Cannabis is among the most used drugs in the world, with consumers using various forms for both recreational and medicinal purposes. In recent years, a growing number of countries and jurisdictions have introduced policies with an aim to improve legal access to the drug. To date, 38 states and the District of Columbia (DC) have introduced medical cannabis laws and 23 states and DC have introduced recreational cannabis laws. However, despite the perception that cannabis is relatively safe, it is important to be aware of the potential to develop cannabis use disorder (CUD).
Cannabis Use Disorder (CUD)
According to recent findings, the prevalence of CUD has been on the rise in the US. CUD is characterised by a dependence on cannabis use, or engagement in unhealthy behaviours to access to use cannabis. However, the disorder is rarely treated; for example, lifetime and past-year CUD treatment prevalence among people with CUD is estimated to be 13.7% and 6.1%, respectively and a recent study reported decreasing CUD treatment trends among people with CUD in the US between 2002 and 2019. There are currently no FDA-approved pharmacological treatments of CUD; however, treatment primarily involves psychosocial interventions to reduce cannabis use frequency and dependence severity.
Some evidence suggests that there may be a correlation between the introduction of new legislation which makes cannabis more easily available either recreationally or medically and increases in cannabis use among adults in the US.
Despite these findings, evidence testing the relationship between the introduction of new cannabis laws and CUD treatment is limited. Therefore, the authors of a recent study aimed to fill knowledge gaps in the association between cannabis laws and self-reported CUD treatment.
Design and Methods of the Study
The researchers assessed data from the NSDUH – a nationally- and state-representative annual survey of individuals aged ≥12 from across America. Participants who were included in the current study included people classified as needing CUD treatment, defined as meeting past-year DSM-5-proxy CUD criteria or reporting treatment in a specialist facility (including inpatient or outpatient care in a rehabilitation facility, hospital, or mental health centre) for cannabis use in the last/current past-year treatment episode.
Results of the Study
Approximately 68,000 people were sampled in the NSDUH, annually. Of these, 2.4-2.5% of people aged 12 years and older were classified as needing CUD treatment. Of these, between 7.3% and 10.4% reported any CUD treatment. Among people with CUD, 4.2-6.4% reported any CUD treatment, 2.1-2.9% reported specialty CUD treatment and 1.4-2.6% perceived a need for CUD treatment.
In 2004-2014, the average state prevalence of specialty CUD treatment was 6.91% before medical cannabis laws became effective and 5.56% after medical cannabis laws without dispensary provisions. After medical cannabis laws with dispensary provisions became effective, specialty CUD treatment prevalence fell to 4.76%. Patterns were similar in 2015-2019, but associations were not significant.
Conclusions
The current study was the first to estimate relationships between medical and recreational cannabis laws and self-reported CUD treatment in a nationally representative US community-based sample. The results clarify past studies reporting associations between cannabis policies and cannabis-related admissions in publicly funded specialty treatment facilities.
While only medical cannabis laws with cannabis dispensary provisions were associated with decreases in specialty CUD treatment among people with CUD, both medical and recreational cannabis laws were associated with reductions in treatment among people needing CUD treatment, including those who reported past-year specialty treatment. The authors also note that evidence of lagged cannabis policy effects could lead to further reductions in CUD treatment.
The findings of this study indicate an unmet treatment need for CUD in the US.
