Marijuana (Cannabis) Use Disorder
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 --
Marijuana or cannabis use disorder is classified into different categories (mild, moderate, or severe) depending on how many symptoms are present. Mild: 2 to 3; moderate: 4 to 5; severe: 6+ (1). The definition is used when use leads to clinically significant impairment or distress, manifested by two or more of the following symptoms within a 12-month period:
- Taken in larger amounts and over a longer period of time than intended
- Persistent desire or unsuccessful efforts to cut down or control amount used
- A great deal of time spent in activities is necessary to obtain, use, or recover from use.
- Presence of craving for the substance
- 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
- The United States is ranked first among 17 European and North American countries by the World Health Organization for prevalence of marijuana use.
- Cannabis is the most widely used illicit psychoactive substance in the United States (2).
- In 2014, an estimated 22 million Americans, 12 years old and older, self-identified as current marijuana users
- 45% of 12th graders have tried marijuana.
- 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. In 2002, 2% reported using in the last month.
- In 2014, 7% of 18- to 25-year-old women reported use.
- In the United States, the legal landscape is changing rapidly. Multiple states have approved recreational marijuana use.
- Even more states have legalized medical marijuana.
Etiology and Pathophysiology
- Currently, there are two well-known therapeutically active cannabinoids in marijuana, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD).
- THC is responsible for marijuana’s analgesic, anti-emetic, and intoxicating properties.
- Cannabidiol is the nonpsychoactive component responsible for marijuana’s antianxiety, antidepressant, antipsychotic, antispastic, anticonvulsant, and antineoplastic properties.
- In terms of bioavailability, smoking marijuana results in 25–50% absorption of THC, which rapidly passes into the circulation. When ingested, the oral bioavailability of THC is significantly less (only 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.
- Cannabinoid receptors (CBRs) are associated with memory, thinking, concentration, sensory/time perception, pleasure, movement, and coordination.
- THC artificially stimulates the CBRs, disrupting the function of endogenous cannabinoids. A marijuana “high” results from overstimulation of these receptors.
- With time, overstimulation alters the function of CBRs, leading to addiction and withdrawal.
- Age (highest use among those 18 to 25 years)
- Male sex
- Comorbid psychiatric disorders (i.e., bipolar disorder, posttraumatic stress disorder [PTSD])
- Other substance use (i.e., alcohol, cocaine)
- Lower educational achievement (rates of dependence are lowest among college graduates)
- Employment status and income