Cannabis Use and Cannabis Use Disorder among U.S. Adults with Psychiatric Disorders: 2001-2002 and 2012-2013

Objective Rates of cannabis use disorder (CUD) have increased disproportionately among Veterans Health Administration (VHA) patients with psychiatric disorders, but determining whether such an increase occurred more generally among U.S. adults requires nationally representative data. Methods Data came from 2001-2002 (n=43,093) and 2012-2013 (n=36,309) national surveys. Outcomes were any past-year non-medical cannabis use, frequent non-medical use (≥3 times weekly), and DSM-IV CUD. Psychiatric disorders included mood, anxiety disorders, antisocial personality disorder, and bipolar I. Logistic regressions were used to generate predicted marginal prevalences of the outcomes for each survey, risk differences calculated, and additive interaction tests determined whether between-survey differences in risk of cannabis outcomes differed between those with and without psychiatric conditions. Results Cannabis outcome prevalences increased more among those with than without any psychiatric disorder. The difference in prevalence differences included any past-year non-medical cannabis use, 2.45% (95%CI=1.29, 3.62); frequent non-medical cannabis use, 1.58% (95%CI=0.83, 2.33); CUD, 1.40% (95%CI=0.58, 2.21). For each specific disorder, prevalences increased more among those with the disorder, except CUD among those with antisocial personality disorder. Conclusions In the U.S. general population, rates of cannabis use and CUD increased at a greater rate among adults with psychiatric disorders, similar to findings from VHA patients. These results suggest that although VHA patients are not representative of all U.S. adults, findings from this important patient group can be informative. As U.S. cannabis use continues to expand, greater clinical and policy attention to CUD is needed for adults with psychiatric disorders. ### Competing Interest Statement Dr. Hasin receives support from Syneos Health for an unrelated project. Dr. Saxon has received consulting fees from Indivior, travel support from Alkermes, research support from MedicaSafe, and royalties from UpTo-Date. Dr. Keyes has served as an expert witness in litigation. The other authors report no financial relationships with commercial interests. ### Funding Statement This study was supported by NIDA grant R01DA048860, the New York State Psychiatric Institute, and the VA Centers of Excellence in Substance Addiction Treatment and Education. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: IRB of United States Bureau of the Census gave ethical approval for this work. IRB of United States Office of Management and Budget gave ethical approval for this work. IRB of National Institute of Health gave ethical approval for this work. IRB of Westat gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data is not publicly available.