD is among people living in states with legal recreational cannabis.
This new study aimed to determine the prevalence of CUD among adults using cannabis for medical and nonmedical purposes in Washington, where recreational cannabis use has been legal since 2012.
Looking at cannabis use disorder in Washington state
The study was conducted by researchers at Kaiser Permanente Washington, a large healthcare system in the state.
They surveyed a sample of 1,463 patients aged 18 and older who reported cannabis use when screened during routine primary care appointments.
Participants completed a validated questionnaire assessing them for DSM-5 criteria of cannabis use disorder.
They were also asked about their reasons for using cannabis – whether for medical purposes, nonmedical purposes, or both.
This allowed the researchers to compare rates of CUD among these groups.
Key findings from the cannabis study
The study found:
- 21% of all primary care patients who used cannabis met criteria for some level of CUD based on their symptoms
- 6% had moderate to severe CUD (4-11 symptoms)
- 13% of patients using just for medical reasons had mild CUD
- Only 1% of medical-only users had moderate/severe CUD
- 7% of nonmedical-only users had moderate/severe CUD
- 7% of those using for both medical and nonmedical reasons had moderate/severe CUD
The most common symptoms across all groups were tolerance, loss of control over use, and cravings.
But nonmedical users and those using for both reasons had higher rates of withdrawal, hazardous use, continuing use despite consequences, time spent using, and giving up activities.
These findings demonstrate that cannabis use disorder is common even in states where recreational cannabis is legal.
Roughly 1 in 5 adults who use cannabis – whether for medical, nonmedical or both reasons – exhibit signs of a problematic relationship with it.
Moderate to severe CUD was most prevalent among those reporting any nonmedical cannabis use.
But a sizeable percentage of medical-only users also showed mild disorder symptoms, indicating medicinal use does not preclude the development of CUD.
Cannabis use disorder – a concerning trend with legalization
With a growing number of states legalizing recreational cannabis, use is increasing nationwide.
The new study shows that alongside this rise in use, cannabis use disorder remains highly prevalent.
This highlights the importance of screening for CUD and providing education on safer use, even in states with legal access.
Healthcare providers should be assessing patients for cannabis use and warning about disorder risks.
Patients using for nonmedical purposes need information on moderating intake and handling cravings and withdrawal.
Those using for medical purposes need guidance on correct dosing and types of cannabis products to minimize disorder risk.
And all users exhibiting CUD symptoms need to be informed about treatment options.
References
- Study: Prevalence of Cannabis Use Disorder & Reasons for Use Among Adults in a U.S. State Where Recreational Cannabis Use is Legal
- Authors: Gwen T. Lapham et al. (2023)
