Abstract
Abstract
Background
Cannabis is marketed as a treatment for pain. There is limited data on the prevalence of cannabis use and its correlates among Veterans prescribed opioids.
Objective
To examine the prevalence and correlates of cannabis use among Veterans prescribed opioids.
Design
Cross-sectional study.
Participants
Veterans with a urine drug test (UDT) from Primary Care 2014–2018, in 50 states, Washington, D.C., and Puerto Rico. A total of 1,182,779 patients were identified with an opioid prescription within 90 days prior to UDT.
Main measures
Annual prevalence of cannabis positive UDT by state. We used multivariable logistic regression to assess associations of demographic factors, mental health conditions, substance use disorders, and pain diagnoses with cannabis positive UDT.
Results
Annual prevalence of cannabis positive UDT ranged from 8.5% to 9.7% during the study period, and in 2018 was 18.15% in Washington, D.C. and 10 states with legalized medical and recreational cannabis, 6.1% in Puerto Rico and 25 states with legalized medical cannabis, and 4.5% in non-legal states. Younger age, male sex, being unmarried, and marginal housing were associated with use (p < 0.001). Post-traumatic stress disorder (adjusted odds ratio [AOR] 1.17; 95% confidence interval [CI] 1.13–1.22, p < 0.001), opioid use disorder (AOR 1.14; CI 1.07–1.22, p < 0.001), alcohol use disorder or positive AUDIT-C (AOR 1.34; 95% CI 1.28–1.39, p < 0.001), smoking (AOR 2.58; 95% CI 2.49–2.66, p < 0.001), and other drug use disorders (AOR 1.15; 95% CI 1.03–1.29, p = 0.02) were associated with cannabis use. Positive UDT for amphetamines AOR 1.41; 95% CI 1.26–1.58, p < 0.001), benzodiazepines (AOR 1.41; 95% CI 1.31–1.51, p < 0.001) and cocaine (AOR 2.04; 95% CI 1.75–2.36, p < 0.001) were associated with cannabis positive UDT.
Conclusions
Cannabis use among Veterans prescribed opioids varied by state and by legalization status. Veterans with PTSD and substance use disorders were more likely to have cannabis positive UDT. Opioid-prescribed Veterans using cannabis may benefit from screening for these conditions, referral to treatment, and attention to opioid safety.
Funder
Health Services Research and Development
Publisher
Springer Science and Business Media LLC
Subject
Psychiatry and Mental health
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