Cannabis Use Disorder Among Primary Care Patients in Washington State

"In this cross-sectional study of primary care patients in a state with legal recreational cannabis use, CUD was common among patients who used cannabis, with 21% having CUD and 6% having moderate to severe CUD. Patients who used cannabis for medical reasons only were mostly older and likely to use applied products. Patients who reported any nonmedical use were at greatest risk of moderate to severe CUD (7.2% to 7.5%). While the prevalence of moderate to severe CUD was lowest among patients who reported medical use only (1.3%), 13.4% met criteria for mild, moderate, or severe CUD.

"The prevalence of CUD among patients who use cannabis found here is comparable to recent studies of patients who use cannabis in states with legal medical and recreational use.^12,27 Moreover, comparable to the study by Browne et al,¹² the prevalence of moderate to severe CUD in this study was significantly lower for patients reporting medical use only.

"The finding that CUD was common among primary care patients in a state with legal recreational use, where more than 20% of the population reports cannabis use,¹³ underscores the importance of assessing patient cannabis use in clinical settings. Population-based screening with a validated single-item screen can identify patients who use cannabis and may be at risk of CUD.²² Knowledge of patient use provides an opportunity to discuss risks and limited benefits of cannabis use and potentially safer treatment alternatives for those using cannabis for medical reasons.²⁸ For patients with higher risk cannabis use (eg, daily), psychometrically valid brief assessments for DSM-5 symptoms of CUD can identify and gauge CUD severity.²⁹ Such knowledge can support engagement around symptoms, shared decision-making, and offering of treatment if desired, especially for patients with moderate to severe CUD who may benefit most from treatment. Yet research is needed on how best to assess and document patient reasons for cannabis use and to engage individuals with CUD in treatment."