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New York State Practitioner Education Medical Use of Marijuana 2-hr Required Course
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Section 5.0: Cannabis Use and Mental Health
Part 2
Cannabis Use Disorder
In this part of the course, we will address Cannabis Use Disorder. We will discuss the recognition, diagnosis, treatment and strategies for risk evaluation and mitigation of this disorder.
Cannabis is the most commonly used illicit drug in the world (1). In fact, approximately 22 million Americans aged 12 years or older used cannabis illicitly during a one-month period in 2014 (2). (This number, 22 million, corresponds to 8.4 percent of the population of 12 years and older.) According to a 2014 National Survey on Drug Use and Health, approximately 4.2 million individuals aged 12 years or older had a cannabis use disorder (2). These statistics and the adverse effects of cannabis on health underscore the need for effective diagnosis and treatment of cannabis use disorder (3).
Recognition of cannabis use disorder can be challenging. Rarely are problems directly associated with cannabis use a part of a patient's chief complaint. A careful and thorough history, which includes questions on drug and alcohol use, however, should provide clues that a patient is having problems related to cannabis use. A patient may be having problems at work, school, or in relationships. For example, a high school student who is typically active in extracurricular activities may withdraw from them. Other psychiatric disorders such as mood disorders and anxiety disorders often co-occur with cannabis use disorder (4,5) and signs of these disorders may be notable. Unfortunately, due to the subtle and insidious nature of cannabis problems, collateral information may be necessary to indicate that a clinician should further inquire about a patient's cannabis use.
Patients with cannabis use disorder have problems in multiple spheres of their lives (6). In this way, cannabis use disorder is similar to other substance use disorders. Patients may find that they use more and more cannabis to get the same effect and they may describe withdrawal symptoms such as anxiety and insomnia when they try to stop daily or near daily use. Patients may be spending a significant amount of time obtaining the cannabis, using the cannabis and then recovering from the effects of the cannabis.
Catastrophic incidents like opioid-overdoses or alcohol withdrawal seizures do not occur in patients with cannabis use disorders; this can make the diagnosis of cannabis use disorders more challenging than diagnosis of other substance use disorders. Despite the public perception that cannabis is not as harmful as alcohol or other drugs, by the time a patient is diagnosed with a cannabis use disorder, they often look very similar to patients with other substance use disorders—their lives and the lives of their loved ones have suffered as a result of their addiction (7).
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