Key Takeaways

From the Authors As published in the article
  1. National data on cannabis use in US veterans are limited, with little attention to geographic variation. This study fills an important gap by demonstrating marked regional differences in cannabis use and probable cannabis use disorder (CUD), highlighting how regional policy, access, and norms may shape risk patterns among veterans.
Extended Takeaways
  1. In this nationally representative 2022 sample, 284 veterans (weighted 11.6%) reported cannabis use and 70 (weighted 2.9%) had probable CUD, reinforcing that disorder affects a substantial subset of users rather than being limited to occasional use.
  2. The Pacific region stood out clinically because it combined the highest cannabis use prevalence (18.6%) with the highest probable CUD prevalence (8.8%), and its probable CUD rate exceeded the contemporary general adult US population estimate of 7%.
  3. High cannabis use and probable CUD were not confined to states with legalized recreational cannabis at the time of data collection; Oklahoma had cannabis use of 20.5%, and North Carolina and Indiana were among the top 5 states for probable CUD at 9.0% and 4.9%, respectively.
  4. New England illustrates that high cannabis exposure does not necessarily translate into equally high disorder burden: cannabis use was 13.4%, not significantly different from the Pacific region (P = .24), while probable CUD was 3.5% and significantly lower than the Pacific region.
  5. Veterans with probable CUD showed a distinct service-use profile in that they were more likely to use the VA as their primary source of health care, suggesting that VHA settings may be especially important sites for identifying and managing cannabis-related problems.
  6. The age profile of affected veterans was older than many clinicians may expect: the mean ages of veterans with cannabis use and CUD were 59 and 53 years, respectively, supporting cannabis assessment even in aging veteran populations.
Clinical Pearls

  1. Do not reserve cannabis screening for younger veterans; in this sample, the mean ages were 59 years for cannabis use and 53 years for probable CUD.

  2. Treat the Pacific region as a high-yield setting for case-finding: veterans there had the highest prevalence of cannabis use (18.6%) and probable CUD (8.8%), and the probable CUD rate was significantly higher than all other regions.

  3. High cannabis exposure does not always translate into equally high disorder burden; New England had cannabis use of 13.4% that did not differ from the Pacific region (P = .24), but probable CUD was 3.5%.

  4. Do not assume cannabis-related risk is confined to states with legalized recreational cannabis; Oklahoma had cannabis use of 20.5%, while North Carolina and Indiana were among the top 5 states for probable CUD at 9.0% and 4.9%.

  5. Use brief structured screening rather than relying on disclosure alone; on the 3-item CUDIT-SF, a score ≥2 is indicative of probable CUD.

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Physicians Postgraduate Press, Inc. (PPP) makes no warranties about the accuracy or completeness of any information published in The Journal of Clinical Psychiatry or other PPP materials, and disclaims liability for any use or non-use of that information. Clinicians should not rely solely on these materials and should exercise their own professional judgment when making patient care decisions on an individualized basis.

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