Article Summary
Clinical Summary: Geographic Differences in Cannabis Use and Cannabis Use Disorder in the US Veteran Population
Veterans often use cannabis for chronic pain, PTSD, anxiety, and insomnia, yet cannabis use disorder carries meaningful psychiatric and functional burden. This study shows that cannabis risk is not evenly distributed across the country, giving clinicians and health systems a clearer map of where routine screening and treatment capacity may be most needed.
Design
the 2022 National Health and Resilience in Veterans Study (NHRVS), a web-based survey administered from August 11 to September 12, 2022
N
Of the 2,951 veterans invited to participate, 2,441 (82.7%) completed the survey.
Population
the weighted sample is nationally representative of US veterans, although not necessarily representative at the state level
Duration
over the past six months
Key Findings
- Of the 2,441 Veterans who completed the survey, 284 (weighted 11.6%) reported cannabis use and 70 (weighted 2.9%) had probable CUD.
- Significant geographic variation in cannabis use and probable CUD was observed across the 9 US Census Bureau–defined regions (χ2 16 = 73.33, P < .001).
- The Pacific region had the highest prevalence of both cannabis use (18.6%) and probable CUD (8.8%).
- The Pacific region’s rate of probable CUD was significantly higher than all other regions (all uncorrected Ps < .05), including New England (3.5%).
- For cannabis use, prevalence was significantly higher in the Pacific region relative to all regions except for New England (13.4%; P = .24).
Clinical Bottom Line
Cannabis use and probable CUD are common in US veterans, with the highest burden concentrated in the Pacific region. Routine cannabis screening is especially important in higher-prevalence regions and in VA settings where veterans with probable CUD are more likely to receive care.
Practice Implications
- In veterans receiving care in high-prevalence regions, particularly the Pacific, incorporate routine assessment of cannabis use and probable CUD rather than relying on spontaneous disclosure.
- Use a brief structured screen such as the CUDIT-SF, where a score ≥2 is indicative of probable CUD, to identify veterans who need further evaluation or treatment referral.
- Do not limit concern about cannabis-related problems to states with legalized recreational cannabis; high prevalence was also seen in Oklahoma for cannabis use (20.5%) and in North Carolina (9.0%) and Indiana (4.9%) for probable CUD.
- Maintain cannabis screening in older veterans as well, because the mean ages of veterans with cannabis use and CUD were 59 and 53 years, respectively.
