Cannabis Use and Cannabis Use Disorder Among Adult Cancer Survivors in the United States: A Population-Based Cross-Sectional Analysis

Marina Alacoque Rodrigues, MSc, BPharm
University of Florida

Co-authors: Amie Goodin, University of Florida

Background: The epidemiology of Cannabis Use Disorder (CUD) in cancer survivors, a clinically vulnerable population, remains poorly characterized despite increasing cannabis use.

Objectives: To characterize trends and prevalence in cannabis use and cannabis use disorder (CUD) among adult cancer survivors, including sociodemographic correlates, cannabis use characteristics, and healthcare-based substance use screening practices.

Methods: We conducted a repeated cross-sectional analysis of the 2021–2024 National Survey on Drug Use and Health (NSDUH). We included adults aged ≥18 years with a self-reported lifetime history of cancer diagnosis. Sampling-weighted analyses estimated annual and pooled prevalence of past-year and past-month cannabis use. CUD prevalence was assessed using DSM-5 criteria. Multivariable logistic regression models accounting for complex survey design estimated correlates of cannabis use and CUD among cancer survivors. Severity and healthcare-based substance screenings were also described for cancer survivors with CUD.

Results: Among adult cancer survivors (n = 7,769), the weighted prevalence of past-year cannabis use increased from 12.74% (95% CI, 10.24%–15.25%) in 2021 to 15.39% (95% CI, 13.17%–17.61%) in 2024 (2024 vs. 2021: adjusted odds ratio [AOR], 1.40; p = 0.029). Younger age (e.g., age 18–25 vs. ≥65 years: AOR, 7.82; p < 0.001), male sex, and poverty were independently associated with cannabis use in this population. Among past-year cannabis users with a history of cancer, CUD prevalence across pooled years was 16.79% (95% CI, 13.83%–19.75%), increasing to 21.98% (95% CI, 17.92%–26.04%) among past-month users, compared with 30.45% and 39.50%, respectively, in the general population. In multivariable analyses, the strongest predictors of CUD among cannabis-using cancer survivors were younger age (18–25 vs. ≥65 years: AOR, 21.31; p < 0.001) and multimodal use (AOR, 7.24; 95% CI, 4.33–12.12; p < 0.001), whereas cancer type was not associated with the outcome. Although 87.98% of cancer survivors with CUD had at least one outpatient visit in the previous year, and most CUD cases were of mild severity, only 68.51% (95% CI, 57.27%–79.74%) reported being asked about drug use, and 43.12% (95% CI, 33.31%–52.94%) reported discussing substance use with a healthcare professional.

Conclusions: Cannabis use among adult cancer survivors increased significantly between 2021 and 2023-2024 in adjusted models. Use was concentrated among younger, male, and lower-income individuals. Routine substance use screening remained suboptimal, with approximately one-third of CUD-positive cancer survivors with healthcare visits going unscreened.