UCLA Study Advocates Routine Cannabis Screening in Primary Care

A new study from UCLA Health has found that one in six primary care patients regularly use marijuana, with many saying they use it for medicinal purposes. However, more than a third of the patients surveyed who used marijuana had a moderate to high risk of a cannabis use disorder, based on their frequency of marijuana use. These findings have led UCLA researchers to call for routine cannabis screening as part of primary care.

“Patients may not tell their primary care providers about their cannabis use, and their doctors may not ask about it,” said Dr. Lillian Gelberg of UCLA Health, the study’s lead author, in a statement summarizing her research. “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.”

Study Methodology

Dr. Gelberg and her colleagues recently published their findings in JAMA Network Open. The UCLA study analyzed a cross-section of electronic health record data from their healthcare system in Los Angeles. The study included data from 175,734 patients aged 18 and older who had an annual wellness visit between January 2021 and May 2023. Researchers employed the World Health Organization’s Alcohol Substance Involvement Screening Test (ASSIST) to assess cannabis use. The ASSIST tool is a validated questionnaire designed to identify risky substance use behaviors. The study also collected sociodemographic data, including age, race and ethnicity, sex, employment status, and socioeconomic data to understand the factors associated with cannabis use.

Key Findings

After analyzing the data, researchers found that 17 percent of the primary care patients surveyed reported using cannabis in the past three months. Notably, the prevalence of cannabis use was significantly higher among male patients (20 percent) compared to female patients (14.7 percent). Furthermore, younger patients aged 18-29 years (31 percent) were much more likely to use cannabis compared to older patients aged 60 years and above (8.5 percent).

The study also identified that a significant portion of these users were at risk for cannabis use disorder (CUD). Specifically, 34.7 percent of those who reported cannabis use had ASSIST scores indicating moderate to high risk for CUD. This highlights the importance of routine screening, as early identification of CUD can help doctors identify which patients need medical interventions. Timely intervention can potentially mitigate the long-term health consequences of CUD.

Other important findings from the study include:

• Among different economic groups, patients living in the poorest neighborhoods had the lowest percentage of cannabis users, at 14 percent. However, this group also had the highest risk for CUD.

• Ingesting edibles and inhaling cannabis were the most common methods of use, and the UCLA Health summary of the study said patients used those methods at roughly the same rates. About 29 percent of patients who reported using cannabis vaped.

• Among self-reported cannabis users, 40 percent used it once or twice in the previous three months, 17 percent used it monthly, 25 percent used it weekly, and 19 percent used it daily or almost daily.

Reasons for Cannabis Use

One of the primary goals of the UCLA study was to identify the reasons why patients use cannabis. Researchers found that while 15.6 percent of patients said they strictly used cannabis for medical reasons, a substantial 75.7 percent of those surveyed who used cannabis said they did so to manage various health-related symptoms such as pain, stress, and sleep issues. The most common symptoms reported among those who use cannabis to manage health conditions were sleep (56 percent), stress (50.2 percent), and anxiety (36.3 percent).

The use of cannabis for symptom management underscores the need for primary care clinicians to discuss cannabis use with their patients openly. Many patients may not volunteer this information unless directly asked, particularly if they do not identify as medical cannabis users.

Importance of Routine Screening

The 2020 U.S. Preventive Services Task Force recommended that primary care clinicians screen adult patients for substance use, including cannabis. Despite this recommendation, many primary doctors still do not routinely screen for drug use. This gap in practice can leave a significant portion of the patient population at risk of undiagnosed substance use disorders. Routine screening can help identify patients who use cannabis and may be at risk for CUD, providing a crucial opportunity for intervention.

The study’s findings suggest that integrating routine cannabis screening into primary care practices can help identify patients who might benefit from counseling or treatment for CUD. Routine drug screening could also help doctors make sure that patients who use cannabis for symptom management do so safely and effectively.

What the UCLA Health Study Tells Us

There are some limitations to what we can learn from this study. Any research based on self-reports from participants depends on honest answers from those participants, and not all patients who took part in the study may have been fully honest. Additionally, much of the data collected in the survey came from screenings that took place during California’s COVID-19 lockdown, when more people than usual may have been using cannabis.

Finally, the study’s findings are not necessarily applicable nationwide. Many parts of the country have different demographics than the population included in the UCLA health system. There may also be different patterns of cannabis use in states where it is not legal for medicinal or recreational purposes.

Still, the UCLA study provides compelling evidence for the need for routine cannabis screening in primary care. With 17 percent of patients reporting recent cannabis use and over a third of reported cannabis users at risk for CUD, primary care settings can play a pivotal role in identifying and managing cannabis use among patients. By adopting routine screening practices, primary care doctors can better understand their patients’ cannabis use patterns and provide appropriate care and intervention to those who need it. This proactive approach can lead to improved health outcomes and a better understanding of the role of cannabis in managing health conditions.

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