Prevalence of cannabis use disorder among individuals using medical cannabis at admission to inpatient treatment for substance use disorders

In Canada, patients were granted legal access to cannabis for medical purposes in 2001 by the Medical Marijuana Access Regulations (Ware & Ziemianski, 2015). During the last five years, the number of individuals using cannabis for medical purposes has tripled; cannabis is now widely authorized for numerous psychological and physical conditions (Baron, 2015, Yarnell, 2015). While some countries permit cannabis for specific medical conditions, Canadian patients can obtain cannabis for medical purposes for any condition with physician authorization (Ng et al., 2021).

In 2018, the Canadian Clinical Practice Guideline and the US National Academies of Science, Engineering, and Medicine proposed limited indications for authorizing cannabis for medical purposes, including chemotherapy-induced nausea and vomiting, neuropathic and palliative pain, and multiple sclerosis-induced spasticities (Allan et al., 2018, Groce, 2018, National Academies of Sciences, Engineering, and Medicine, 2017). These guidelines were based on the most robust scientific evidence at the time, aiming to limit the wide usage of medical cannabis given the mixed evidence for efficacy. Further, a recent international guideline had a weak recommendation for using non-inhaled medical cannabis or cannabinoids for people living with chronic cancer or non-cancer pain in addition to standard care (Busse et al., 2021).

One population of particular interest in medical cannabis use is individuals diagnosed with substance use disorder (SUD). The reason is an increasing interest in using cannabis as a potential treatment for opioid use disorder (OUD) (Hurd et al., 2019), alcohol use disorder (AUD) (Turna et al., 2019), and even cannabis use disorder (CUD) itself (Rømer Thomsen et al., 2022). Individuals with SUDs also report therapeutic use of cannabis for anxiety, depression, and sleep problems (Kosiba et al., 2019, Sexton et al., 2016, Sznitman et al., 2020). Despite the potential therapeutic benefits of medical cannabis, regular use may lead to the development of CUD, especially among those with SUD. Therefore, caution for recommending medical cannabis in SUD treatment settings is warranted.

Moreover, it is not unusual for individuals to report medical and recreational cannabis use, i.e., “dual motives use” (Turna et al., 2020). Individuals reporting dual motives for cannabis use endorse more problematic cannabis and other substance use behaviors and psychiatric problems than those who use cannabis for medical-only purposes (Rotermann & Pagé, 2018). Despite a lack of scientific support, those reporting dual-use also endorse using cannabis to manage underlying psychiatric conditions. Further, US studies reported that those who report medical and recreational cannabis use also prefer cannabis products with higher tetrahydrocannabinol (THC) content (Morean & Lederman, 2019). However, no studies have examined CUD in individuals with SUDs reporting medical cannabis in SUD clinical settings.

Therefore, the current analysis aimed to explore the prevalence of CUD and other psychiatric illnesses among individuals who reported cannabis for medical purposes only vs dual cannabis use in an inpatient SUD population. Based on previously observed differences, we hypothesized that CUD criteria endorsement would differ between the Medical-Only and the Dual-Use groups.

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