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Marijuana (Cannabis) Use Disorder

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

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Basics

Description

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
  • Withdrawal

Epidemiology

  • 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.

Risk Factors

  • 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

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Citation

Stephens, Mark B., et al., editors. "Marijuana (Cannabis) Use Disorder." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816446/all/Marijuana__Cannabis__Use_Disorder.
Marijuana (Cannabis) Use Disorder. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816446/all/Marijuana__Cannabis__Use_Disorder. Accessed April 24, 2019.
Marijuana (Cannabis) Use Disorder. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816446/all/Marijuana__Cannabis__Use_Disorder
Marijuana (Cannabis) Use Disorder [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 24]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816446/all/Marijuana__Cannabis__Use_Disorder.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Marijuana (Cannabis) Use Disorder ID - 816446 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816446/all/Marijuana__Cannabis__Use_Disorder PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -