Cannabis use disorder rates increased among US veterans with chronic pain between 2005 and 2019, particularly as cannabis availability expanded.
VA clinicians, veterans with chronic pain, pain medicine specialists, and substance use policy researchers.
2005-2019 increaseCUD rates rose among US veterans with chronic pain over 14 years as cannabis access expanded
What the researchers found
Time trend analysis showed increasing rates of cannabis use disorder among VHA patients with chronic pain from 2005 to 2019, suggesting that expanded cannabis access may be contributing to growing problematic use in this vulnerable population.
Why it matters
Veterans are disproportionately affected by chronic pain and may turn to cannabis for symptom management, but rising CUD rates indicate that some are developing problematic patterns that require clinical attention.
The numbers in context
The study examined trends in cannabis use disorder from 2005 to 2019 among Veterans Health Administration patients with chronic pain.
How the study worked
Retrospective time-trend analysis of VHA electronic health records examining CUD diagnoses among chronic pain patients from 2005-2019.
Who was studied
US veterans with chronic pain receiving care through the Veterans Health Administration from 2005-2019.
What this study cannot tell us
Administrative data may undercount CUD if not diagnosed; changes in screening and diagnostic practices over time may inflate trends; pain and CUD definitions may have evolved.
How to read the evidence
Retrospective time-trend analysis of large administrative dataset; provides strong descriptive evidence of temporal trends.
When this study was published
Recent analysis covering a critical period of cannabis policy change in the US.
The bigger picture
The intersection of the chronic pain epidemic and expanding cannabis access creates a population at elevated risk for CUD, requiring integrated pain and substance use care strategies within the VA system.
Replication
Consistent with broader trends of increasing CUD alongside cannabis legalization; veteran population adds important clinical context.
Funding
Not specified
Conflicts of interest
Not specified
Questions still open
- Is CUD growth driven by increased cannabis use or increased diagnosis?
- Are veterans substituting cannabis for opioids?
- What CUD prevention strategies could be implemented in VA pain clinics?
Read the original research
Increasing risk of cannabis use disorder among U.S. veterans with chronic pain: 2005-2019.
Pain, 164(9), 2093-2103
Citation
Mannes, Zachary L; Malte, Carol A; Olfson, Mark; Wall, Melanie M; Keyes, Katherine M; Martins, Silvia S; Cerdá, Magdalena; Gradus, Jaimie L; Saxon, Andrew J; Keyhani, Salomeh; Maynard, Charles; Livne, Ofir; Fink, David S; Gutkind, Sarah; Hasin, Deborah S. (2023). Increasing risk of cannabis use disorder among U.S. veterans with chronic pain: 2005-2019.. Pain, 164(9), 2093-2103. https://doi.org/10.1097/j.pain.0000000000002920