Just One Question Can Help Clinicians Screen for Cannabis Use Disorder, Study Claims

If you need to quickly assess whether a patient might have cannabis use disorder (CUD), ask them how often they’ve used cannabis in the past year. At least, that is the suggestion put forward in new research published this week in JAMA Network Open.

According to this new analysis, such a single-item screening question has shown good sensitivity and specificity at screening for CUD, after it was recently adopted by clinicians at Kaiser Permanente Washington healthcare service.

Integrating this single-item screen-cannabis (SIS-C) question into annual health check-ups may help to ensure that cases of CUD are being properly recognized and that additional assessments and support can be promptly offered, the researchers say.

Screening for CUD

As the prevalence of cannabis use grows, clinicians are in need of an easy screening tool that can be asked quickly at routine health check-ups, which can effectively flag whether a patient may have CUD and could need further assessment.

CUD is hallmarked by a continued pattern of cannabis use despite negative effects on one’s life and health. People with CUD often report using cannabis in larger amounts or over a longer period than intended, being unsuccessful in attempts to quit or reduce their cannabis use, and struggling to fulfill responsibilities at home or at work.

There is a physical side to the disorder too; many people with CUD experience uncomfortable withdrawal symptoms when trying to quit, such as anxiety, abdominal pain, sweating, and sleep disturbances.

The current standard for assessing CUD is the Composite International Diagnostic Interview Substance Abuse Module (CIDI-SAM), a 15-item questionnaire that reflects the CUD criteria present in the DSM-5. Mild CUD correlates to two or more criteria being met, with moderate to severe CUD being four or more items checked.

But while this assessment is good at accurately diagnosing CUD, it is impractically long to administer in the short amount of time allocated for regular health checks. Single-item screening questions for other substance disorders have been used and integrated into other behavioral and lifestyle questionnaires in the past, but not for CUD.

Single question demonstrates “excellent performance” in screening

At the request of clinicians, Kaiser Permanente Washington recently integrated a Single-Item Screen-Cannabis (SIS-C) question about the frequency of past year cannabis use into their routine care, in order to screen for potential CUD. In this question, patients can report either daily, weekly, monthly, or less than monthly cannabis use.

To evaluate the effectiveness of this screen, a total of 1,688 patients who had recently answered the SIS-C were contacted by researchers and asked to complete the 15-item CIDI-SAM questionnaire. From this, it was determined that 6.6% of respondents met the criteria for having at least mild CUD in the past year.

The researchers found that when the SIS-C screen was negative (the patient reported using cannabis less than monthly, for instance) the probability of the patient having CUD was almost zero.

When the screen was positive, the probability that the patient had CUD was still fairly low overall, but setting the threshold in this manner “balanced sensitivity and specificity”, according to the researchers.

For populations where the prevalence of CUD was around 6%, researchers calculated that the probability of a patient having CUD given a positive SIS-C screen was between 17% to 34%, and the probability of no CUD with a negative screen was between 97% to 100%.

“A lower threshold, such as any use, may be appropriate for some settings (eg, mental health) and populations (eg, young men) expected to have a higher prevalence of CUD; whereas a higher threshold, such as daily use, may be appropriate for general medical settings,” the researchers wrote.

In practice, the SIS-C would not be a diagnostic tool for CUD. But a positive SIS-C screen could be used as a starting point to ask patients about their cannabis use in more detail and explore the various effects that this might have on their health.

Treating CUD

While CUD is getting more attention in recent years, there are still a number of misconceptions about the condition. For example, it was long believed that CUD was mostly associated with recreational cannabis users. However, recent research has suggested that CUD is just as prevalent among medical cannabis users who self-medicate with illicit cannabis.

Different treatments for CUD are also actively being investigated. Currently, behavioral therapies, such as motivational interviewing and cognitive behavioral therapy, are generally the most favored treatment methods. Now, new research suggests that cannabis-based medications may also provide benefits to patients struggling with CUD and cannabis dependance.

In a randomized controlled trial published in JAMA Internal Medicine, researchers from the University of Sydney found that people who received a CHD:THC oral medication alongside counseling treatments experienced fewer withdrawal symptoms and reported improved physical and psychological wellbeing compared to those given a placebo.

“This is the first study with sufficient power to allow us to draw conclusions regarding the efficacy of cannabinoid medicines for outpatient treatment of cannabis dependence,” Nick Lintzeris, the study’s lead author and professor of addiction at the University of Sydney, told Analytical Cannabis at the time.

“The counseling and regular reviews had some benefits – but that these are enhanced when combined with active medication” he added. “This is a finding generally consistent with the evidence from other areas of health care – that combined medication and counseling is often more effective than either approach alone.”