Association between cannabis use disorder symptom severity and probability of clinically-documented diagnosis and treatment in a primary care sample.

Matson TE, Williams EC, Lapham GT, Oliver M, Hallgren KA, Bradley KA. Association between cannabis use disorder symptom severity and probability of clinically-documented diagnosis and treatment in a primary care sample. Drug and Alcohol Dependence. 2023 Oct 1; 251:110946.

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Abstract:

BACKGROUND: 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. METHODS: This observational study 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. RESULTS: 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 = 1379). CONCLUSION: Despite documented symptoms, CUD was underdiagnosed and undertreated in medical settings.