Cannabis legalization and cannabis use disorder in United States Veterans Health Administration patients with and without psychiatric disorders, 2005–2022: a repeated cross-sectional studyResearch in context
Summary: Background: We investigated whether the associations of state medical and recreational cannabis legalization (MCL, RCL enactment) with increasing prevalence of Cannabis Use Disorder (CUD) differed among patients in the United States (US) Veterans Health Administration (VHA) who did or did...
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Elsevier
2025-08-01
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| Series: | The Lancet Regional Health. Americas |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667193X25001656 |
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| author | Deborah S. Hasin Carol Malte Melanie M. Wall Daniel Alschuler Tracy L. Simpson Mark Olfson Ofir Livne Zachary L. Mannes David S. Fink Katherine M. Keyes Magdalena Cerdá Charles C. Maynard Salomeh Keyhani Silvia S. Martins Scott Sherman Andrew J. Saxon |
| author_facet | Deborah S. Hasin Carol Malte Melanie M. Wall Daniel Alschuler Tracy L. Simpson Mark Olfson Ofir Livne Zachary L. Mannes David S. Fink Katherine M. Keyes Magdalena Cerdá Charles C. Maynard Salomeh Keyhani Silvia S. Martins Scott Sherman Andrew J. Saxon |
| author_sort | Deborah S. Hasin |
| collection | DOAJ |
| description | Summary: Background: We investigated whether the associations of state medical and recreational cannabis legalization (MCL, RCL enactment) with increasing prevalence of Cannabis Use Disorder (CUD) differed among patients in the United States (US) Veterans Health Administration (VHA) who did or did not have common psychiatric disorders. Methods: Electronic medical record data (2005–2022) were analyzed on patients aged 18–75 with ≥1 VHA primary care, emergency department, or mental health visit and no hospice/palliative care within a given year (sample sizes ranging from 3,234,382 in 2005 to 4,436,883 in 2022). Patients were predominantly male (>80%) and non-Hispanic White (>60%). Utilizing all 18 years of data, CUD prevalence increases attributable to MCL or RCL enactment were estimated among patients with affective, anxiety, psychotic-spectrum disorders, and Any Psychiatric Disorder (APD) using staggered difference-in-difference (DiD) models and 99% Confidence Intervals (CIs), testing differences between patient groups with and without psychiatric disorders via non-overlap in the 99% CIs of their DiD estimates. Findings: Among APD-negative patients, CUD prevalence was <1.0% in all years, while among APD-positive patients, CUD prevalence increased from 3.26% in 2005 to 5.68% in 2022 in no-CL states, from 3.51% to 6.35% in MCL-only states, and from 3.41% to 6.35% in MCL/RCL states. Among the APD group, DiD estimates of MCL-only and MCL/RCL effects were modest-sized, but the lower bound of the 99% CI for the DiD estimate for MCL-only and MCL/RCL effects was larger than the upper bound of the 99% CI among the no-APD group, indicating significantly stronger MCL-only and MCL/RCL effects among patients with APD. Results were similar for MCL-only and MCL/RCL effects among disorder-specific groups (depression, post-traumatic stress disorder [PTSD], anxiety or bipolar disorders) and for MCL/RCL effects among patients with psychotic-spectrum disorders. Interpretation: Cannabis legalization contributed to greater CUD prevalence increases among patients with psychiatric disorders. However, modest-sized DiD estimates suggested operation of other factors, e.g., commercialization, changing attitudes, expectancies. As cannabis legalization widens, recognizing and treating CUD in patients with psychiatric disorders becomes increasingly important. Funding: This study was supported by National Institute on Drug Abuse grant R01DA048860, the New York State Psychiatric Institute, and the VA Centers of Excellence in Substance Addiction Treatment and Education. |
| format | Article |
| id | doaj-art-e70ed55baa744d91b32fd8de5c1e6150 |
| institution | Kabale University |
| issn | 2667-193X |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
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| series | The Lancet Regional Health. Americas |
| spelling | doaj-art-e70ed55baa744d91b32fd8de5c1e61502025-08-20T03:27:33ZengElsevierThe Lancet Regional Health. Americas2667-193X2025-08-014810115510.1016/j.lana.2025.101155Cannabis legalization and cannabis use disorder in United States Veterans Health Administration patients with and without psychiatric disorders, 2005–2022: a repeated cross-sectional studyResearch in contextDeborah S. Hasin0Carol Malte1Melanie M. Wall2Daniel Alschuler3Tracy L. Simpson4Mark Olfson5Ofir Livne6Zachary L. Mannes7David S. Fink8Katherine M. Keyes9Magdalena Cerdá10Charles C. Maynard11Salomeh Keyhani12Silvia S. Martins13Scott Sherman14Andrew J. Saxon15Columbia University Irving Medical Center Department of Psychiatry, 630 West 168th Street, New York, NY, 10032, USA; New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY, 10032, USA; Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA; Corresponding author. Columbia University/New York State Psychiatric Institute, 1051 Riverside Drive, Box 123, New York, NY, 10032, USA.Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA; Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USAColumbia University Irving Medical Center Department of Psychiatry, 630 West 168th Street, New York, NY, 10032, USA; New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY, 10032, USANew York State Psychiatric Institute, 1051 Riverside Dr, New York, NY, 10032, USACenter of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA; Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USAColumbia University Irving Medical Center Department of Psychiatry, 630 West 168th Street, New York, NY, 10032, USANew York State Psychiatric Institute, 1051 Riverside Dr, New York, NY, 10032, USAColumbia University Irving Medical Center Department of Psychiatry, 630 West 168th Street, New York, NY, 10032, USA; Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USANew York State Psychiatric Institute, 1051 Riverside Dr, New York, NY, 10032, USAColumbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USANew York University, 50 West 4th Street, New York, NY, 10012, USAHealth Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA; University of Washington, 1400 NE Campus Parkway, Seattle, WA, 98195, USASan Francisco VA Health System, 4150 Clement St, San Francisco, CA, 94121, USA; University of California at San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USAColumbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USANew York University, 50 West 4th Street, New York, NY, 10012, USA; VA Manhattan Harbor Healthcare, 423 E 23rd St, New York, NY, 10010, USAHealth Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA; Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA; Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USASummary: Background: We investigated whether the associations of state medical and recreational cannabis legalization (MCL, RCL enactment) with increasing prevalence of Cannabis Use Disorder (CUD) differed among patients in the United States (US) Veterans Health Administration (VHA) who did or did not have common psychiatric disorders. Methods: Electronic medical record data (2005–2022) were analyzed on patients aged 18–75 with ≥1 VHA primary care, emergency department, or mental health visit and no hospice/palliative care within a given year (sample sizes ranging from 3,234,382 in 2005 to 4,436,883 in 2022). Patients were predominantly male (>80%) and non-Hispanic White (>60%). Utilizing all 18 years of data, CUD prevalence increases attributable to MCL or RCL enactment were estimated among patients with affective, anxiety, psychotic-spectrum disorders, and Any Psychiatric Disorder (APD) using staggered difference-in-difference (DiD) models and 99% Confidence Intervals (CIs), testing differences between patient groups with and without psychiatric disorders via non-overlap in the 99% CIs of their DiD estimates. Findings: Among APD-negative patients, CUD prevalence was <1.0% in all years, while among APD-positive patients, CUD prevalence increased from 3.26% in 2005 to 5.68% in 2022 in no-CL states, from 3.51% to 6.35% in MCL-only states, and from 3.41% to 6.35% in MCL/RCL states. Among the APD group, DiD estimates of MCL-only and MCL/RCL effects were modest-sized, but the lower bound of the 99% CI for the DiD estimate for MCL-only and MCL/RCL effects was larger than the upper bound of the 99% CI among the no-APD group, indicating significantly stronger MCL-only and MCL/RCL effects among patients with APD. Results were similar for MCL-only and MCL/RCL effects among disorder-specific groups (depression, post-traumatic stress disorder [PTSD], anxiety or bipolar disorders) and for MCL/RCL effects among patients with psychotic-spectrum disorders. Interpretation: Cannabis legalization contributed to greater CUD prevalence increases among patients with psychiatric disorders. However, modest-sized DiD estimates suggested operation of other factors, e.g., commercialization, changing attitudes, expectancies. As cannabis legalization widens, recognizing and treating CUD in patients with psychiatric disorders becomes increasingly important. Funding: This study was supported by National Institute on Drug Abuse grant R01DA048860, the New York State Psychiatric Institute, and the VA Centers of Excellence in Substance Addiction Treatment and Education.http://www.sciencedirect.com/science/article/pii/S2667193X25001656CannabisCannabis use disorderEpidemiologyMilitary psychiatryICDPTSD |
| spellingShingle | Deborah S. Hasin Carol Malte Melanie M. Wall Daniel Alschuler Tracy L. Simpson Mark Olfson Ofir Livne Zachary L. Mannes David S. Fink Katherine M. Keyes Magdalena Cerdá Charles C. Maynard Salomeh Keyhani Silvia S. Martins Scott Sherman Andrew J. Saxon Cannabis legalization and cannabis use disorder in United States Veterans Health Administration patients with and without psychiatric disorders, 2005–2022: a repeated cross-sectional studyResearch in context The Lancet Regional Health. Americas Cannabis Cannabis use disorder Epidemiology Military psychiatry ICD PTSD |
| title | Cannabis legalization and cannabis use disorder in United States Veterans Health Administration patients with and without psychiatric disorders, 2005–2022: a repeated cross-sectional studyResearch in context |
| title_full | Cannabis legalization and cannabis use disorder in United States Veterans Health Administration patients with and without psychiatric disorders, 2005–2022: a repeated cross-sectional studyResearch in context |
| title_fullStr | Cannabis legalization and cannabis use disorder in United States Veterans Health Administration patients with and without psychiatric disorders, 2005–2022: a repeated cross-sectional studyResearch in context |
| title_full_unstemmed | Cannabis legalization and cannabis use disorder in United States Veterans Health Administration patients with and without psychiatric disorders, 2005–2022: a repeated cross-sectional studyResearch in context |
| title_short | Cannabis legalization and cannabis use disorder in United States Veterans Health Administration patients with and without psychiatric disorders, 2005–2022: a repeated cross-sectional studyResearch in context |
| title_sort | cannabis legalization and cannabis use disorder in united states veterans health administration patients with and without psychiatric disorders 2005 2022 a repeated cross sectional studyresearch in context |
| topic | Cannabis Cannabis use disorder Epidemiology Military psychiatry ICD PTSD |
| url | http://www.sciencedirect.com/science/article/pii/S2667193X25001656 |
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