Understanding Cannabis Use Disorder Diagnoses in the U.S. Veterans Health Administration in the Era of Legalization.
Understanding Cannabis Use Disorder Diagnoses in the U.S. Veterans Health Administration in the Era of Legalization.
复制标题
了解合法化时代美国退伍军人健康管理局的大麻使用障碍诊断。
DOI：
10.1176/appi.ajp.20220675
复制
发表时间：
2022
期刊：
影响因子：
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通讯作者：
Cooper,ZivaD
中科院分区：
文献类型：
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作者：
Lake,Stephanie;Cooper,ZivaD
Cannabis has long been one of the most used psychoactive substances worldwide. With substantial shifts in legal access to cannabis for medical and nonmedical purposes in Canada and more than 35 US states and the District of Columbia, there is increasing interest in understanding both the therapeutic benefits and the potential health risks associated with its use. Approximately one in five people with past-year cannabis use will meet criteria for past-year cannabis use disorder (1), and the risk is modified by a host of interacting sociodemographic, behavioral, genetic, and environmental factors. Veterans are a particularly important population to monitor for cannabis use disorder, as they have complex health care needs related to high rates of unemployment and homelessness, chronic pain and disability, and psychiatric and substance use disorders (2). In this issue of the Journal, Hasin et al. examine trends in cannabis use disorder diagnoses among the US Veterans Health Administration (VHA) patient population since 2005 (3). Using records obtained for all veterans who received outpatient care at a VHA facility in the United States, the investigators calculated the annual proportion of patients ages 18–34, 35–64, and 65 or older who met criteria for cannabis use disorder, captured via ICD-9 (2005–2015) or ICD-10 (2015–2019) codes. Controlling for sex and race/ethnicity, the prevalence of cannabis use disorder increased between 2005 and 2019 in all three age groups: from 1.70% to 4.55% among those ages 18–34, from 1.59% to 2.86% among those ages 35–64, and from 0.03% to 0.74% among those age 65 or older. The authors also assessed trends by sex, noting that the increase in cannabis use disorder diagnoses was higher for males, except in more recent years (2016–2019) in the youngest age group, where females had a higher increase in cannabis use disorder diagnoses compared to their male counterparts. Finally, the authors compared prevalence of cannabis use disorder diagnoses over time by race/ethnicity and found that 1) Black patients were consistently more likely to be diagnosed with cannabis use disorder, and 2) relative to White patients, Black patients ages 18–34 and age 65 or older experienced a significantly greater increase in cannabis use disorder diagnoses across the study period. The findings reported by Hasin et al. raise several additional questions to be addressed in future research. First, the rise in cannabis use disorder diagnoses occurred over a period in which several states legalized cannabis for medical or nonmedical purposes. Using cross-sectional data from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III), Browne et al. recently demonstrated in the Journal (4) that veterans living in a medical cannabis state had significantly increased odds of meeting diagnostic criteria for cannabis use disorder, but the influence of state-specific cannabis laws on increases in cannabis use disorder diagnoses in the veteran population has yet to be determined. Hasin et al. consider the possibility that their findings were driven by shifts to products with higher THC potency. While THC potency has increased over time in jurisdictions where cannabis remains prohibited, concentrated THC products have overtaken a substantial share of the market in many legal states (eg, cannabis concentrates constitute 30% of cannabis sales in Colorado [5]). However, there is opportunity to mitigate harm in legal markets through regulatory options to curb consumer behavior (eg, potency taxes), so establishing the influence of various policy structures on cannabis use disorder growth would be …
