76% Of Primary Care Patients Use Cannabis For Symptom Management, UCLA Study Finds

A UCLA-led study found that 76.1% of nearly 176,000 patients reported using cannabis for symptom management despite identifying as recreational marijuana users. The study was published on June 5 in JAMA Network Open.

“Patients may not tell their primary care providers about their cannabis use, and their doctors may not ask about it,” said lead author Dr. Lillian Gelberg, professor of family medicine at the David Geffen School of Medicine at UCLA.

“Not asking patients about their cannabis use results in a missed opportunity for opening up doctor-patient communication regarding the use of cannabis generally and for management of their symptoms.”

The study noted, “Integrating screening efforts to include information regarding cannabis use for symptom management could help enhance the identification and documentation of medical cannabis usage, particularly in the health care context.”

The UCLA Health system is one of the few to ask patients to voluntarily complete cannabis use surveys during pre-appointment check-ins.

In response to the U.S. Preventive Services Task Force‘s 2020 recommendation for routine cannabis screening, the researchers implemented a universal, electronic health record-based survey at UCLA. This self-administered survey, conducted during pre-visit check-ins via the EPIC patient portal (a MyChart system for patients), assessed cannabis use among nearly 176,000 patients from January 2021 to May 2023.

Of these patients, about 30,000 (17%) reported using cannabis. Among these users, 35% showed scores indicating a moderate- to high-risk for cannabis use disorder (CUD) based on the World Health Organization's Alcohol Substance Involvement Screening Test. Usage patterns varied, with 40% using cannabis once or twice in the previous three months, 17% using it monthly, 25% weekly and 19% daily or almost daily.

Cannabis use was least common (14%) in the most disadvantaged neighborhoods, yet this group had the highest risk for disordered use. Inhalation (65%) and ingestion (64.7%) were equally common modes of use, with 29% of users reporting vaping, and 47% citing medical reasons. Many users managed symptoms such as mental health issues or stress (56%), sleep problems (56%) and pain (37%).

The study’s limitations include reliance on self-reported data, which may underreport usage due to legal concerns, even in states where cannabis is legal. Additionally, much of the data was collected during the COVID-19 lockdowns, a period potentially associated with higher cannabis use.

However, “given the high rates of cannabis use and medical cannabis use that we found in this large urban health care system, it is essential that health care systems implement routine screening of all primary care patients,” the researchers noted.

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