Objective: Cannabis use disorders (CUD) are increasing among U.S. adults and are more prevalent among cannabis users with comorbid psychiatric disorders. Changing cannabis laws, increasing cannabis availability, and higher potency cannabis may have recently placed cannabis users with psychiatric disorders at disproportionately increasing risk for CUD. The authors used Veterans Health Administration (VHA) data to examine whether trends in CUD prevalence among VHA patients differ by whether they have psychiatric disorders. Methods: VHA electronic health records from 2005 to 2019 (n range=4,332,165-5,657,277) were used to identify overall and age-specific (<35, 35-64, ≥65 years) trends in prevalence of CUD diagnoses among patients with depressive, anxiety, PTSD, bipolar, or psychotic-spectrum disorders, and to compare these to corresponding trends among patients without any of these disorders. Given transitions in ICD coding, differences in trends were tested within two periods: 2005-2014 (ICD-9-CM) and 2016-2019 (ICD-10-CM). Results: Greater increases in prevalence of CUD diagnoses were observed in veterans with, compared to without, psychiatric disorders (2005-2014: difference in prevalence change=1.91%, 95% CI=1.87%-1.96%; 2016-2019: 0.34%, 95% CI=0.29%-0.38%). Disproportionate increases in CUD prevalence among those with psychiatric disorders were greatest in veterans ages <35 between 2005-2014, and in those ages ≥65 between 2016-2019. Among patients with psychiatric disorders, greatest increases in CUD prevalences were observed in those with bipolar and psychotic-spectrum disorders. Conclusions: Results highlight disproportionately increasing disparities in risk of CUD among VA patients with common psychiatric disorders. Greater public health and clinical efforts are needed to monitor, prevent and treat CUD among this population.

Dr. Hasin receives support from Syneos Health for an unrelated project. Dr. Saxon has received consulting fees from Indivior, travel support from Alkermes, research support from MedicaSafe, and royalties from UpTo-Date. Dr. Keyes has served as an expert witness in litigation. The other authors report no financial relationships with commercial interests.

This study was funded by NIDA grant R01DA048860, the New York State Psychiatric Institute, and the VA Centers of Excellence in Substance Addiction Treatment and Education.

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Study approvals and waivers/exemptions of informed consent was granted by New York State Psychiatric Institute, Veterans Affairs Puget Sound and Veterans Affairs New York Harbor Healthcare Systems Institutional Review Boards.

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