Asking patients about cannabis may benefit overall health

Drs. Lapham and Bradley find frequency of cannabis use can be tied to other behavioral health patterns and needs

People who reported more frequent cannabis use were increasingly more likely to report other substance use, including tobacco and unhealthy alcohol use, and mental health symptoms, according to a recent analysis by KPWHRI scientists Gwen Lapham, PhD, MPH, MSW, and Kathy Bradley, MD, MPH.

Their team recently published their findings, “Prevalence of Behavioral Health Conditions Across Frequency of Cannabis Use Among Adult Primary Care Patients in Washington State,” in the Journal of General Internal Medicine. This report builds on their prior research: Kaiser Permanente researchers explore patients’ marijuana use: Routinely asking about cannabis use can better serve patients by helping clinicians start conversations about risks and benefits. This work was inspired, in part, by the research group’s desire to anticipate possible downstream health effects of cannabis legalization in Washington state.

Among the primary care patients whose anonymous data went into the analysis, nearly half of those who use cannabis every day reported depression symptoms — and more than a third had a received a mental health disorder diagnosis from their health care provider within the past year.

Explaining why these findings are important, Dr. Lapham wrote, “It’s important to understand that patients may engage in cannabis use to manage their depression or anxiety symptoms. At the same time, cannabis use can exacerbate these symptoms and has been associated with new onset of depression. Asking our patients about their cannabis use affords providers an opportunity to talk with their patients about their cannabis use and how it may relate to their mental health symptoms.”

Because these research findings suggest that frequent cannabis use can be associated with an increased risk of other substance use disorders, the article’s authors suggest that primary care providers consider integrating discussions about cannabis use with those about tobacco and alcohol use. Additionally, patients with mental health conditions who use cannabis should be advised that cannabis can worsen mental health symptoms and that cannabis withdrawal can mirror symptoms of anxiety and depression.

As cannabis legalization expands to other states, integrating routine assessment of its use into primary care provides an opportunity for improving behavioral health care.

By Susan Brandzel