Cannabis Use Disorder Among Individuals with Multiple Chronic Conditions

Background and Purpose: Medically recommended cannabis use continues to increase in the United States. Little is known about the differences between cannabis use that is recommended by a physician and self-guided cannabis use, especially among individuals with multiple chronic health conditions (MCC). It has been shown that frequent cannabis use is correlated with a higher likelihood of developing a cannabis use disorder (CUD) and that cannabis use is often linked to the management of MCCs. Therefore, the purpose of this study was to examine the relationship between MCC, cannabis use disorder, and physician-recommended cannabis use.

Methods: Data came from the 2023 National Survey on Drug Use and Health (NSDUH), an annual survey of adolescents and adults. The sample for this study included adults 18 and over who had used cannabis in the past year, which led to a total sample size of n=14,185. A binary variable representing past-year cannabis use disorder was created by asking respondents questions that aligned with criteria found in the fifth edition of The Diagnostic and Statistical Manual of Mental Disorders. Multiple chronic conditions were coded for any individual having 2 or more of the following conditions: diabetes, COPD, cirrhosis, hepatitis, kidney disease, asthma, HIV/AIDS, heart conditions, high blood pressure, or any type of cancer. A binary variable was also created to represent all past-year cannabis use being physician-recommended. Logistic regression was utilized to examine the relationship between MCCs, physician-recommended cannabis use, and cannabis use disorder while accounting for age, sex, race/ethnicity, past-month binge drinking, and income. Next, logistic regression models were estimated to examine the moderating effect of all past-year cannabis use being medically recommended.

Results: Among past-year cannabis users, 35.6% met criteria for a past-year cannabis use disorder. Additionally, around 8% of the sample had multiple chronic conditions and 10% of past-year cannabis users reported that all of their past-year cannabis use had been recommended by a doctor. Having multiple chronic health conditions increased the odds of having met criteria for a past-year cannabis use disorder by around 35% (AOR= 1.35, p < 0.01, CI= 1.16 – 1.56), and having all use being physician recommended increased the likelihood of CUD by around 37% (AOR= 1.37, p < 0.01, CI= 1.21 – 1.55), while accounting for sociodemographic variables. A significant interaction effect was observed between physician-recommended cannabis use and multiple chronic conditions. Cannabis users with MCCs showed around a 40% increased likelihood of having a CUD if their use had not been recommended by a doctor (AOR= 1.40 p < 0.01, CI= 1.19 – 1.65), while there was no significant difference if cannabis use had been medically recommended (AOR= 1.01, p > 0.05, CI= 0.72 – 1.42).

Conclusion and Implications: Results suggest medical involvement in cannabis use practices may represent a protective factor for cannabis users with multiple chronic health conditions. Future research is needed to understand the benefits of increased physician involvement in cannabis use for individuals with MCCs, along with understanding characteristics that lead to increased risk of CUD for individuals with MCCs.