Marijuana (Cannabis) Use Disorder

Marijuana (Cannabis) Use Disorder is a topic covered in the 5-Minute Clinical Consult.

To view the entire topic, please or .

Medicine Central™ is a quick-consult mobile and web resource that includes diagnosis, treatment, medications, and follow-up information on over 700 diseases and disorders, providing fast answers—anytime, anywhere. Explore these free sample topics:

-- The first section of this topic is shown below --

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 unsuccessful efforts 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
    • Use is continued despite knowledge of having 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 3 behavioral symptoms such as anxiety, restlessness, depression, irritability, insomnia, odd dreams, or physical symptoms such as tremors and/or decreased appetite
    • Legal problems are no longer a criteria. Dependence and abuse have been merged into a single category.
  • According to Diagnostic and Statistical Manual of Mental Disorders, 5th edition, 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 World Health Organization ranks the United States ranks first among 17 European and North American countries for the prevalence of marijuana use.
  • 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, with 15% of U.S. adults reporting use in the past year (2).
  • In 2014, an estimated 22 million Americans, age >12 years, self-identified as current marijuana users
  • Approximately 30% of students have used marijuana at 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 is increasing in pregnant women. with 7% of pregnant women aged 18 to 25 years reporting use in 2014
  • In the United States, the legal landscape is changing rapidly. Many states have legalized marijuana in some form.
  • Popular opinion has changed over time. In 1969, only 12% of people approved of legalizing marijuana. In 2015, 58% approved of legalization.

Etiology and Pathophysiology

  • There are two therapeutically active cannabinoids in marijuana, 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.
  • 12% of frequent users experience withdrawal.
  • Use in men is reported at 3.5% and women 1.7%; females have a faster transition from use to cannabis use disorder (4).

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).
  • Marijuana use is an independent risk factor for heart failure (6).
  • 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

-- To view the remaining sections of this topic, please or --

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 unsuccessful efforts 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
    • Use is continued despite knowledge of having 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 3 behavioral symptoms such as anxiety, restlessness, depression, irritability, insomnia, odd dreams, or physical symptoms such as tremors and/or decreased appetite
    • Legal problems are no longer a criteria. Dependence and abuse have been merged into a single category.
  • According to Diagnostic and Statistical Manual of Mental Disorders, 5th edition, 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 World Health Organization ranks the United States ranks first among 17 European and North American countries for the prevalence of marijuana use.
  • 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, with 15% of U.S. adults reporting use in the past year (2).
  • In 2014, an estimated 22 million Americans, age >12 years, self-identified as current marijuana users
  • Approximately 30% of students have used marijuana at 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 is increasing in pregnant women. with 7% of pregnant women aged 18 to 25 years reporting use in 2014
  • In the United States, the legal landscape is changing rapidly. Many states have legalized marijuana in some form.
  • Popular opinion has changed over time. In 1969, only 12% of people approved of legalizing marijuana. In 2015, 58% approved of legalization.

Etiology and Pathophysiology

  • There are two therapeutically active cannabinoids in marijuana, 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.
  • 12% of frequent users experience withdrawal.
  • Use in men is reported at 3.5% and women 1.7%; females have a faster transition from use to cannabis use disorder (4).

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).
  • Marijuana use is an independent risk factor for heart failure (6).
  • 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

There's more to see -- the rest of this entry is available only to subscribers.