Cannabis Use Rose 900% Among Rheumatology Patients With Major Racial Disparities

Cannabis use documentation rose from 0.1% to 1.1% (900% increase) over 2004-2024. 24.5% of patients had at least one note of current use. Pain was the leading motive (37.9%), higher among Black (54.5%) and Hispanic (43.2%) patients. Cannabis users had higher comorbidity, more ER visits (2.1 vs. 1.3/year), more hospitalizations (1.4 vs. 0.9), and more opioid prescriptions (65% vs. 32.7%).

NLP applied to 2.6 million EHR notes from 5,051 adults with autoimmune rheumatic diseases at a tertiary center (2004-2024). Classifiers achieved F1=0.85 for use status and F1=0.83 for reasons. Analyzed use patterns, reasons, sociodemographic disparities, and healthcare utilization.

Autoimmune patients often use cannabis for pain that persists despite controlled inflammation. The significant racial disparities — with Black and Hispanic patients more likely to use for pain — suggest unequal access to other pain management options.

The fact that cannabis users also have more opioid prescriptions suggests these patients have more severe or refractory pain, not that cannabis is replacing opioids. The racial disparities in pain-motivated use may reflect unequal access to pain management rather than differing preferences.

Single tertiary center. NLP may miss undocumented use. Association between cannabis use and higher healthcare utilization may reflect sicker patients, not cannabis effects. Documentation ≠ actual use rates. Cannabis users may be more willing to discuss use at this center.