TOPLINE:

In primary care clinics, implementing integrated strategies involving routine screening, assessment of symptoms, and provision of relevant care improved the rates of screening, diagnosis, and initiation of treatment for cannabis use disorder.

METHODOLOGY:

• Researchers conducted a cluster randomized trial to assess whether strategies for integrated care at the primary care level can improve diagnosis and management of cannabis and other drug use disorders.
• They included adults with insurance (mean age, 49-50 years; 58% women) who had a primary care visit between January 2015 and July 2019 across 19 sites.
• The participants were screened annually using questions about their use of cannabis, any illegal drug, or a prescription medication for nonmedical reasons in the past year. Those reporting frequent use were asked about their symptoms to assess for cannabis or drug use disorders.
• Practice facilitators worked with primary care and integrated mental health clinicians to implement strategies, including the use of electronic health records to screen patients, to remind clinicians to diagnose cannabis and other drug use, and to deliver prompts for initiating treatment.
• Primary outcomes were rates of treatment initiation and engagement for any new drug use disorder; engagement was defined as at least two subsequent diagnoses for the same substance type within 30 days of visit for treatment initiation.

TAKEAWAY:

• Before implementing the integrated strategies, 244,542 patients made 942,400 primary care visits, which increased to 287,696 patients making 1,087,565 visits after implementation.
• During the implementation period, the number of patients with positive screens increased from 9 to 153 per 10,000 patient-visits for cannabis use and from 4 to 62 per 10,000 patient-visits for other drug use (P < .001 for both).
• The number of patients with new diagnoses for drug use disorder increased significantly, driven by an increase in the rate of new diagnoses of cannabis use disorder from 10 to 17 per 10,000 patient-visits (P < .001).
• The number of patients initiating treatment for cannabis use disorder rose from 0.4 to 1 per 10,000 patient-visits (P = .006), although the rate of treatment engagement did not change; the rate of neither initiation nor engagement improved for other drug use or opioid use disorder.

IN PRACTICE:

“The implementation of this intervention represents a significant step forward in addressing the underdiagnosis and undertreatment of CUD [cannabis use disorder] but not OUD [opioid use disorder] or other DUD [drug use disorder],” the authors of the study wrote.

SOURCE:

This study was led by Theresa E. Matson, PhD, Kaiser Permanente Washington Health Research Institute, Seattle. It was published online on September 15, 2025, in American Journal of Preventive Medicine.

LIMITATIONS:

This study was conducted in a single regional health system in the US where adult cannabis use was legal, limiting generalizability to systems with uninsured patients or with different regulations for cannabis use. Relying on diagnoses for treatment outcomes could overestimate or underestimate actual care. Impact of new strategies on the patient care experience was not evaluated.

DISCLOSURES:

This study received support from the National Institute on Drug Abuse of the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality. One author reported receiving additional support from Kaiser Permanente Washington Health Research innovation funds. Three authors reported receiving grants from NIH. One author reported serving on the behavioral health measures advisory panel of National Committee for Quality Assurance.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.