Cannabis-Only Drug Users in the ER Had Less Severe Problems Than Users of Other Drugs | Research

The takeaway

Among 686 ED patients who used drugs, cannabis-only users had lower drug severity scores and fewer psychiatric and alcohol problems than users of other drugs, though 19-29% of cannabis-only users still had problematic use.

Read this if you work in emergency medicine or substance use screening.

19-29% of cannabis-only ED patients had problematic drug use; daily users had lower self-efficacy for avoidance.

What the researchers found

Researchers compared three groups among 686 adult emergency department patients who reported drug use: daily cannabis-only users, non-daily cannabis-only users, and users of other drugs.

The three groups did not differ on most demographic factors or medical problem severity, but they differed significantly on substance-related outcomes. Users of drugs other than cannabis had the highest drug severity indicators, more psychiatric problems, and greater alcohol use severity.

However, cannabis-only users were not without problems: 19-29% were identified as having problematic drug use. Daily cannabis-only users fared worse than non-daily users on drug severity and self-efficacy for avoiding drug use.

45% of the entire drug-using ED sample was identified as having a drug use problem, highlighting the ED as an important screening venue.

Why it matters

Emergency departments are increasingly recognized as opportunities for substance use screening and intervention. This study helps clinicians match patients to appropriate care levels: cannabis-only users may benefit from brief interventions focusing on motivation and self-efficacy, while users of other drugs may need referral to specialty treatment.

The numbers in context

686 drug-using ED patients. 45% identified as having a drug use problem. 19-29% of cannabis-only users had problematic use. Other drug users had higher severity scores. Daily cannabis users fared worse than non-daily users on drug severity and self-efficacy.

How the study worked

Cross-sectional study of 686 adult patients at two emergency departments who reported drug use. Groups compared: daily cannabis-only users, non-daily cannabis-only users, and other drug users. Measures included Drug Abuse Screening Test, Addiction Severity Index, psychiatric status, and self-efficacy for drug avoidance.

What this study cannot tell us

Cross-sectional ED sample may not represent all drug users. Self-reported drug use may be inaccurate in an ED setting. The study was conducted at only two EDs. Cannabis-only status is self-reported and may not be verified by drug testing.

How to read the evidence

Moderate evidence from a reasonably sized study at two emergency departments with validated substance use measures.

When this study was published

Published in 2016. ED-based substance use screening and intervention continues to be developed.

The bigger picture

The ED "teachable moment" concept suggests that medical encounters can be leveraged for substance use intervention. This study provides the differentiation needed to target interventions appropriately: cannabis-only users need different approaches than polysubstance users.

Questions still open

Would brief ED-based interventions reduce cannabis use in this population? Are daily cannabis-only users in the ED an earlier stage of a substance use trajectory that could progress to other drugs? What intervention approaches best enhance self-efficacy for cannabis-only users?

Common questions

Are cannabis-only users at lower risk than other drug users?

In this ED study, cannabis-only users had lower drug severity, fewer psychiatric problems, and less alcohol severity than users of other drugs. However, 19-29% of cannabis-only users still had problematic use, and daily users had particular challenges with self-efficacy for avoiding drug use.

Should emergency departments screen for cannabis use?

This study supports screening, as 45% of drug-using ED patients had identifiable drug problems. Cannabis-only users may benefit from brief motivational interventions, while other drug users may need referral to more intensive treatment.

Read the original research

Characteristics of Cannabis-Only and Other Drug Users Who Visit the Emergency Department.

Cannabis and cannabinoid research, 1(1), 149-153

View on PubMed ↗

Citation

Woodruff, Susan I; McCabe, Cameron T; Hohman, Melinda; Clapp, John D; Shillington, Audrey M; Eisenberg, Kimberly; Sise, C Beth; Castillo, Edward M; Chan, Theodore C; Sise, Michael J. (2016). Characteristics of Cannabis-Only and Other Drug Users Who Visit the Emergency Department.. Cannabis and cannabinoid research, 1(1), 149-153.