Marijuana (Cannabis) Use Disorder

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Basics

Description

  • Marijuana use leading to clinically significant impairment or distress, manifested by two or more of the following symptoms within a 12-month period:
    • Consumption of larger amounts over a longer period of time than intended
    • Persistent desire or inability to cut down or control amount used
    • Inordinate amount of time spent in activities is necessary to obtain, use, or recover from use.
    • Presence of craving for cannabis
    • Recurrent use resulting in failure to fulfill major role obligations at work, school, or home
    • Continued use despite having persistent or recurrent social or interpersonal problems due to cannabis use
    • Important social, occupational, or recreational activities are given up or reduced
    • Recurrent use in physically hazardous situations
    • Continued use despite knowledge of a persistent physical or psychological problem caused or exacerbated by cannabis
    • Tolerance defined by using increased amounts of cannabis to achieve the desired effect or intoxication or diminished effect with continued use of the same amount
    • Withdrawal occurs following cessation of prolonged use and has at least three behavioral symptoms such as anxiety, restlessness, depression, irritability, insomnia, odd dreams or physical symptoms such as tremors and/or decreased appetite.
  • According to DSM-5, marijuana or cannabis use disorder is defined as being mild, moderate, or severe depending on how many symptoms are present. Mild: 2 to 3; moderate: 4 to 5; severe: 6+ (1)

Epidemiology

  • The WHO ranks the United States first among 17 European and North American countries for the prevalence of marijuana use.
  • From 2002 to 2014, prevalence of daily cannabis use in the United States has doubled from 1.3% to 2.5%.
  • Cannabis use disorder applies to a subset of marijuana users, ~20% lifetime marijuana users meet criteria for cannabis use disorder, 23% of these individuals meet severe use criteria.
  • Cannabis is the most widely used illicit psychoactive substance in the United States (22.2 million monthly users) (2).
  • Approximately 30% of students have used marijuana by the time of college entry (3).
  • In the United States, 10% of marijuana users become daily users, 20–30% become weekly users.
  • Younger users have a higher rate of addiction; 1 in 6 adolescents become addicted with repeated use.
  • Marijuana use increased 3-fold (from 2.4% to 7%) in pregnant women, from 2002 to 2014.
  • Popular opinion has changed over time. In 1969, only 12% of people approved of legalizing marijuana; by 2019, 67% approved of legalization.
  • In the United States, the legal landscape is changing rapidly. Many states have legalized marijuana in some form.

Etiology and Pathophysiology

  • The two most known therapeutically active cannabinoids in marijuana are δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD).
  • THC is the psychoactive component responsible for marijuana’s analgesic, antiemetic, and intoxicating properties.
  • Cannabidiol is the nonpsychoactive component responsible for marijuana’s antianxiety, antidepressant, antipsychotic, antispastic, anticonvulsant, and antineoplastic properties.
  • THC concentrations in marijuana have risen to an average of 6% (3).
  • Smoking marijuana results in 25–50% absorption of THC, which rapidly passes into the circulation. The oral bioavailability of THC is much less (3–10%).
  • Effects of smoked marijuana occur within minutes and last several hours.
  • Effects from marijuana consumed in foods or beverages appear after 30 minutes to 1 hour and can last up to 4 hours.
  • Frequent users are likely to experience withdrawal.
  • Use in men is reported at 3.5% and women 1.7%; females have a faster transition from recreational use to cannabis use disorder (4).
  • An emerging area of study involved cannabis-related drug interactions and adverse events, which have been noted to be increasing in frequency.

Risk Factors

  • Young individuals, especially 18 to 29 year olds, are at more risk for severe cannabis use disorder (4).
  • Cigarette smokers are at higher risk for cannabis use disorder compared to nonsmokers.
  • Higher potency marijuana increases risk of cannabis use disorder and increases severity of symptoms (5).
  • Family history of chemical dependence
  • Comorbid psychiatric disorders (i.e., antisocial personality disorder)
  • Other substance use (i.e., alcohol, tobacco)
  • Lower educational achievement (Rates of dependence are lowest among college graduates.)
  • Low socioeconomic status
  • Ease of acquisition of marijuana

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Basics

Description

  • Marijuana use leading to clinically significant impairment or distress, manifested by two or more of the following symptoms within a 12-month period:
    • Consumption of larger amounts over a longer period of time than intended
    • Persistent desire or inability to cut down or control amount used
    • Inordinate amount of time spent in activities is necessary to obtain, use, or recover from use.
    • Presence of craving for cannabis
    • Recurrent use resulting in failure to fulfill major role obligations at work, school, or home
    • Continued use despite having persistent or recurrent social or interpersonal problems due to cannabis use
    • Important social, occupational, or recreational activities are given up or reduced
    • Recurrent use in physically hazardous situations
    • Continued use despite knowledge of a persistent physical or psychological problem caused or exacerbated by cannabis
    • Tolerance defined by using increased amounts of cannabis to achieve the desired effect or intoxication or diminished effect with continued use of the same amount
    • Withdrawal occurs following cessation of prolonged use and has at least three behavioral symptoms such as anxiety, restlessness, depression, irritability, insomnia, odd dreams or physical symptoms such as tremors and/or decreased appetite.
  • According to DSM-5, marijuana or cannabis use disorder is defined as being mild, moderate, or severe depending on how many symptoms are present. Mild: 2 to 3; moderate: 4 to 5; severe: 6+ (1)

Epidemiology

  • The WHO ranks the United States first among 17 European and North American countries for the prevalence of marijuana use.
  • From 2002 to 2014, prevalence of daily cannabis use in the United States has doubled from 1.3% to 2.5%.
  • Cannabis use disorder applies to a subset of marijuana users, ~20% lifetime marijuana users meet criteria for cannabis use disorder, 23% of these individuals meet severe use criteria.
  • Cannabis is the most widely used illicit psychoactive substance in the United States (22.2 million monthly users) (2).
  • Approximately 30% of students have used marijuana by the time of college entry (3).
  • In the United States, 10% of marijuana users become daily users, 20–30% become weekly users.
  • Younger users have a higher rate of addiction; 1 in 6 adolescents become addicted with repeated use.
  • Marijuana use increased 3-fold (from 2.4% to 7%) in pregnant women, from 2002 to 2014.
  • Popular opinion has changed over time. In 1969, only 12% of people approved of legalizing marijuana; by 2019, 67% approved of legalization.
  • In the United States, the legal landscape is changing rapidly. Many states have legalized marijuana in some form.

Etiology and Pathophysiology

  • The two most known therapeutically active cannabinoids in marijuana are δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD).
  • THC is the psychoactive component responsible for marijuana’s analgesic, antiemetic, and intoxicating properties.
  • Cannabidiol is the nonpsychoactive component responsible for marijuana’s antianxiety, antidepressant, antipsychotic, antispastic, anticonvulsant, and antineoplastic properties.
  • THC concentrations in marijuana have risen to an average of 6% (3).
  • Smoking marijuana results in 25–50% absorption of THC, which rapidly passes into the circulation. The oral bioavailability of THC is much less (3–10%).
  • Effects of smoked marijuana occur within minutes and last several hours.
  • Effects from marijuana consumed in foods or beverages appear after 30 minutes to 1 hour and can last up to 4 hours.
  • Frequent users are likely to experience withdrawal.
  • Use in men is reported at 3.5% and women 1.7%; females have a faster transition from recreational use to cannabis use disorder (4).
  • An emerging area of study involved cannabis-related drug interactions and adverse events, which have been noted to be increasing in frequency.

Risk Factors

  • Young individuals, especially 18 to 29 year olds, are at more risk for severe cannabis use disorder (4).
  • Cigarette smokers are at higher risk for cannabis use disorder compared to nonsmokers.
  • Higher potency marijuana increases risk of cannabis use disorder and increases severity of symptoms (5).
  • Family history of chemical dependence
  • Comorbid psychiatric disorders (i.e., antisocial personality disorder)
  • Other substance use (i.e., alcohol, tobacco)
  • Lower educational achievement (Rates of dependence are lowest among college graduates.)
  • Low socioeconomic status
  • Ease of acquisition of marijuana

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