Marijuana (Cannabis) Addiction: Cannabis Use Disorder
Despite the prevalence of use of marijuana (cannabis), many people do not realize that cannabis is an addictive drug. While estimates span a range, it is commonly reported that 9% of cannabis users develop an addictive relationship with the drug. While the psychosocial impact and consequences of cannabis addiction, better described as Cannabis Use Disorder (CUD), are not as detrimental and destructive as heroin addiction and alcoholism, CUD does negatively affect quality of life.
It is important to understand who is at risk for developing CUD and how to reduce those risks.
Over-the-Counter Cannabinoid Medications:
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Clinical Applications of Cannabis:
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Cannabis – Headaches (coming soon)
Cannabis – Inflammatory Bowel Disease (coming soon)
Cannabis – Neuroinflammation (coming soon)
Cannabis – Pain (coming soon)
Cannabis – Sleep (coming soon)
The Medical Science of Cannabis:
Cannabinoids and Terpenes:
Cannabinoids & Terpenes – An Overview (coming soon)
Terpenes – An Overview (coming soon)
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Addiction to Marijuana: Cannabis Use Disorder (CUD
It is commonly reported that about 9% of individuals who initiate cannabis use will develop cannabis use disorder (CUD) in their lifetime. It is estimated that approximately 20-30% of current cannabis users have symptoms of CUD and 50% of those who use cannabis illicitly every day may meet criteria for CUD. By comparison, 15-22% of individuals who initiate alcohol use will develop alcohol use disorder in their lifetime and 8-12% of patients prescribed opioids will develop an opioid use disorder in their lifetime.
Initiating cannabis use at an earlier age and increasing frequency of use are significantly associated with developing CUD. According to the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5), increasing frequency of cannabis use is also associated with a syndrome of problematic cannabis misuse—where cannabis negatively impacts a person’s life—but does not meet the criteria of CUD. Cannabis use is also associated with an increased risk of developing dependencies on substances other than cannabis.
While many people who use cannabis regularly will develop symptoms of withdrawal when abruptly discontinuing or reducing their cannabis use, it is important to underatand that the severity of withdrawal symptoms does not define or predict the diagnosis of CUD. Any addiction, cannabis included, has definitive characteristics that set it apart from the use, misuse or abuse of a medication or drug. All too often, people believe that difficulty discontinuing the use of a drug or medication due to withdrawal symptoms is equivalent to an addiction to the drug or medication. It is not. To learn more about addiction and what it is, click here: addiction.
For more information regarding cannabis withdrawal and discontinuing cannabis:
Cannabis Use Disorder is a diagnosis defined in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition or DSM-5. The DSM is used by clinicians and psychiatrists to diagnose psychiatric illnesses. In 2013, a new version known as the DSM-5 was released. The DSM is published by the American Psychiatric Association and covers all categories of mental health disorders for both adults and children. The DSM is utilized widely in the United States for psychiatric diagnosis, treatment recommendations and insurance coverage purposes.
Symptoms of Cannabis Use Disorder – DSM-V Criteria
At least two of the following symptoms within a 12 month period indicate Cannabis Use Disorder:
- Taking more cannabis than was intended
- Difficulty controlling or cutting down cannabis use
- Spending a lot of time on cannabis use
- Craving cannabis
- Problems at work, school and home as a result of cannabis use
- Continuing to use cannabis despite social or relationship problems
- Giving up or reducing other activities in favor of cannabis
- Taking cannabis in high risk situations
- Continuing to use cannabis depite physical or psychological problems
- Tolerance to cannabis
- Withdrawal when discontinuing cannabis.
The severity of CUD can be further stratified:
- Mild – indicates 2-3 symptoms
- Moderate – indicates 4-5 symptoms
- Severe – indicates 6 or more symptoms
It should be understood that the severity of a person’s physical addiction is unrelated to the severity of their disorder. With a list of 11 symptoms to evaluate, one can have CUD – Severe, without having any tolerance or withdrawal, typical hallmarks of addiction. By the same token, one can meet the criteria for CUD – Mild, despite experiencing severe physical tolerance and withdrawal.
A Brief Review of the Neurobiology of Cannabis
As a plant, marijuana contains many pharmacologically active “cannabinoids” that interact with theendocannabinoid system throughout the brain, nervous system and most organs and tissues throughout the rest of the body. The endocannabinoid system modulates nerve transmission, both inhibitory and excitatory, in brain regions relevant to the regulation of pain, emotion, motivation, and thought processing. This signaling system is engaged by the primary active component of cannabis, ∆9-THC, which exerts its pharmacological effects by activation of the two known cannabinoid receptors, CB1 and CB2, although there is increasing research suggesting that additional cannabinoid receptors exist.
High concentrations of CB1 receptors are found in the hippocampus, neocortex, basal ganglia, and cerebellum. CB2 receptors are found primarily in the peripheral tissues, and are thought to modulate immune and inflammatory responses. During chronic cannabis use, a series of changes occur in the brain and nervous system (neuroplastic changes), which are not well understood. These changes lead to the development of withdrawal symptoms, physical and emotional dependence.
Treatment of CUD
Currently, cannabis-use disorders are treated using a variety of psychosocial interventions, including Motivational Enhancement Therapy (MET) and Cognitive Behavior Therapy (CBT) as most effective. Pharmacotherapy for CUD is very limited, with only a few medications identified that offer mild benefit and no medications actually FDA-approved for treating CUD. While a number of medications have been evaluated, only gabapentin (Neurontin) and baclofen have been shown to reduce cravings, mostly during the withdrawal stages, although there is some preliminary research suggesting potential for long term benefit.
Cannabanoid replacement therapy for treating CUD, analogous to the use methadone or buprenorphine in opioid SUD, is being studied currently and with further research it is likely the future holds an effective cannabanoid for CUD. Dronabinol is an orally bioavailable synthetic form of THC that acts as a cannabinoid-receptor agonist at the CB receptor. It is approved for use in the US for AIDS-related anorexia and nausea as a result of chemotherapy. It has also shown some benefit in doses of 10–50 mg in reducing cannabis-withdrawal symptoms, with minimal side effects.
Cannabis Use Disorder – Overviews
Cannabis Use Disorder – Measuring Severity
Cannabis Withdrawal Treatement – Overviews
Cannabis Withdrawal Treatment – Baclofen
Cannabis Withdrawal – Gabapentin (Neurontin)
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