Trends in Prevalence of Cannabis Use Disorders among U.S. Veterans with and without Psychiatric Disorders Between 2005 and 2019

ABSTRACT Objective Cannabis use disorders (CUD) are increasing among U.S. adults and are more prevalent among cannabis users with comorbid psychiatric disorders. Changing cannabis laws, increasing cannabis availability, and higher potency cannabis may have recently placed cannabis users with psychiatric disorders at disproportionately increasing risk for CUD. The authors used Veterans Health Administration (VHA) data to examine whether trends in CUD 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-specific (<35, 35-64, ≥65 years) trends in prevalence of CUD diagnoses among patients with depressive, anxiety, PTSD, 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 CUD diagnoses were observed in veterans with, compared to without, psychiatric disorders (2005-2014: difference in prevalence change=1.91%, 95% CI=1.87%-1.96%; 2016-2019: 0.34%, 95% CI=0.29%-0.38%). Disproportionate increases in CUD prevalence among those with psychiatric disorders were greatest in veterans ages <35 between 2005-2014, and in those ages ≥65 between 2016-2019. Among patients with psychiatric disorders, greatest increases in CUD prevalences were observed in those with bipolar and psychotic-spectrum disorders. Conclusions Results highlight disproportionately increasing disparities in risk of CUD among VA patients with common psychiatric disorders. Greater public health and clinical efforts are needed to monitor, prevent and treat CUD among this population.