Cannabis use disorder diagnoses rose faster among veterans with psychiatric conditions than those without

What the researchers found

Cannabis use disorder prevalence increased more among veterans with psychiatric disorders than those without (difference in prevalence change: 1.91% from 2005-2014, 0.34% from 2016-2019). The greatest increases were among patients with bipolar and psychotic spectrum disorders.

Why it matters

Veterans with mental health conditions appear to be developing cannabis use disorder at faster rates than other veterans. As cannabis becomes more available, this population may need more targeted screening and intervention.

The numbers in context

4.3 to 5.7 million VHA patient records per year. CUD prevalence gap between psychiatric and non-psychiatric patients widened by 1.91 percentage points (2005-2014) and 0.34 percentage points (2016-2019). Biggest increases among patients under 35 (earlier period) and over 65 (later period).

How the study worked

Analysis of Veterans Health Administration electronic health records from 2005 to 2019, covering 4.3 to 5.7 million patients annually. Examined overall and age-group-specific trends in CUD diagnoses stratified by psychiatric disorder status, with separate analyses for ICD-9 (2005-2014) and ICD-10 (2016-2019) periods.

What this study cannot tell us

Based on diagnoses in medical records, which may reflect changes in screening practices or coding rather than true prevalence changes. VHA population may not represent all veterans or the general population.

How to read the evidence

Large-scale longitudinal analysis of health system records spanning 15 years, though limited by diagnostic coding changes and the observational design.

When this study was published

2024 publication analyzing 2005-2019 data.

The bigger picture

The intersection of expanding cannabis access and high rates of psychiatric conditions among veterans creates a growing clinical challenge. These data suggest the mental health system may need to prepare for rising rates of co-occurring cannabis use disorder.

Questions still open

• Is the increase driven by more cannabis use, better screening, or changes in diagnostic thresholds? Would targeted cannabis use screening for veterans with psychiatric disorders reduce CUD rates?

Common questions

Read the original research

Trends in Prevalence of Cannabis Use Disorder Among U.S. Veterans With and Without Psychiatric Disorders Between 2005 and 2019.

The American journal of psychiatry, 181(2), 144-152

Citation

Livne, Ofir; Malte, Carol A; Olfson, Mark; Wall, Melanie M; Keyes, Katherine M; Maynard, Charles; Gradus, Jaimie L; Saxon, Andrew J; Martins, Silvia S; Keyhani, Salomeh; McDowell, Yoanna; Fink, David S; Mannes, Zachary L; Gutkind, Sarah; Hasin, Deborah S. (2024). Trends in Prevalence of Cannabis Use Disorder Among U.S. Veterans With and Without Psychiatric Disorders Between 2005 and 2019.. The American journal of psychiatry, 181(2), 144-152. https://doi.org/10.1176/appi.ajp.20230168

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