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.

中文翻译：

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2005 年至 2019 年间患有和不患有精神疾病的美国退伍军人中大麻使用障碍的患病率趋势

客观的：

美国成年人中大麻使用障碍的诊断正在增加，并且在患有共存精神疾病的人群中更为普遍。最近大麻法律的变化、大麻供应量的增加以及大麻效力的提高可能使吸食大麻和精神疾病的人患大麻使用障碍的风险不成比例地增加。作者使用退伍军人健康管理局 (VHA) 数据来研究 VHA 患者中大麻使用障碍患病率的趋势是否因他们是否患有精神疾病而有所不同。

方法：

使用 2005 年至 2019 年的 VHA 电子健康记录（N 范围，4,332,165–5,657,277）来确定患者中大麻使用障碍诊断患病率的总体和特定年龄组（<35、35-64 和 ≥65 岁）趋势患有抑郁症、焦虑症、创伤后应激障碍、双相情感障碍或精神病谱系障碍的患者，并将这些疾病与没有任何这些疾病的患者的相应趋势进行比较。鉴于 ICD 编码的转变，在两个时期内测试了趋势差异：2005-2014 年 (ICD-9-CM) 和 2016-2019 年 (ICD-10-CM)。

结果：

与没有精神疾病的患者相比，在患有精神疾病的患者中观察到大麻使用障碍诊断患病率的增加更大（患病率变化差异，2005-2014年：1.91%，95% CI=1.87-1.96；2016-2019年：0.34%，95% CI=0.29–0.38）。2005年至2014年期间，精神疾病患者中大麻使用障碍患病率增幅最大的是35岁以下患者，2016年至2019年间，65岁或以上患者中大麻使用障碍患病率增幅最大。在精神疾病患者中，大麻使用障碍患病率增幅最大在双相情感障碍和精神病谱系障碍患者中观察到。

结论：

研究结果强调，患有常见精神疾病的 VHA 患者大麻使用障碍的风险差异不成比例地增加。需要加大公共卫生和临床工作来监测、预防和治疗该人群的大麻使用障碍。