Identifying HIV care enrollees at-risk for cannabis use disorder

ABSTRACT

Increased scientific attention given to cannabis in the United States has particular relevance for its domestic HIV care population, given that evidence exists for both cannabis as a therapeutic agent and cannabis use disorder (CUD) as a barrier to antiretroviral medication adherence. It is critical to identify relative risk for CUD among demographic subgroups of HIV patients, as this will inform detection and intervention efforts. A Center For AIDS Research Network of Integrated Clinical Systems cohort (N = 10,652) of HIV-positive adults linked to care at seven United State sites was examined for this purpose. Based on a patient-report instrument with validated diagnostic threshold for CUD, the prevalence of recent cannabis use and corresponding conditional probabilities for CUD were calculated for the aggregate sample and demographic subgroups. Generalized estimating equations then tested models directly examining patient demographic indices as predictors of CUD, while controlling for history and geography. Conditional probability of CUD among cannabis-using patients was 49%, with the highest conditional probabilities among demographic subgroups of young adults and those with non-specified sexual orientation (67–69%) and the lowest conditional probability among females and those 50+ years of age (42% apiece). Similarly, youthful age and male gender emerged as robust multivariate model predictors of CUD. In the context of increasingly lenient policies for use of cannabis as a therapeutic agent for chronic conditions like HIV/AIDS, current study findings offer needed direction in terms of specifying targeted patient groups in HIV care on whom resources for enhanced surveillance and intervention efforts will be most impactful.

KEYWORDS:

• Cannabis use disorder
• HIV/AIDS
• care settings
• United States

Acknowledgements

The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Health. The authors thank Julia C. Dombrowski for her review and comments on an initial draft of the manuscript, as well as the providers and patients from the CNICS sites for their participation in the data collection.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was sponsored by the University of Washington Alcohol & Drug Abuse Institute with support from the Washington State I-502 Dedicated Marijuana Fund, and by the National Institute on Drug Abuse under R03 DA039719. CNICS is funded by National Institute of Allergy and Infectious Diseases under R24 AI067039, at University of Alabama at Birmingham (P30 AI027767), University of Washington (P30 AI027757), University of California San Diego (P30 AI036214), University of California San Francisco (P30 AI027763), Case Western Reserve University (P30 AI036219), Johns Hopkins University (P30 AI094189, U01 DA036935), Harvard University (P30 AI060354), and University of North Carolina at Chapel Hill (P30 AI50410).