Medical and recreational marijuana use linked to higher risk of cannabis use disorder

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A new study has found that cannabis use disorder (CUD) is relatively common among primary care patients in Washington state, one of the first states to fully legalize cannabis, and can even occur in people who only use medical marijuana. CUD is a condition where a person has difficulty controlling their cannabis use, experiences withdrawal symptoms, and suffers negative consequences in their life due to cannabis.

What is cannabis use disorder?

According to the US Centers for Disease Control and Prevention (CDC), CUD is diagnosed when a person has two or more of the following symptoms in a 12-month period:

  • Using more cannabis than intended or for longer periods of time
  • Having a strong desire or urge to use cannabis
  • Spending a lot of time obtaining, using, or recovering from cannabis
  • Having cravings for cannabis
  • Failing to fulfill major obligations at work, school, or home due to cannabis use
  • Continuing to use cannabis despite social or interpersonal problems caused by it
  • Giving up or reducing important social, occupational, or recreational activities because of cannabis use
  • Using cannabis in physically hazardous situations, such as driving or operating machinery
  • Continuing to use cannabis despite physical or psychological problems caused by it
  • Developing tolerance to cannabis, meaning needing more of it to get the same effect
  • Experiencing withdrawal symptoms when stopping or reducing cannabis use, such as irritability, anxiety, insomnia, decreased appetite, or restlessness

CUD can range from mild to severe depending on the number and severity of symptoms. CUD can impair a person’s functioning, health, and quality of life. It can also increase the risk of developing other mental health disorders, such as depression, anxiety, psychosis, or substance use disorders.

Medical and recreational marijuana

How common is cannabis use disorder?

The study, published in JAMA Network Open on Tuesday, surveyed nearly 110,000 patients of a Kaiser Permanente integrated health system in Washington state about their attitudes and behaviors regarding cannabis. Out of those, 5,000 were asked more confidential questions about their cannabis use in the past year. Only those who reported using cannabis in the past 30 days, or 1,500 people, were included in the analysis.

The researchers found that 18.1% of the participants met the criteria for CUD. The prevalence of CUD was higher among those who used both medical and recreational cannabis (26.3%) than those who used only medical (6.1%) or only recreational (10.5%) cannabis. The study also found that using both medical and recreational cannabis was associated with more severe CUD symptoms than using medical cannabis alone.

The study is one of the first to examine the prevalence and severity of CUD among primary care patients in a state with legal cannabis use. The researchers noted that their findings may not be generalizable to other populations or settings. They also acknowledged that some people may have underreported their cannabis use due to stigma or fear of legal consequences.

What are the implications of the study?

The study suggests that legalizing cannabis does not eliminate the risk of developing CUD. In fact, it may increase the availability and accessibility of cannabis for both medical and recreational purposes, which could lead to more frequent and problematic use.

The study also highlights the need for screening and intervention for CUD among primary care patients who use cannabis. The researchers recommended that primary care providers ask their patients about their reasons for using cannabis, their patterns and frequency of use, and any negative consequences they experience from it. They also suggested that providers educate their patients about the potential harms of cannabis use and offer them evidence-based treatment options for CUD if needed.

The study also calls for more research on the effects of legalizing cannabis on public health outcomes, such as CUD prevalence, severity, and treatment utilization. The researchers urged policymakers to consider the potential benefits and harms of legalizing cannabis and implement regulations and policies that minimize the adverse impacts of cannabis use on individuals and communities.

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