Association between cannabis use disorder symptom severity and probability of clinically-documented diagnosis and treatment in a primary care sample.
Brief cannabis screening followed by standardized assessment of symptoms may support diagnosis and treatment of cannabis use disorder (CUD). This study tested whether the probability of a medical provider diagnosing and treating CUD increased with the number of substance use disorder (SUD) symptoms documented in patients’ EHRs.
This observational study from the Health Systems Node (related to CTN-0113) used EHR and claims data from an integrated healthcare system. Adult patients were included who reported daily cannabis use and completed the Substance Use Symptom Checklist, a scaled measure of DSM-5 SUD symptoms (0-11), during routine care 3/1/2015-3/1/2021. Logistic regression estimated associations between SUD symptom counts and: 1) CUD diagnosis; 2) CUD treatment initiation; and 3) CUD treatment engagement, defined based on Healthcare Effectiveness Data and Information Set (HEDIS) ICD-codes and timelines. We tested moderation across age, gender, race, and ethnicity.
Patients (N=13,947) were predominantly middle-age, male, White, and non-Hispanic. Among patients reporting daily cannabis use without other drug use (N=12,568), the probability of CUD diagnosis, treatment initiation, and engagement increased with each 1-unit increase in Symptom Checklist score (p’s<0.001). However, probabilities of diagnosis, treatment, and engagement were low, even among those reporting =2 symptoms consistent with SUD: 14.0% diagnosed (95% CI: 11.7-21.6), 16.6% initiated treatment among diagnosed (11.7-21.6), and 24.3% engaged in treatment among initiated (15.8-32.7). Only gender moderated associations between Symptom Checklist and diagnosis (p=0.047) and treatment initiation (p=0.012). Findings were similar for patients reporting daily cannabis use with other drug use (N=1,379).
Conclusions: This study highlights the need to improve diagnosis and treatment of CUD in general medical settings. While the probability of provider-documented CUD diagnosis and treatment increased with patient-report of symptoms, most patients with severe CUD did not receive diagnosis or treatment. The probability of CUD diagnosis and treatment could be even lower in other settings without routine cannabis assessment. There were missed opportunities across all sociodemographic subgroups, but women with severe CUD may be particularly less likely to initiate treatment. Further research should identify optimal approaches for initiating and engaging patients in CUD treatment in medical settings.
Related protocols: CTN-0113