Cannabis use disorder risks among Medicaid enrollees with comorbid psychiatric illnesses: 2012–2021

Objectives: To examine trends in prevalence of cannabis use disorder (CUD) among Medicaid enrollees with and without comorbid psychiatric illnesses - depression, anxiety, or insomnia - overall and by sex and age subgroups. Methods: Medicaid enrollees aged 18–64 in the Merative Multi-state Claims and Encounters Database with diagnoses of CUD and comorbid psychiatric illnesses - depression, anxiety, or insomnia - from 2012 to 2021 were examined using a multi-variate logit regression adjusting for sex, age, and race. Additionally, CUD and comorbid chronic pain diagnosis for the same population were examined as a comparison. We estimated the changes in the prevalence of CUD among enrollees with and without depression, anxiety, or insomnia. Results: From 2012–2021, the predicted prevalence of CUD among enrollees with depression, anxiety, and insomnia as a comorbidity increased by 1.04 (p < 0.001), 1.36 (p < 0.001), 1.64 (p < 0.001) times compared to the enrollees without those comorbidities, respectively, while the predicted prevalence of CUD among enrollees with chronic pain reduced by 0.90 (p < 0.001) times compared to those without chronic pain. Relative increases in the predicted prevalence of CUD were higher among females and those aged 35–64 with anxiety and depression, and among males and those aged 21–34 with insomnia. Conclusions: Medicaid enrollees with depression, anxiety, or insomnia were increasingly more likely to experience CUD diagnoses for the past decade compared to those without the condition. Further research is needed to understand the mechanism between cannabis use and psychiatric illnesses and curb the rising CUD associated with comorbid psychiatric illnesses.