Why we think it’s important
This article highlights the high prevalence of cannabis use among primary care patients and underscores the necessity for routine screening to manage health symptoms and identify risks for cannabis use disorder. Implementing such screenings can enhance patient care by addressing both therapeutic use and potential substance use issues.
Introduction
The article titled “Prevalence and Reasons for Cannabis Use Among Patients in a Large Health System: A Cross-Sectional Study” presents a comprehensive analysis of cannabis use among primary care patients in a university-based health system in Los Angeles, California. This study, leveraging electronic health record data from 175,734 patients, aims to elucidate the prevalence of cannabis use, factors associated with its use, and the reasons behind it, particularly focusing on the medical use of cannabis.
Key Findings
The study reveals that 17% of patients reported cannabis use in the past three months, with 34.7% of these users showing signs of moderate to high risk for cannabis use disorder (CUD) according to the Alcohol Substance Involvement Screening Test (ASSIST). ASSIST is a comprehensive questionnaire designed by the World Health Organization to screen for risky substance use and related disorders, including alcohol and drugs. Interestingly, while a significant majority of cannabis users (76.1%) reported using it to manage health symptoms, only a small fraction identified as medical cannabis users. This discrepancy underscores a critical gap in the recognition and documentation of medical cannabis use within healthcare systems.
Demographic Insights
Cannabis use was more prevalent among younger patients, with 31% of those aged 18-29 reporting use, compared to only 8.5% among those aged 60 and older. Men were more likely to use cannabis than women (20% vs. 14.7%). The study also highlights a socioeconomic dimension, with lower cannabis use observed among patients from the most socioeconomically disadvantaged neighborhoods. However, those from these neighborhoods exhibited a higher risk for CUD.
Modes and Reasons for Use
Edibles emerged as the most common mode of cannabis consumption (61.6%), followed by smoking (51.7%) and vaporizing (29%). Patients reported using cannabis primarily for symptom management, with the most common symptoms being sleep disturbances (56%), stress (50.2%), and pain (31.7%). The median number of symptoms managed with cannabis was higher among those at moderate to high risk for CUD, suggesting a potential link between the number of symptoms treated and the risk of developing CUD.
Clinical Implications
The study’s findings have significant implications for clinical practice. The high prevalence of cannabis use and the substantial proportion of users at risk for CUD highlight the need for routine cannabis screening in primary care settings. By identifying patients who use cannabis, particularly those at risk for CUD, healthcare providers can offer targeted interventions and support. The study suggests that screening should include specific questions about the symptoms being managed with cannabis, rather than solely relying on patient self-identification as medical or recreational users.
Limitations
While the study provides valuable insights, it is not without limitations. The reliance on self-reported data may introduce response bias, as patients might underreport their cannabis use despite its legalization in California. Additionally, the study’s findings are based on a specific population within a large health system, which may limit the generalizability to other settings or regions where cannabis use is not legalized. Furthermore, the data were collected during the COVID-19 pandemic, which may have influenced cannabis use patterns.
Conclusion
This study sheds light on the widespread use of cannabis among primary care patients, particularly for symptom management. The high rates of cannabis use and the associated risk of CUD underscore the necessity for healthcare systems to implement routine screening and integrate discussions about cannabis use into primary care. By doing so, clinicians can better understand their patients’ cannabis use, manage potential risks, and provide appropriate guidance and intervention. Given the evolving legal landscape and increasing acceptance of cannabis use, these findings are crucial for informing public health strategies and clinical practices aimed at addressing the complexities of cannabis use in healthcare settings.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2819559?resultClick=1
Gelberg L, Beck D, Koerber J, et al. Cannabis Use Reported by Patients Receiving Primary Care in a Large Health System. JAMA Netw Open. 2024;7(6):e2414809. doi:10.1001/jamanetworkopen.2024.14809
