Outcomes for older trauma patients in the emergency department screening positive for alcohol, cocaine, or marijuana use

Identifying factors predicting outcomes after major trauma in older patients: Prognostic systematic review and meta-analysis

INTRODUCTION

Trauma is the most common cause of morbidity and mortality in older people, and it is important to determine the predictors of outcomes after major trauma in older people.

METHODS

MEDLINE, Embase, and Web of Science were searched, and manual search of relevant papers since 1987 to February 2023 was performed. Random-effects meta-analyses were performed. The primary outcome of interest was mortality, and secondary outcomes were medical complications, length of stay, discharge destination, readmission, and intensive care requirement.

RESULTS

Among 6,064 studies in the search strategy, 136 studies qualified the inclusion criteria. Forty-three factors, ranging from demographics to patient factors, admission measurements, and injury factors, were identified as potential predictors. Mortality was the commonest outcome investigated, and increasing age was associated with increased risk of in-hospital mortality (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.03-1.07) along with male sex (OR, 1.40; 95% CI, 1.24-1.59). Comorbidities of heart disease (OR, 2.59; 95% CI, 1.41-4.77), renal disease (OR, 2.52; 95% CI, 1.79-3.56), respiratory disease (OR, 1.40; 95% CI, 1.09-1.81), diabetes (OR, 1.35; 95% CI, 1.03-1.77), and neurological disease (OR, 1.42; 95% CI, 0.93-2.18) were also associated with increased in-hospital mortality risk. Each point increase in the Glasgow Coma Scale lowered the risk of in-hospital mortality (OR, 0.85; 95% CI, 0.76-0.95), while each point increase in Injury Severity Score increased the risk of in-hospital mortality (OR, 1.07; 95% CI, 1.04-1.09). There were limited studies and substantial variability in secondary outcome predictors; however, medical comorbidities, frailty, and premorbid living condition appeared predictive for those outcomes.

CONCLUSION

This review was able to identify potential predictors for older trauma patients. The identification of these factors allows for future development of risk stratification tools for clinicians.

LEVEL OF EVIDENCE

Systematic Review and Meta-Analysis; Level III.

Approaches and reporting of alcohol and other drug testing for injured patients in hospital-based studies: A systematic review

ISSUE

Hospital alcohol and/or other drug (AOD) testing is important for identifying AOD-related injuries; however, testing methods vary. This systematic review aimed to examine biological AOD testing methods from hospital-based studies of injured patients and quantify what proportion reported key information on those testing methods.

APPROACH

Observational studies published in English from 2010 onwards involving biological AOD testing for injured patients presenting to hospital were included. Studies examining single injury causes were excluded. Extracted data included concentration thresholds for AOD detection (e.g., lower limits of detection, author-defined cut-offs), test type (e.g., immunoassay, breathalyser) and approach (e.g., routine, clinical discretion), timing of testing, sample type and the proportion of injured cases tested for AODs.

KEY FINDINGS

Of 83 included studies, 76 measured alcohol and 37 other drugs. Forty-nine studies defined blood alcohol concentration thresholds (ranging from 0 to 0.1 g/100 mL). Seven studies defined concentration thresholds for other drugs. Testing approach was reported in 39/76 alcohol and 18/37 other drug studies. Sample type was commonly reported (alcohol: n = 69/76; other drugs: n = 28/37); alcohol was typically measured using blood (n = 60) and other drugs using urine (n = 20). Studies that reported the proportion of cases tested (alcohol: n = 53/76; other drugs: n = 28/37), reported that between 0% and 89% of cases were not tested for alcohol and 0% and 91% for other drugs. Timing of testing was often unreported (alcohol: n = 61; other drugs: n = 30).

IMPLICATIONS AND CONCLUSION

Variation in AOD testing methods alongside incomplete reporting of those methods limits data comparability and interpretation. Standardised reporting of testing methods will assist AOD-related injury surveillance and prevention.

Mechanisms of Injury in Adolescent Trauma Patients With a Positive Marijuana Screen

BACKGROUND

Marijuana use among adolescents may have increased after its legalization in the United States. An association between violence and marijuana use in adults has been demonstrated in previous reports. We hypothesized that adolescent trauma patients presenting with a positive marijuana screen (pMS) are more likely to have been injured by gunfire or knives and will have more severe injuries overall, compared to patients with a negative marijuana screen (nMS).

METHODS

The 2017 Trauma Quality Improvement Program database was queried for adolescent (13-17 years old) pMS patients and compared to adolescents who tested negative for all substance/alcohol. Patients with positive polysubstance/alcohol were excluded.

RESULTS

From 8257 adolescent trauma patients, 2060 (24.9%) had a pMS with a higher rate of males in the pMS group (76.3% vs 64.3%, P < .001). The pMS group presented more frequently after gun (20.3% vs 7.9%, P < .001) or knife trauma (5.7% vs 3.0%, P < .001) and less frequently after falls (8.9% vs 15.6%, P < .001) and bicycle collisions (3.3% vs 4.8%, P = .002). The rate of serious thoracic injury (AIS ≥3) was higher for pMS patients (16.7% vs 12.0%, P < .001), and more pMS patients required emergent operation (14.9% vs 10.6%, P < .001).

DISCUSSION

In our adolescent patient population, one quarter tested positive for marijuana. These patients are more likely to be injured by guns and/or knives suffering serious injuries, and often require immediate operative intervention. A marijuana cessation program for adolescents can help improve outcomes in this high-risk patient group.

Cocaine use in trauma: the vices-paradox revisited

BACKGROUND

The "vices-paradox" describes the paradoxical association between illicit substance use and decreased mortality risk in trauma patients. Cocaine's vasoconstrictive effects may decrease hemorrhage but also increase the risk of thromboembolic complications. To clarify the effects of cocaine use on trauma patients, we compared the risk of mortality and thromboembolic complications in patients screening positive for cocaine with those screening negative.

METHODS

We searched the Trauma Quality Improvement Program database to identify patients 18 years and over who had presented with a drug and alcohol screen on admission between 2017 and 2019. After excluding all patients who had tested positive for alcohol and substances other than cocaine, we then compared the clinical outcomes of patients who were positive and negative for cocaine use.

RESULTS

Of the 312,553 patients identified, 11,942 (3.82%) had tested positive for cocaine. Cocaine users were significantly more likely to present with stab (8.0% vs 3.1%) or gunshot wounds (8.0% vs 3.0%) but had lower rates of mortality (3.6% vs 4.7%), myocardial infarction (0.1% vs 0.2%,) and cerebrovascular accident (0.3% vs 0.4%,). After controlling for covariates, the risk of death, myocardial infarction, and cerebrovascular accident did not significantly differ between cocaine and non-cocaine users.

CONCLUSION

Trauma patients positive for cocaine have similar risks of death and thromboembolic complications and so have a similar prognosis to patients negative for all drugs or alcohol, indicating that the "vices-paradox" does not apply to cocaine use. However, these patients more commonly present after penetrating trauma, suggesting cocaine use in hazardous environments.

Trends and outcomes of trauma patients positive to marijuana and cocaine

PURPOSE

Substance misuse has long been recognized as a major predisposing risk factor for traumatic injury. However, there still exists no clear scientific consensus regarding the impact of drug use on patient outcomes. Therefore, this study aims to evaluate the demographic profile, hospital-course factors, and outcomes of trauma patients based on their toxicology.

METHODS

This is a non-concurrent cohort study of 3709 patients treated at the Puerto Rico Trauma Hospital during 2002-2018. The sample was divided into four groups according to their toxicology status. Statistical techniques used included Pearson's chi-square test, Spearman correlation, and negative binomial and logistic regressions.

RESULTS

Admission rates for marijuana (rho = 0.87) and marijuana and cocaine positive (rho = 0.68) patients increased. Positive toxicology patients underwent surgery more often than negative testing patients (marijuana: 68.7%, cocaine: 65.6%, marijuana & cocaine: 69.8%, negative: 57.0%). Among patients with non-penetrating injuries, a positive toxicology for cocaine or marijuana was linked to a 48% and 42% increased adjusted risk of complications, 37% and 27% longer TICU LOS, and 32% and 18% longer hospital LOS, respectively.

CONCLUSION

Our results show an association between positive toxicology for either marijuana, cocaine, or both with higher need for surgery. Additionally, our results show an increase in complications, TICU LOS, and hospital LOS among non-penetrating trauma patients testing positive for marijuana or cocaine. Therefore, this study provides valuable information on the clinical profile of patients with positive toxicology, suggesting they might benefit from more aggressive management.

Trends in emergency department visits associated with cannabis use among older adults in California, 2005-2019

BACKGROUND

The use of cannabis among older adults is increasing in the United States. While cannabis use has been suggested to help alleviate chronic symptoms experienced by older adults, its potential adverse effects may lead to unintended consequences, including increased acute healthcare utilization related to its use. The objective of this study was to examine trends in cannabis-related emergency department (ED) visits in California.

METHODS

Using data from the Department of Healthcare Access and Information, we conducted a trend analysis of cannabis-related ED visits from all acute care hospitals in California from 2005 to 2019. For each calendar year, we determined the cannabis-related ED visit rate per 100,000 ED visits for adults aged ≥65 utilizing primary or secondary diagnosis codes. We estimated the absolute and relative changes in overall cannabis-related visit rates during the study period and by subgroup, including age (65-74, 75-84, ≥85), race/ethnicity, sex, payer/insurance, Charlson comorbidity index score, and cannabis-related diagnosis code.

RESULTS

The cannabis-related ED visit rate increased significantly for adults aged ≥65 and all subgroups (p < 0.001). The overall rate increased from 20.7 per 100,000 visits in 2005 to 395.0 per 100,000 ED visits in 2019, a 1804% relative increase. By race/ethnicity, older Black adults had the highest ED visit rate in 2019 and the largest absolute increase while older males had a higher ED visit rate in 2019 and a greater absolute increase than older women. Older adults with a higher Charlson score had a higher ED visit rate in 2019 and a larger absolute increase during the study period.

CONCLUSION

Cannabis-related ED visits are increasing among older adults in California and are an adverse effect of cannabis use. Asking about cannabis use and providing education about its use should be a part of routine medical care for older adults.

Past-month binge drinking and cannabis use among middle-aged and older adults in the United States, 2015-2019

The aging United States population, which includes the large Baby Boomer generation, is leading to an increasing number of middle-aged and older adults who engage in psychoactive substance use. Due to the size of this cohort, and their changing attitudes around psychoactive substance use, there has been a sharp increase in prevalence of past-month cannabis use among adults aged ≥50; however, little is understood about recent trends in the use of both cannabis and excess alcohol use, such as binge drinking, in this population. The current use of both alcohol and cannabis has important health implications for older adults, given their higher prevalence of chronic diseases and prescribed medications. This study aimed to 1) estimate national trends among older adults who report both past-month binge drinking and cannabis use, and 2) examine correlates of reporting both. We examined aggregated data from a nationally representative sample of noninstitutionalized adults aged ≥50 from the 2015 to 2019 National Survey on Drug Use and Health. During the study period, there was an estimated 2.5% increase (a 64.1% relative increase) in past-month cannabis use (linear trend p < 0.001), a non-significant decrease in past-month binge drinking, and a 0.5% estimated increase in both past-month cannabis use and binge drinking (a 26.3% relative increase) (p = 0.03). The sharpest increase in both past-month cannabis use and binge drinking was among adults aged ≥65, with the estimated prevalence increasing from 0.2% in 2015 to 1.1% in 2019 (a 450% relative increase, p < 0.001). Those engaging in past-month binge drinking and cannabis use were more likely to be younger, male, non-Hispanic Black, use tobacco, and report past-year mental health treatment. Results suggest that the prevalence of both past-month cannabis use and binge drinking among middle-aged and older adults increased between 2015 and 2019, especially among adults aged ≥65, which indicates an increased need to screen for both excess alcohol and cannabis use to minimize potential harm.

Impacts of medical and non-medical cannabis on the health of older adults: Findings from a scoping review of the literature

BACKGROUND

Cannabis legalization has enabled increased consumption in older adults. Age-related mental, physical, and physiological changes may lead to differences in effects of cannabis in older adults compared to younger individuals.

OBJECTIVE

To perform a scoping review to map the evidence regarding the health effects of cannabis use for medical and non-medical purposes in older adults.

METHODS

Electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Library) were searched for systematic reviews (SRs), randomized controlled trials (RCTs) and non-randomized/observational studies (NRSs) assessing the health effects and associations of cannabis use (medical or non-medical) in adults ≥ 50 years of age. Included studies met age-related inclusion criteria or involved a priori identified health conditions common among older adults. Records were screened using a liberal accelerated approach and data charting was performed independently by two reviewers. Descriptive summaries, structured tables, effect direction plots and bubble plots were used to synthesize study findings.

FINDINGS

From 31,393 citations, 133 publications describing 134 unique studies (26 SRs, 36 RCTs, 72 NRSs) were included. Medical cannabis had inconsistent therapeutic effects in specific patient conditions (e.g., end-stage cancer, dementia), with a number of studies suggesting possible benefits while others found no benefit. For medical cannabis, harmful associations outnumbered beneficial, and RCTs reported more negative effects than NRSs. Cannabis use was associated with greater frequencies of depression, anxiety, cognitive impairment, substance use and problematic substance use, accidents/injuries, and acute healthcare use. Studies often were small, did not consistently assess harms, and did not adjust for confounding.

DISCUSSION

The effects of medical cannabis are inconsistent within specific patient conditions. For older adults, generally, the available evidence suggests cannabis use may be associated with greater frequencies of mental health issues, substance use, and acute healthcare use, and the benefit-to-risk ratio is unclear. Studies with a balanced assessment of benefits and harms may guide appropriate public health messaging to balance the marketing pressures of cannabis to older adults.

Rates and types of urine drug screen false negative results compared with confirmatory toxicology testing in major trauma patients

BACKGROUND

Trauma centers are required to screen patients for alcohol use, and if necessary, intervene and refer to treatment (SBIRT). Similar screening for illicit drug use is recommended but not required. Urine drug screening (UDS) underestimates problematic substance use. This study aimed to estimate the types and rates of UDS false negatives (FN) compared to comprehensive testing by liquid chromatography-mass spectrometry (LC-MS) in trauma patients.

METHODS

We performed a prospective cohort study of deidentified urine samples from adult trauma and burn activation patients. Both UDS and LC-MS comprehensive testing of >200 analytes were performed by a reference laboratory on all samples. Iatrogenic medications were excluded from the FN count. Crosstab analyses were conducted for UDS versus LC-MS outcomes to establish FN types and rates. We dichotomized the results by creating an "intentionality" variable (intentional injuries by self/others versus accidental injuries). A series of crosstabs with odds ratios considered intentionality by substance class and demographics. Statistically significant variables by Chi-Square were assessed by logistic regression.

RESULTS

Psychoactive FN were detected in 56/100 urine samples analyzed; the most frequent included anticonvulsants (primarily gabapentin, N = 13), opioid agonists (N = 12), antihistamines (primarily diphenhydramine, N = 10), and phenethylamines (primarily bupropion, N = 5). Nonpsychoactive FN were detected in 70/100 samples; the most common were nicotine (N = 33), caffeine (N = 23), acetaminophen (N = 22), and antidepressants (N = 12). Of substance classes included in the UDS and also tested by LC-MS, FN occurred for opiates (3%), amphetamines (5%) and opioids (25%). Polypharmacy was associated with fall injuries in elderly patients. Cocaine (p = 0.015) and cannabinoids (p = 0.002) were significantly associated with intentionality.

CONCLUSIONS

Our results indicate that FN for potentially important psychoactive and nonpsychoactive substances are common when toxicologic testing is limited to routine UDS in trauma patients. We recommend expanding SBIRT in this patient population to include misuse of tobacco products, prescription analgesics, and over-the-counter antihistamines.

Ageing and older people who use illicit opioids, cocaine or methamphetamine: a scoping review and literature map

AIMS

To provide an overview of research literature on ageing and older people who use illicit opioids and stimulants by documenting the conceptual frameworks used and content areas that have been investigated.

METHODS

We conducted a scoping review of literature relating to ageing and older people who use illicit stimulants and opioids, defining 'older' as 40 years and above. Primary studies, secondary studies and editorials were included. Searches were conducted in PubMed and Embase in July 2020 and March 2021; the Cochrane library was searched in November 2021. Charted data included methodological details, any conceptual frameworks explicitly applied by authors and the content areas that were the focus of the publication. We developed a hierarchy of content areas and mapped this to provide a visual guide to the research area.

RESULTS

Of the 164 publications included in this review, only 16 explicitly applied a conceptual framework. Seven core content areas were identified, with most publications contributing to multiple content areas: acknowledgement of drug use among older people (n = 64), health status (n = 129), health services (n = 109), drug use practices and patterns (n = 84), social environments (n = 74), the criminal legal system (n = 28) and quality of life (n = 15).

CONCLUSIONS

The literature regarding older people who use illicit drugs remains under-theorized. Conceptual frameworks are rarely applied and few have been purposely adapted to this population. Health status and health services access and use are among the most frequently researched topics in this area.

The Effect of Substance Abuse Programs on Positive Drug Screening Tests in Trauma Patients

BACKGROUND

According to the National Institute on Drug Abuse, West Virginia has the highest age-adjusted rate of drug overdose deaths involving opioids. To combat this crisis, comprehensive drug counseling support services were established within the Cabell Huntington Hospital (CHH) system in October 2018 in Huntington, WV, USA. The purpose of this study was to investigate whether these services significantly reduced the number of trauma patients with a positive urine drug screen (UDS) seen at CHH.

METHODS

The trauma registry at CHH was used to obtain data on trauma patients with positive UDS from January 2017 to October 2019, which was divided into groups before and after October 2018. Exclusion criteria were any patients who were prescribed the drug. The percentages of the total number of positive drug screens within each group were calculated, and a t-test analysis was performed to determine the P values.

RESULTS

345 trauma patients with positive UDS were selected. Results showed that there was an overall decrease in the rate of nonprescribed use after October 2018 of benzodiazepines (18.1%-11.5%), cocaine (19.5%-15.3%), opioids (19.1%-12.3%), and oxycodone (10.2%-4.6%). However, none of these changes were statistically significant. There was an increase in the rate of nonprescribed use of amphetamine (20.0%-23.8%) and methamphetamine (14.4%-33.8%).

DISCUSSION

Our hypothesis is that the support systems are relatively new, and may need more time to identify and intervene on patients before a statistically significant effect on drug abuse rates in our region can be seen.

Current illicit drug use profile of orthopaedic trauma patients and its effect on hospital length of stay

INTRODUCTION

The purpose of this study was to investigate the prevalence of illicit drug use among patients admitted with traumatic orthopaedic injuries and to determine its effect on hospital length of stay (LOS). We hypothesized that patients with pre-injury drug use would have a longer hospital LOS compared to those who do not use drugs.

METHODS

We conducted a retrospective cohort study at our level 1 urban trauma center of patients admitted with traumatic orthopaedic injuries between 2013 and 2015 with urine toxicology screening. We collected demographic and hospital LOS data from chart review.

RESULTS

Of 611 patients, over half (55%) had a positive drug screen: marijuana (41%), amphetamine (19%), cocaine (7%), and/or PCP (2%). The highest incidence of drug use was in males under 19 years of age (81%). Patients with any drug use had a longer hospital LOS compared to those who did not use drugs (8.3 vs. 6.3 days; p = 0.03). Patients who used amphetamines had a longer hospital LOS than those patients who did not (9.5 vs. 6.9 days; p = 0.01).

CONCLUSION

Compared to the orthopaedic trauma population two decades ago, the current population using illicit drugs is younger (<30 years) with an increased preference for amphetamine and marijuana and a decreased preference for cocaine. Pre-injury drug use was associated with a longer hospital LOS in patients with a traumatic orthopaedic injury. Knowledge of the current trends in illicit drug use amongst orthopaedic trauma patients could facilitate medical decision-making regarding clinical care and optimizing resource utilization in this complex population of individuals.

Orthopaedic Injury Profiles in Methamphetamine Users: A Retrospective Observational Study

INTRODUCTION

We sought to characterize the prevalence of methamphetamine (MA) abuse and associated orthopaedic injury patterns at our level 1 trauma center.

METHODS

We conducted a retrospective review of all orthopaedic consults for the year 2016. Patients were classified as MA users based on urine toxicology results and social history.

RESULTS

The prevalence of MA use was 10.0%. MA users were more likely to present with hand lacerations and other infections (P < 0.05 for all). Regarding the mechanism of injury, MA users were more likely to be involved in automobile versus pedestrian, automobile versus bicycle, ballistic, knife, closed fist, other assault/altercation, and animal bite injuries (P < 0.05 for all).

DISCUSSION

MA use is prevalent at our level 1 trauma center. The prevalence and injury patterns of MA abuse warrant deeper study into the effects of this drug on orthopaedic outcomes.

LEVEL OF EVIDENCE

Level III.

Older marijuana users' marijuana risk perceptions: associations with marijuana use patterns and marijuana and other substance use disorders

ABSTRACTBackground:Compared to their non-using age peers, older marijuana users are known to have lower marijuana risk perceptions. We examined associations of older marijuana users' risk perceptions with their marijuana use patterns and substance use disorders.

METHODS

Data are from 2013 to 2015 National Survey of Drug Use and Health (N = 24,057 respondents aged 50+ years). Bivariate logistic regression was used to compare risk perceptions among never users, former users, and past-year users aged 50+ years. Multivariable logistic regression was used to test associations between risk perception and marijuana use status and between risk perception and marijuana use patterns.

RESULTS

Among the total sample, former (AOR = 0.30, 95% CI = 0.27-0.32) and past-year (AOR = 0.05, 95% CI = 0.04-0.06) marijuana users had significantly lower odds of moderate/great risk perception (as opposed to no/slight risk perception) than never users. Among past-year users, odds of moderate/great risk perception were lower among those who used marijuana more frequently (AOR = 0.14, 95% CI = 0.07-0.28 for 300+ days of use compared to 1-11 days of use) and who reported any medical marijuana use (AOR = 0.27, 95% CI = 0.14-0.51). However, those who had marijuana use disorder were 3.5 times more likely to report moderate/great risk perception (AOR = 3.50, 95% CI = 1.62-7.58). Those who had a college education, had higher incomes, and resided in states with medical marijuana laws also had lower risk perceptions.

CONCLUSIONS

Public health education on scientific evidence about marijuana's benefits and harms and age-appropriate treatment for older adults with substance use problems are needed. Research on risk perception formation using longitudinal data among older adults is also needed.

The impact of pre-injury controlled substance use on clinical outcomes after trauma

BACKGROUND

A disproportionately high percentage of trauma patients use controlled substances, and they often co-ingest multiple drugs. Previous studies have evaluated the effect of individual drugs on clinical outcomes after trauma. However, the impact of all drugs included in a comprehensive screening panel has not yet been compared in a single cohort of patients.

METHODS

All trauma patients who underwent urine drug screens after admission to the LAC + USC Medical Center (January 2008-June 2015) were identified retrospectively. Univariable and multivariable regression analyses determined the significance of all drugs tested in the hospital's standard toxicology screen (amphetamine, barbiturate, benzodiazepine, cocaine, opiate, phencyclidine) on clinical outcomes.

RESULTS

A total of 10,166 patients who underwent admission toxicology screening were identified. Although 5,621 patients had completely negative screens, 3,292 patients tested positive for only one drug and 1,253 patients tested for multiple drugs. Univariable analysis indicated that patients who tested positive for multiple drugs had higher rates of operative intervention (p < 0.001), longer hospital stay (p < 0.001), and longer ICU stays (p < 0.001). Multivariable analysis indicated that phencyclidine was associated with higher rates of mortality (p = 0.025) whereas amphetamine was associated with lower rates of mortality (p = 0.012). Higher rates of operative intervention were observed in patients testing positive for amphetamine (p < 0.001), benzodiazepine (p < 0.001), or opiate (p < 0.001). Benzodiazepine use was associated with higher rates of mechanical ventilation (p < 0.001), but use of amphetamines (p = 0.021) or opiates (p < 0.001) was associated with lower rates.

CONCLUSIONS

Pre-injury use of amphetamine, barbiturate, benzodiazepine, cocaine, opiate, and PCP has a significant and variable impact on clinical outcomes after trauma. Comparing the relative effect of each drug class can help clinicians risk-stratify all trauma patients, including those who test positive for multiple substances.

LEVEL OF EVIDENCE

Epidemiologic study, level III.

Prevalence of Marijuana Use Disorders in the United States Between 2001-2002 and 2012-2013

IMPORTANCE

Laws and attitudes toward marijuana in the United States are becoming more permissive but little is known about whether the prevalence rates of marijuana use and marijuana use disorders have changed in the 21st century.

OBJECTIVE

To present nationally representative information on the past-year prevalence rates of marijuana use, marijuana use disorder, and marijuana use disorder among marijuana users in the US adult general population and whether this has changed between 2001-2002 and 2012-2013.

DESIGN, SETTING, AND PARTICIPANTS

Face-to-face interviews conducted in surveys of 2 nationally representative samples of US adults: the National Epidemiologic Survey on Alcohol and Related Conditions (data collected April 2001-April 2002; N = 43,093) and the National Epidemiologic Survey on Alcohol and Related Conditions-III (data collected April 2012-June 2013; N = 36,309). Data were analyzed March through May 2015.

MAIN OUTCOMES AND MEASURES

Past-year marijuana use and DSM-IV marijuana use disorder (abuse or dependence).

RESULTS

The past-year prevalence of marijuana use was 4.1% (SE, 0.15) in 2001-2002 and 9.5% (SE, 0.27) in 2012-2013, a significant increase (P < .05). Significant increases were also found across demographic subgroups (sex, age, race/ethnicity, education, marital status, income, urban/rural, and region). The past-year prevalence of DSM-IV marijuana use disorder was 1.5% (0.08) in 2001-2002 and 2.9% (SE, 0.13) in 2012-2013 (P < .05). With few exceptions, increases in the prevalence of marijuana use disorder between 2001-2002 and 2012-2013 were also statistically significant (P < .05) across demographic subgroups. However, the prevalence of marijuana use disorder among marijuana users decreased significantly from 2001-2002 (35.6%; SE, 1.37) to 2012-2013 (30.6%; SE, 1.04).

CONCLUSIONS AND RELEVANCE

The prevalence of marijuana use more than doubled between 2001-2002 and 2012-2013, and there was a large increase in marijuana use disorders during that time. While not all marijuana users experience problems, nearly 3 of 10 marijuana users manifested a marijuana use disorder in 2012-2013. Because the risk for marijuana use disorder did not increase among users, the increase in prevalence of marijuana use disorder is owing to an increase in prevalence of users in the US adult population. Given changing laws and attitudes toward marijuana, a balanced presentation of the likelihood of adverse consequences of marijuana use to policy makers, professionals, and the public is needed.