AUGUST 12, 2024
Primary care patients who use cannabis to manage symptoms are at risk for cannabis use disorder (CUD), according to a study from a university-based health system in Los Angeles.
The cross-sectional study (JAMA Netw Open 2024;7[6]:e241480) presents the results of an electronic health records analysis between January 2021 and May 2023. Outcomes of interest included cannabis use in the past three months and moderate to high risk for CUD, according to the study, which validated results and created
Primary care patients who use cannabis to manage symptoms are at risk for cannabis use disorder (CUD), according to a study from a university-based health system in Los Angeles.
The cross-sectional study (JAMA Netw Open 2024;7[6]:e241480) presents the results of an electronic health records analysis between January 2021 and May 2023. Outcomes of interest included cannabis use in the past three months and moderate to high risk for CUD, according to the study, which validated results and created algorithms using the Alcohol Substance Involvement Screening Test (ASSIST).
“ASSIST assesses risk of substance use disorder. We used a cutoff score of 8 and above to classify those at moderate to high risk of CUD,” said author Marjan Javanbakht, MPH, PhD, an adjunct professor at the University of California, Los Angeles Fielding School of Public Health. “This is a more conservative cutoff, as we wanted to ensure we are identifying those who are not only frequent users but experiencing social and/or health consequences of use.”
Researchers screened 175,734 patients to find 29,898 (17%) who reported cannabis use in the past three months. More than 31% used cannabis for medical and nonmedical purposes—with almost 76% managing symptoms including pain, stress and sleep problems.
More men than women used cannabis (20% vs. 14.7%), with those aged 18 to 29 years reporting more frequent use (31%) than those 60 years and older (8.5%). More than 17% of those in the least socioeconomically disadvantaged neighborhoods used cannabis, compared with almost 14% in worse areas.
“Little is known about cannabis use among clinical populations, especially the reasons why patients are using cannabis,” Javanbakht said.
Indeed, the study noted that few health systems screen patients routinely for cannabis use. It deems screening essential to healthcare providers.
Desimir Mijatovic, MD, a pain medicine physician at Cleveland Clinic’s Center for Spine Health, listed the ways pain medicine providers can screen for cannabis use.
“While screening for medical versus nonmedical use can be difficult, there are a few tools that can be helpful. Talking to the patient as well as using questionnaires can differentiate medical versus nonmedical use. In most states, you can see if there is a record of prescriptions, dispensary sales or other methods of obtaining medical cannabis. These records and databases can identify medical uses,” Mijatovic said.
Limitations cited by the study include self-reported data; screening during COVID-19 restrictions, which may have increased cannabis use; and selecting patients from a large healthcare center.
Mijatovic called the study limitations “very common. Screening during COVID is a big limitation because the pandemic may have influenced cannabis use in people due to the drastic change in lifestyle. Now that life has normalized a bit, research done after the pandemic may be more generalizable,” Mijatovic noted. He advised that “there’s plenty pain physicians can take away from the article.
“Patients will often ask questions about cannabis use. Understanding the different modes of use, including risks and benefits, can be important conversation topics. It’s also important to talk about dosing to avoid dangerous use, side effects and overconsumption,” he said.
“When it comes to comprehensive pain management, cannabis poses certain limitations and benefits that need to be looked into further. Pain physicians need to be aware of cannabis use to ensure the safety of other treatments and proper monitoring. Pain doctors should work collaboratively with [primary care] physicians for the overall treatment plan of the patient,” he commented.
Javanbakht agreed. “For primary care physicians, our data support speaking to patients about cannabis use for pain symptoms. I imagine pain medicine physicians are better versed at discussing cannabis use with their patients. Certainly, other studies that overcome these limitations would help to further lend support (to or refute) our findings.”
—Sherree Geyer
