Cannabis use, other drug use, and risk of subsequent acute care in primary care patients. (1st November 2020)

• Record Type: Journal Article
• Authors: Matson, Theresa E.; Lapham, Gwen T.; Bobb, Jennifer F.; Johnson, Eric; Richards, Julie E.; Lee, Amy K.; Bradley, Katharine A.; Glass, Joseph E.
• Is Part Of: Drug and alcohol dependence. Volume 216(2020)
• Publication Date: 2020-11-01
• Subjects: Marijuana -- Substance use -- Primary care -- Screening -- Acute care -- Emergency visits; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2020.108227
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Frequency of past-year cannabis and other drug use predicted risk of acute care. Rare and frequent cannabis use was associated with higher risk of acute care. Increasing use of other drugs was associated with higher risk of acute care. Associations were modified by gender and age. Abstract: Background: Cannabis and other drug use is associated with adverse health events, but little is known about the association of routine clinical screening for cannabis or other drug use and acute care utilization. This study evaluated whether self-reported frequency of cannabis or other drug use was associated with subsequent acute care. Method: This retrospective cohort study used EHR and claims data from 8 sites in Washington State that implemented annual substance use screening. Eligible adult primary care patients (N = 47, 447) completed screens for cannabis (N = 45, 647) and/or other drug use, including illegal drug use and prescription medication misuse, (N = 45, 255) from 3/3/15-10/1/2016. Separate single-item screens assessed frequency of past-year cannabis and other drug use: never, less than monthly, monthly, weekly, daily/almost daily. An indicator of acute care utilization measured any urgent care, emergency department visits, or hospitalizations ≤19 months after screening. Adjusted Cox proportional hazards models estimated risk of acute care. Results: Patients were predominantly non-Hispanic White. Those reporting cannabis use less than monthly (Hazard Ratio [HR] = 1.12, 95 % CI = 1.03–1.21) or daily (HR = 1.24; 1.10–1.39) had greater risk of acute care during follow-up than those reporting no use. Patients reporting other drug use less than monthly (HR = 1.34; 1.13–1.59), weekly (HR = 2.21; 1.46–3.35), or daily (HR = 2.53; 1.86–3.45) had greater risk of acute care than those reporting no other drug use. Conclusion: Population-based screening for cannabis and other drug use in primary care may have utility for understanding risk of subsequent acute care. It is unclear whether findings will generalize to U.S. states with broader racial/ethnic diversity.