Researchers examined differences in cannabis use disorder prevalence and use frequency between medical and nonmedical cannabis users, finding higher rates of both among those using cannabis for medical purposes, according to a cross-sectional study.

Using publicly available deidentified data from the 2021 to 2022 National Surveys on Drug Use and Health (mean weighted interview response rate = 47.5%), researchers analyzed 72,668 U.S. adults aged 18 to 49 years. Among participants, 29.5% reported past-year cannabis use: 83.7% reported nonmedical-only use, 9.2% reported medical-only use, and 5.7% reported medical-nonmedical use.

Based on DSM-5 criteria, overall cannabis use disorder (CUD) prevalence was 34.8%, with severity classified as mild (2 to 3 symptoms), moderate (4 to 5 symptoms), or severe (≥ 6 symptoms). Males and females aged 18 to 34 years and males aged 35 to 49 years reporting either medical-only or medical-nonmedical use showed higher adjusted prevalence of CUD at all severity levels compared with nonmedical-only users. Among males aged 18 to 34 years, medical-only users demonstrated higher adjusted prevalence of moderate and severe CUD vs nonmedical-only users. However, females aged 35 to 49 years showed different patterns, with no statistically significant differences in CUD prevalence between medical-only and nonmedical-only users.

Cannabis use frequency was consistently higher in both medical-only and medical-nonmedical groups across all demographics. Among males aged 18 to 34 years, the adjusted mean number of use days was 217.2 for medical-only users and 212.2 for medical-nonmedical users compared with 154.3 for nonmedical-only users.

"These findings suggest that medically recommended cannabis is not associated with reduced addiction risk compared with nonmedical use," wrote lead study author Beth Han, MD, PhD, MPH, and colleagues from the National Institute on Drug Abuse at the National Institutes of Health in Bethesda, Maryland in JAMA Psychiatry. Study limitations included reliance on self-reported data and potential overestimation of CUD prevalence in medical cannabis users as a result of DSM-5 criteria developed before widespread medical cannabis use.

The researchers emphasized the importance of clinicians considering addiction risks and monitoring for CUD when recommending medical cannabis.

Full disclosures can be found in the published letter.