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Abstract

Objective:

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.

Methods:

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).

Results:

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.

Conclusions:

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.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 144 - 152
PubMed: 38018141

History

Received: 2 March 2023
Revision received: 20 July 2023
Accepted: 16 August 2023
Published online: 29 November 2023
Published in print: February 01, 2024

Keywords

  1. Substance-Related and Addictive Disorders
  2. Cannabis
  3. Epidemiology

Authors

Details

Ofir Livne, M.D., M.P.H.
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).
Carol A. Malte, M.S.W.
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).
Mark Olfson, M.D., M.P.H.
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).
Melanie M. Wall, Ph.D.
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).
Katherine M. Keyes, Ph.D.
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).
Charles Maynard, Ph.D.
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).
Jaimie L. Gradus, D.M.Sc.
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).
Andrew J. Saxon, M.D.
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).
Silvia S. Martins, M.D., Ph.D.
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).
Salomeh Keyhani, M.D.
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).
Yoanna McDowell, Ph.D.
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).
David S. Fink, Ph.D.
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).
Zachary L. Mannes, Ph.D.
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).
Sarah Gutkind, M.S.P.H.
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).
Deborah S. Hasin, Ph.D. [email protected]
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).

Notes

Send correspondence to Dr. Hasin ([email protected]).

Competing Interests

Dr. Saxon receives royalties from UpToDate. Dr. Hasin has received support from Syneos Health.The other authors report no financial relationships with commercial interests.

Funding Information

Supported by NIDA grant R01DA048860 (principal investigator, Dr. Hasin), NIDA grant K23DA057417 (principal investigator, Dr. Livne), New York State Psychiatric Institute, and the Veterans Administration Center for Excellence in Substance Addiction Treatment and Education.

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