A recent study published in the Journal of General Internal Medicine showed that those diagnosed with cannabis use disorder (CUD) faced a significantly higher risk of death than similar patients without the diagnosis. Anh P. Nguyen, PhD, Assistant Professor of Health Systems Science at Kaiser Permanente Bernard J. Tyson School of Medicine (KPSOM) and lead author of the study, teamed with Claudia A. Steiner, MD, MPH, Professor of Health Systems Science, and researchers to discover findings that suggest clinicians who identify CUD should look beyond cannabis-related concerns and assess patients for a wider range of risks, including polysubstance use, overdose, injuries, chronic disease and gaps in preventive care.
The matched cohort study followed 100,140 people ages 12 and older who received care in a Colorado integrated health system between 2006 and 2024. Researchers compared 16,693 people diagnosed with CUD with 83,447 patients of similar age and sex who did not have the diagnosis. Over a median follow-up of 7.7 years, CUD was associated with a 52 percent higher adjusted risk of death overall, a 91 percent higher risk of injury-related death, and a 40 percent higher risk of illness-related death. Overall, the strongest CUD associations were seen for deaths involving drug overdose, accidents, and cancer.
Most overdose deaths among patients with CUD involved opioids, psychostimulants, or cocaine rather than cannabis itself, highlighting the importance of screening for polysubstance use. Mortality risk was greatest among patients who had CUD along with another substance use disorder, but it remained elevated among patients with CUD alone. The authors noted that the observational study identifies associations and does not establish that CUD caused the deaths.
Nguyen co-developed the study’s concept and design, drafted the manuscript, contributed to the statistical analysis, obtained funding, and supervised the work while Steiner co-developed the study concept and design, contributed to the acquisition, analysis, and interpretation of data, critically revised the manuscript, and shared supervisory responsibilities.
The study reinforces the potential value of treating a CUD diagnosis as a signal for more comprehensive evaluation. It calls for attention to overdose and injury prevention, co-occurring substance use and mental health conditions, cancer screening, and other preventive care needs, particularly because no medication has been approved by the U.S. Food and Drug Administration specifically to treat CUD.
“As cannabis use becomes increasingly common in the U.S., cannabis use disorder represents an important but often underrecognized health concern,” said Nguyen. “About 3 in 10 people who use cannabis meet criteria for cannabis use disorder. Our study found that patients with the disorder have elevated risk of death from both injuries and illnesses. As one of the first studies in the U.S. to establish this association, our findings highlight cannabis use disorder as a potentially important marker of serious clinical vulnerability. [It] also underscores the need to better understand what is driving this increase in mortality risk and how clinicians and health systems can help reduce [risk].”
