One out of six primary care patients said they used marijuana in a survey of cannabis use, with many saying their use was primarily for medical reasons. The study by researchers at the University of California Los Angeles also found that a third of cannabis consumers reported weed at levels that put them at moderate or high risk of cannabis use disorder.
The research, which was Updated by JAMA Open Network on Wednesday, suggests that many cannabis consumers use the drug for medicinal purposes, despite characterizing their use as recreational. The researchers behind the study say the findings indicate a need for routine cannabis screenings of primary care patients. Currently, few healthcare systems offer screenings for cannabis use in the primary care setting.
“Patients may not tell their primary care providers about their cannabis use, and their doctors may not ask about it,” lead author Dr. Lillian Gelberg, professor of family medicine at the David Geffen School of Medicine at UCLA and of health policy and management at the UCLA Fielding School of Public Health, said in a statement to UCLA Health. “Not asking patients about their cannabis use results in a missed opportunity for opening up doctor-patient communication regarding use of cannabis generally and for management of their symptoms.”
In 2020, the U.S. Preventive Services Task Force recommended that primary care physicians screen their adult patients for the use of cannabis and other substances. The following year, the researchers who conducted the study launched a self-administered survey on cannabis use and medical cannabis use as part of the UCLA Health medical system’s universal electronic health record. Patients complete the survey via the system’s online portal as part of the pre-visit screening before visits for primary care.
UCLA Health is one of only a few healthcare systems that ask patients to complete a voluntary cannabis use assessment as part of the pre-visit process for primary care patients. UCLA Health uses the WHO Alcohol Substance Involvement Screening Test (ASSIST) to assess cannabis use.
The researchers used anonymized health record data collected by UCLA Health between January 2021 and May 2023 to determine the prevalence of cannabis use and the reasons patients are using the drug and to identify other factors that correlate with cannabis use. Approximately 176,000 patients completed the survey, including almost 30,000 (17%) who said they were cannabis users. Among those who self-reported cannabis use, 35% had results that suggested a moderate or high risk of cannabis use disorder.
Among cannabis users, 40% had consumed weed once or twice during the previous three months, 17% used marijuana monthly, a quarter (25%) used cannabis every week and nearly a fifth (19%) used weed on a daily or near-daily basis.
Nearly half (47%) of respondents said that they used cannabis medicinally. However, 76% used weed to manage symptoms such as mental health symptoms or stress (56%), sleep (56%) and pain (37%). Additionally, most patients who said they used marijuana recreationally had also used it to manage a symptom at some point in their lives.
The researchers note that the study had limitations, including a reliance on self-reported data. Additionally, while cannabis is legal in California, the stigma attached to the plant may mean that some patients did not fully disclose their cannabis use. The survey data was collected during the Covid-19 pandemic when the use of cannabis may have been higher than it would have been otherwise.
However, “given the high rates of cannabis use and medical cannabis use that we found in this large urban healthcare system, it is essential that healthcare systems implement routine screening of all primary care patients,” the researchers wrote. “Integrating screening efforts to include information regarding cannabis use for symptom management could help enhance the identification and documentation of medical cannabis usage, particularly in the healthcare context.”
Dr. Benjamin Caplan, M.D., the author of The Doctor-Approved Cannabis Handbook, cited other shortcomings of the study, including its focus on cannabis use disorder. He says that the test used by the researchers is designed to assess multiple substance use disorders and lacks a detailed focus on cannabis users’ specific characteristics.
Despite these and other study limitations, Caplan commended the researchers for “acknowledging important opportunities, like the need for informed conversations.”
“Healthcare providers must integrate discussions about cannabis use into routine care, allowing patients to communicate their experiences openly,” he wrote in an email to High Time. “Doctors need to understand why patients choose cannabis over conventional treatments and be informed about both the risks and benefits of cannabis. This will lead to better management strategies and support systems for cannabis users, whether their use is medical or non-medical.”
Caplan added that the study “reveals a key takeaway: even patients within primary care are heavily reliant on cannabis for symptom relief. This underscores a critical issue that is seen throughout our medical system, which is that doctors are not adequately meeting patients’ needs for managing anxiety, sleeplessness, pain, and other symptoms. That is important news that isn’t discussed loudly enough.”
