Rates of Cannabis Use Disorder Rising for Medicare Patients
/By Pat Anson
A new FDA study is documenting the growing use of cannabis by seniors and how some are being diagnosed as having “cannabis use disorder” by their doctors.
A research team led by FDA epidemiologist Silvia Perez-Vilar, PharmD, analyzed the health data of nearly 56 million Medicare beneficiaries aged 65 and older. They looked for Medicare claims that included at least one of the many billable diagnostic codes for cannabis use disorder (CUD).
There are over three dozen such codes, which include everything from cannabis intoxication and dependence to delusions, psychosis and “perceptual disturbance” – a diagnosis that can mean anything from not being able to recognize words to seeing things that aren’t there. There are even CUD codes for “unspecified” symptoms of cannabis use and for being in remission.
The research findings, recently published in JAMA Network Open, found that Medicare claims for CUD have steadily risen in recent years, especially in states where cannabis was legalized for medical or adult recreational use.
“Rates of cannabis-related disorder encounters increased from 2017 through 2022 among US Medicare-insured older adults. We observed the highest rates in states or territories that legalized adult and medical use of cannabis,” they wrote. “Overall, data suggest that increasing rates of health care encounters documenting cannabis-related disorders among older adults might be associated with the type of cannabis legalization.”
What were these “increasing rates” documenting CUD? In states where cannabis is legal, about 45 CUD cases were filed in 2022 for every 10,000 Medicare claims. That’s about 0.45% of all claims – not a large amount by any means. The CUD rate was even lower in states where cannabis is illegal, less than 0.28%.
Those may be rock bottom rates, but the researchers noted that “differences in cannabis use patterns and perception of risk may influence policy changes.” Exactly what kind of policy changes are warranted aren’t spelled out, but it implies there should be more screening for CUD.
Another recent JAMA study called for U.S. primary care physicians to start screening all patients for CUD, regardless of age or even whether they currently use cannabis. Patients identified as high risk cannabis users should then be referred for “possible addiction treatment.”
Treatments for CUD are currently limited to counseling and cognitive behavioral therapies. Unlike opioid use disorder, there are no FDA-approved pharmaceutical treatments for CUD, although there are several such drugs in the pipeline. One is being tested in clinical studies by Indivior, the company that makes Suboxone for opioid use disorder.
Cannabis vs. Opioids
Many patients who live with pain are turning to cannabis as an alternative to opioids, which are increasingly difficult to obtain. In a recent PNN survey, over 30% of pain patients said they had used cannabis for pain relief. Many did so because they couldn’t get an opioid prescription or had problems getting one filled.
“I have a medical marijuana referral and my doctor at the Cleveland Clinic flat out refuses to write me any prescriptions for any opioids. Bunch of BS,” one patient told us.
“I am very lucky. My pain management doctor supports medical cannabis,” said another. “Since my (opioid) dose has been cut in half, it does provide a bit of relief and helps me sleep a few hours.”
“My pharmacy ran out of oxycodone & hydrocodone. My pain doctor switched me over to hydromorphone and so far I've been able to get that filled. If I'm no longer able to get that, I'll have to consider medical marijuana,” wrote another pain patient.
About 10% of U.S. adults over age 50 reported using cannabis within the past year, a number that’s expected to rise when the federal government reschedules cannabis as a less dangerous drug. As more seniors experiment with cannabis, they’ll have to get used to the fact that it carries a stigma, just like opioids. And there’s a good chance their doctor will be evaluating them for signs of CUD.
“Many older adults are turning to cannabis for help with increased pain syndromes—osteoarthritis, degenerative joint diseases, as well as insomnia,” Brooke Worster, MD, an associate professor and cannabis expert at Thomas Jefferson University, told Fortune.
“The question really is, how do we recognize and avoid abuse or CUD, which is important and only now being recognized and discussed in the medical community more regularly.”
