Increasing risk of cannabis use disorder among U.S. Veterans with chronic pain: 2005-2019

Abstract: Aim: Medical cannabis use is legal in most U.S. states for chronic pain. Veterans’ Health Administration (VHA) patients are disproportionately affected by such pain and may use cannabis for symptom management. Because cannabis use increases the risk of cannabis use disorders (CUD), we examined time trends in CUD among VHA patients with and without chronic pain, and whether these trends differed by age. Methods: From VHA electronic health records from 2005 to 2019 (∼4.3 million to ∼5.6 million patients/year), we extracted provider-made diagnoses of CUD and chronic pain conditions (ICD-9-CM, 2005-2014; ICD-10-CM, 2016-2019). Differential trends in CUD prevalence overall and age-stratified (<35, 35-64, ≥65) were assessed by pain (any chronic pain and total pain conditions [0, 1, ≥2]) using multivariate logistic regression models that included study year, chronic pain and an interaction term for chronic pain x study year, adjusted for sex, race/ethnicity, and age. Results: From 2005-2014, VHA patients with any chronic pain had a significantly greater increase in CUD (1.23% to 2.56%) than those without pain (0.73% to 1.16%), p<0.001. Significantly greater increases in CUD among patients with versus without chronic pain occurred across all age groups and were highest among those with ≥2 pain conditions (p-values<0.001). From 2016-2019, veterans age ≥65 with chronic pain had significantly greater increases in CUD prevalence (0.63% to 1.01%) than those without chronic pain (0.28% to 0.47%) with the highest risk among those with ≥2 pain conditions (p<0.001). Conclusions: Over time, risk of CUD has increased more among VHA patients with chronic pain than other VHA patients, with the highest current increase in risk among those age ≥65. Clinicians should monitor symptoms of CUD among veterans and others with chronic pain who use cannabis, and consider non-cannabis therapies, particularly since the effectiveness of cannabis for chronic pain treatment remains inconclusive.

Read the full article
Report a problem with this article

Related articles

  • More for Researchers

    Relationship satisfaction change among UK service personnel: Associations with socio-demographics, military factors, and mental health

    Abstract: The unique demands of military life can adversely impact romantic relationships; however, research has mainly focused on these adverse outcomes at one-time point, overlooking changes over time or potential positive outcomes. Using a subsample of 3,845 male and female military personnel and veterans from a large UK dataset, this study examined positive and negative changes in relationship satisfaction between two-time points (2007–2009; 2014–2016). Most participants reported no change in their relationship satisfaction, suggesting stability − 8% reported a positive change and 10% a negative change. Positive change was associated with being in a long-term relationship, alcohol misuse remission, and persistent alcohol misuse. Negative change was associated with the onset of mental health problems (probable PTSD, CMD, or alcohol misuse) and having children under 18. Some factors, like increasing age, childhood family relationship adversity, and mental health problems, were associated with both positive and negative changes in relationship satisfaction. This study highlights the complexity of factors associated with relationship satisfaction among military personnel and veterans, with some experiencing positive changes, as well as negative changes over time.

    Family / Relationships Peer reviewed