Cannabis use disorder risk among midlife adults reporting medical and nonmedical cannabis use, 2019-2024.

Abstract

High-frequency cannabis use is a key cannabis use disorder (CUD) risk factor that also is associated with medical (vs. nonmedical) use. This analysis examined overall and sex- and age-stratified associations between medical cannabis use, use frequency, and CUD outcomes among midlife adults. Monitoring the Future Longitudinal Panel study data from 5454 US adults ages 40-60 reporting past 12-month use surveyed in 2019-2024 were used. Logistic regression models examined overall and sex- and age-stratified associations between medical cannabis use and self-reported CUD symptom prevalence, severity, and criteria before and after controlling for use frequency. Among adults using cannabis, prevalence of any and moderate/severe CUD symptoms was 23.9% and 9.4%, respectively; among those using near-daily (20 + occasions in past 30 days), 49.7% had CUD symptoms. Medical (vs. nonmedical) use was associated with any CUD symptoms (33.8% vs. 22.5%; p < .001), moderate/severe symptoms (15.1% vs. 8.7%; p < .001), and 10 of the 11 individual CUD criteria (p = 0.037 to <.001). Controlling for use frequency explained all overall medical (vs. nonmedical) use and CUD associations. Stratification models showed medical use remained associated with tolerance among females but not males (p = 0.017 vs. 0.981), and range of CUD outcomes among those ages 55-60 (but not 40-50), including tolerance (p = 0.007 vs. 0.826) and moderate/severe CUD symptoms (p = 0.012 vs. 0.118). Overall, high-frequency cannabis use-medical or nonmedical-is associated with CUD risk. Even after controlling for use frequency, medical use is associated with tolerance among females and older adults, and moderate/severe CUD symptoms among older adults.