Clinical Summary: Geographic Differences in Cannabis Use and Cannabis Use Disorder in the US Veteran Population
Veterans often use cannabis for symptoms such as chronic pain, PTSD, anxiety, and insomnia, yet cannabis use and cannabis use disorder are linked to elevated psychiatric comorbidity and suicide-related outcomes. This study shows that risk is not evenly distributed across the country, giving clinicians a clearer sense of where routine screening and treatment capacity may be most needed.
Key Findings
- Significant geographic variation in cannabis use and probable CUD was observed across the 9 US Census Bureau–defined regions (χ2 16 = 73.33, P < .001).
- The Pacific region had the highest prevalence of both cannabis use (18.6%) and probable CUD (8.8%).
- The Pacific region’s rate of probable CUD was significantly higher than all other regions (all uncorrected Ps < .05), including New England (3.5%).
- For cannabis use, prevalence in the Pacific region was significantly higher than all regions except New England (13.4%; P = .24), and New England did not significantly differ from any other region (all Ps > .17).
- In the full sample, 284 (weighted 11.6%) reported cannabis use and 70 (weighted 2.9%) had probable CUD.
Regional context matters when assessing cannabis-related risk in veterans: the Pacific region carries the highest burden of both cannabis use and probable CUD, while high use prevalence does not always translate into equally high disorder prevalence. Clinicians serving veterans should routinely assess not just cannabis use, but symptoms of impaired control and consequences, especially in higher-prevalence regions.
Practice Implications
- In veterans living in the Pacific region, make routine screening for both cannabis use and probable CUD part of primary care and mental health visits, given prevalence rates of 18.6% and 8.8%, respectively.
- Do not equate higher cannabis use with higher disorder burden alone; New England had cannabis use of 13.4% but probable CUD of 3.5%, so screening should include symptom-based assessment rather than use status alone.
- Maintain cannabis-related assessment in older veterans as well, because the authors note mean ages of 59 years for veterans who used cannabis and 53 years for those with probable CUD.
- Have a low threshold to assess veterans who rely on the VA as their primary source of health care, as veterans with probable CUD were more likely to use the VA as their primary source of health care.
