ArticleJournal of cannabis research2025
Cannabis use among primary care patients with depression and anxiety disorders: cross-sectional analysis in a large health system in Los Angeles, CA.
Article in Journal of cannabis research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDepression, anxiety, and cannabis use are growing, interconnected primary care concerns, but remain understudied due few health systems conducting systematic cannabis use screening. This study examines cannabis use and risk of cannabis use disorder (CUD) among primary care patients, comparing outcomes by depression and anxiety diagnoses and psychotropic prescriptions.
methodsWe assessed past three-month cannabis use, reasons for use, and risk of CUD among 170,032 adult primary care patients at a large health system in Los Angeles, CA under a routine screening protocol using the validated, self-administered ASSIST survey. This survey was embedded in the electronic health record (EHR), where data on ICD-10 diagnostic codes for depressive and anxiety disorders, psychotropic prescriptions, and demographics were collected. Logistic regression analysis assessed the association of depression and anxiety diagnoses on risk of CUD.
resultsMedian age was 48 years (IQR 35-61), 57.8% were female, and 17.5% reported cannabis use. 24.0% had anxiety diagnoses and 9.0% had depression diagnoses. Cannabis use was higher among patients diagnosed with depression or anxiety than other patients (21.7%-27.4% vs. 15.5%, p < 0.001). Most patients who reported cannabis use and had depression or anxiety diagnoses reported using cannabis to manage emotional symptoms (62.5%-71.3%); notably, 47.3% of these patients had current antidepressant or anxiolytic prescriptions. Moderate-to-high risk of CUD was elevated among patients who reported cannabis use diagnosed with depression (9.8%), anxiety (8.0%), and particularly depression and anxiety (12.9%) (other patients = 4.9%; p < 0.001). After adjusting for age, sex, race and ethnicity, sexuality (LGB + versus heterosexual), employment, and Charlson Comorbidity Index, depression and anxiety diagnoses were associated with elevated risk of CUD [aOR 1.99 (95% CI 1.78-2.23); aOR 1.6 (95% CI 1.51-1.69), respectively], with the highest association among patients with both diagnoses [aOR 2.58 (95% CI 2.34-2.83)].
conclusionsClinical depression and anxiety diagnoses were associated with elevated cannabis use prevalence and risk of CUD. Many primary care patients reported using cannabis to manage mental health-related symptoms, even when prescribed psychotropic medications. These findings highlight the need for providers to assess and address cannabis use and potential CUD among primary care patients, especially those diagnosed with depression or anxiety.
trial registrationClinical trial number: not applicable.
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