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Abstract
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This editorial comments on the article by Javanbakht et al. Cannabis use, comorbidities, and prescription medication use among older adults in a large healthcare system in Los Angeles, CA 2019-2020 https://doi.org/10.1111/jgs.17719
Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number R01DA044207. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Javanbakht et al. published an important paper in this issue of the Journal of the American Geriatrics Society (JAGS) that estimated the prevalence of current cannabis use among older adults within a large healthcare system in Los Angeles, California.1
The authors should be commended for appropriately noting many of the limitations of utilizing a data source derived from self-report. We hope to expand this discussion by further considering the potential limitations associated with utilizing data from electronic health records.
In this study, patients were asked about substance use via face-to-face interviews during their annual physical exam visits with medical staff. They were reportedly first asked if they had used any substance from a list of over 30 drugs that included cannabis; those who answered affirmatively regarding any use were subsequently queried about "current" use of said drugs in an open-ended manner. While validated drug screenings are most ideal,2 asking about drug use in any systematic manner is more advantageous than not. However, it is worth noting that asking one overall question about drug use that then leads to specific follow-up questions if answered affirmatively (i.e., gate questions) tends to underestimate the specific behaviors of concern.3, 4
An additional consideration that can lead to underestimation of prevalence is the manner through which self-reported responses are obtained. It has been demonstrated that participants are more likely to underreport on sensitive topics such as drug use during face-to-face interviews (as compared to surveys),5 especially if not conducted in a private setting (e.g., away from others, such as family members).6 While the authors reasonably put forth that the legalization of recreational cannabis in their study location may have been associated with destigmatized reporting of its use, we would implore caution--the direct probing of use between provider and patient in this study may in fact offset any potential reduction in the stigma surrounding use owing to the recent legality of use. Please note that considerations surrounding stigma are further discussed...
Language: en |