What is Cannabis Use Disorder?
The U.S. Food and Drug Administration (FDA) categorizes cannabis, better known as marijuana, as a Schedule I drug. This classification states that the drug has no approved medical use on a national scale and there’s a high risk of it being misused. The only marijuana-related products that are FDA-approved are specifically for certain health issues. These products contain purified CBD (a compound from the cannabis plant) or synthetic THC (the part of marijuana that makes you “high”), and they are used for treating some seizure disorders and loss of appetite in patients with AIDS.
Cannabis comes from a plant family called Cannabaceae and has several different compounds that can affect your body. The most potent of these compounds are THC and CBD. However, despite more U.S. states permitting medical use of marijuana and its compounds, the FDA still sees it as a Schedule I drug with no currently accepted medical use. They caution that it has a high potential for misuse and are trying to bring more national regulations into place to prevent this.
Regardless of these rules, marijuana is still commonly used, especially among teenagers and young adults. The usage typically decreases as these individuals grow older due to new responsibilities such as careers, having a spouse, living with someone, or becoming a parent. However, marijuana use has seen a rise in the recent years as more states pass laws allowing it. The Diagnostic and Statistical Manual of Mental Disorders, often called the DSM-5, describes “cannabis use disorder” as serious impairment or distress over twelve months by showing at least two of several listed behaviors. These can include using more marijuana or using it over a longer time than you intended, having a strong desire to cut down but not being successful, spending lots of time getting, using, or recovering from marijuana, having cravings to use it, neglecting social duties due to using, continuing to use it despite personal problems, avoiding important activities to use marijuana, continuing to use it despite physical injuries, continuing to use it despite physical or psychological problems, growing tolerance to it, or having withdrawal symptoms when not using marijuana.
What Causes Cannabis Use Disorder?
People use cannabis for different reasons, and these reasons often depend on personal factors. Research has shown that college students and young adults usually use cannabis to fit in socially (42%) or to experiment (29%), and because they enjoy it (24%). A smaller group, around 12%, use cannabis primarily to deal with stress or to relax, which aligns with other studies that link cannabis use to mental health issues like depression, anxiety, social anxiety, and PTSD.
Pregnant women who reported using marijuana said they mainly used it to manage depression, anxiety, and stress (63%); pain (60%); and nausea or vomiting (48%). Some also reported using it for fun (39%).
From a biological perspective, having trouble with self-restraint can make a person more likely to develop a substance abuse disorder. However, clinicians aren’t sure if this is the same with marijuana.
How often you use cannabis can dramatically increase your risk of developing a cannabis use disorder, a kind of addiction. Even when using small amounts, certain people are at high risk of this disorder. According to one study, a significant number of cannabis users, especially young people, are at high risk for developing this disorder even with relatively low levels of use.
Risk Factors and Frequency for Cannabis Use Disorder
Nearly 4% of people around the world were using cannabis in 2015, with teenagers, especially in the United States and Europe, showing a high level of use. It’s also important to note that around 9% of all users develop addiction, and many of these users start during their teenage years. On the other hand, evidence is still limited when it comes to cannabis use among older individuals. Interestingly, first-year psychiatry residents in the medical field are more likely to struggle with cannabis use disorders and show a history of sedative use and anxiety.
- During pregnancy, 4% of mothers admit to using drugs, with cannabis being the most common.
- Out of more than 12 million pregnant women surveyed, there was a significant increase in cannabis abuse or dependence from 1999 to 2003, which was linked to complications during childbirth.
- 35% of moms who have used marijuana have done so while pregnant, and 18% have used it while breastfeeding.
As adult consumption increases, there are also increasing cases of children accidentally being exposed to the substance. From 2005 to 2009, nearly a thousand incidents were reported where children (average age of 1.7 years) were unintentionally exposed to cannabis. Places that have legalized marijuana have seen a sharp increase in calls to poison centers and hospital admissions related to its exposure. In general, the usage of cannabis is on the rise for almost all age groups.
Signs and Symptoms of Cannabis Use Disorder
The mental state of a person can provide hints about their phase of cannabis use. Intoxication symptoms can range from joy, worry, excessive laughter, increased hunger, forgetfulness, restlessness, a rapid heart rate, red eyes, and a dry mouth. More severe side effects such as delusions, hallucinations, and altered perception of reality can also occur but are less common. On the other hand, continuous cannabis use or withdrawal can lead to symptoms such as low mood, apathy, low motivation, irritability, lack of interest in usual activities, difficulty focusing, and social withdrawal. Test for cognitive abilities using simple recall or math problems or story recall tests.
If symptoms persist during sober periods, a primary psychiatric disorder might coexist with the substance use. Cannabis use disorders can have both acute and chronic phases including intoxication, withdrawal, and complications like delirium, psychosis, anxiety, and Insomnia. Chronic use can lead to behavioral changes.
Typical signs seen in various situations associated with cannabis use are as follows:
- Cannabis Intoxication: Recent cannabis use can lead to intoxication. This includes changes in behavior or psychological state such as impaired motor coordination, joy, anxiety, feeling like time is slow, poor judgment, social withdrawal, and at least 2 of these symptoms within 2 hours of use: red eyes, increased appetite, dry mouth, and rapid heart rate. It’s important to rule out medical or other mental disorders.
- Cannabis Withdrawal: Cannabis withdrawal can occur after stopping heavy and prolonged cannabis use (usually daily use for several months). Three or more of the following symptoms can develop within a week of stopping use: irritability, anxiety, sleep difficulties, low appetite or weight loss, restlessness, and low mood.
- Cannabis Intoxication Delirium: Symptoms of this disorder are a reduced ability to focus alongside an additional loss in cognition such as memory loss, disorientation, language issues, poor spatial orientation, or altered perception.
- Cannabis-Induced Psychotic Disorder: This includes hallucinations or delusions due to recent cannabis use or withdrawal.
- Cannabis-Induced Anxiety Disorder: This is characterized by panic attacks or anxiety caused by cannabis use.
- Cannabis-Induced Sleep Disorder: A significant change in sleep patterns caused by cannabis intoxication or withdrawal symptomizes this disorder.
- Cannabis Use Disorder: A problem pattern of cannabis use leading to significant distress, characterized by several issues such as the use of greater amounts for a longer period, persistent desire to cut down use, spending a lot of time on cannabis activities, having a strong urge, and failing to fulfill role obligations. This disorder is classified into different levels of severity based on the number of experienced symptoms.
Only a subset of patients experiences withdrawal. Symptoms usually start within the first 24 hours, peak by day 3, and last up to 2 weeks. More recent and increased use can predict the severity of withdrawal.
Testing for Cannabis Use Disorder
Lab tests involving samples of urine, blood, saliva, or hair can help detect if a person has been using cannabis. However, the results from these tests should be interpreted alongside a person’s health symptoms and history. These tests usually work by tracking an ingredient in cannabis called delta-9-tetrahydrocannabinol. This ingredient has been well-studied in various situations such as legal, clinical, and environmental contexts.
A positive test result could suggest that a person has used cannabis but it does not necessarily mean they have a substance use disorder (an addiction) or that they are under the influence of the drug when the test is taken. In the same vein, a negative result doesn’t always mean cannabis has not been used. This is because the level of the drug in the body can be measured in relation to how much cannabis a person says they have consumed. For instance, individuals who frequently smoke cannabis or have smoked it for a long period of time take longer to eliminate the substance from their bodies when compared to one-time or infrequent users.
Additional tests might be helpful in ruling out other conditions that might be related to cannabis use. These can include an imaging scan of the head or lab tests for things like heavy metals, infections, immune system markers, imbalances in body salts (electrolytes) or hormone levels.
Treatment Options for Cannabis Use Disorder
The primary goal of treating someone with a cannabis use disorder should be to enhance their overall function. This can often be achieved through multiple forms of therapy. During the detoxification process, when the body is ridding itself of the drug, providing supportive care can be beneficial. It may also be important for individuals to have access to mental health services as this can help identify and address additional mental health conditions that might be contributing to their disorder. Also, psychological counseling can help an individual change their behaviors and develop healthier ways of handling stress.
As variants of cannabis become increasingly strong and easy to obtain, the chances of developing a cannabis use disorder also rise. For those individuals who are significantly affected by the drug, either through intense bouts of intoxication or periods of withdrawal (the uncomfortable physical and mental changes that occur when the use of a drug is discontinued), the best approach should be to cease using the drug completely. However, it’s often better to gradually reduce use rather than stopping all at once. This can help lessen the withdrawal symptoms and reduce the chance of returning to using the drug.
Cannabis intoxication, the condition of being ‘high,’ generally does not require medical treatment and naturally diminishes over time. But, during this period, keeping individuals in a quiet and soothing environment can be beneficial. There are also medications available for symptomatic treatment, commonly used for symptoms including an increased heart rate, panic attacks, anxiety and restlessness, and psychosis (a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality). It’s important to monitor psychological symptoms as they can signal the onset of withdrawal or a continued mental illness.
Pharmacologic detoxification, which involves using medicine to help people manage withdrawal symptoms, is still being studied for use with cannabis use disorder. Existing research does not strongly support its use due to various reasons, such as small scale of studies, inconsistent findings, and risk of bias. Moreover, no medication is currently officially approved by the FDA (Food and Drug Administration) to treat cannabis use disorder.
Some substances, such as Tetrahydrocannabinol, show potential for treatment but require more research to determine appropriate doses, duration, formulations and complementary therapies. Other options such as Gabapentin and N-acetylcysteine are sometimes used but it’s not clear how much they help. Cannabidiol, another component of cannabis, is also showing promise in this area because it influences several brain systems.
What else can Cannabis Use Disorder be?
When considering a diagnosis, it’s important to keep in mind other conditions that might cause similar symptoms. These might include:
- Being under the influence of amphetamines
- Being under the influence of cocaine
- Withdrawal from benzodiazepines
- Anxiety disorders
- Panic attacks
Furthermore, for patients who have been using substances for a long period of time, it’s crucial to also consider:
- Major depressive disorder
- Bipolar disorder
What to expect with Cannabis Use Disorder
Continued use of cannabis can differ from one person to another. Those who are impulsive are often more likely to try substances like cannabis. If cannabis is used just for trying out, it usually leads to less usage and fewer issues. Factors such as pleasure, habit, enhancing activities, and a change in perception or views are linked to more frequent use and more problems.
People who tend to avoid punishments, boredom, or unpleasant events are less likely to stop using and are at risk of abusing cannabis. Those who feel withdrawal symptoms or use cannabis to escape stressful circumstances might continue to use it.
Possible Complications When Diagnosed with Cannabis Use Disorder
People who frequently or habitually use cannabis can often experience decreased satisfaction with their life and lower levels of achievement compared to those who don’t use the drug. Further, the drug can have negative effects on mental health, physical well-being, and social interactions. Some examples of these negative outcomes include addiction, changes in brain development, cognitive impairment, poor educational outcomes, increased chances of quitting school, and a lower IQ, particularly among adolescent users.
Moreover, it’s been found that chronic and heavy cannabis users, particularly women, are more likely to exhibit deficits in attention. If one is prone to develop chronic mental disorders, prolonged use of cannabis may hasten the onset of those conditions. In chronic heavy users, the level of THC, which is the main psychoactive component in cannabis, can predict conditions such as delusions, hallucinations, and organic brain dysfunction. Long-term brain damage can persist even if cannabis usage stops. Chronic users who smoke cannabis can also develop chronic bronchitis, a persistent lung disease. Furthermore, regular usage might also affect fertility in both men and women.
In pregnant women, using cannabis might lead to cognitive impairments in the child, affecting their intelligence, focus, hand-eye coordination, processing speed, visual memory, and the ration of information between the two brain hemispheres. Though still not conclusive, there is also a potential risk for premature birth, a low birth weight baby, or stillbirth associated with cannabis usage during the maternity period.
Adverse Impacts of Chronic Cannabis Use:
- Decreased life satisfaction and achievement
- Negative effects on mental health
- Physical well-being issues
- Negative impacts on social interactions
- Potential addiction
- Altered brain development and cognitive impairment
- Poor educational outcome and higher chances of school dropout
- Lower intelligence quotient among frequent adolescent users
- Chronic bronchitis
- Potential fertility issues in both genders
- Cognitive impairments like lack of focus, slow processing speed in children from perinatal exposure
- Potential risk for preterm delivery, low birth weight baby, or stillbirth in pregnant users
Preventing Cannabis Use Disorder
There’s a growing misunderstanding that cannabis, or marijuana, is completely safe. However, it’s important that patients understand that using cannabis can have side effects and cause serious health problems over time, especially for people 21 and under. Younger people are at a greater risk for permanent issues with thinking or ‘cognitive impairments’.
If you’re pregnant, you should talk in depth with your healthcare provider about how cannabis can affect your pregnancy and your baby’s health. Adults who use cannabis should make sure it is securely stored to prevent children from accidentally consuming it and getting sick.
Even though medical marijuana is allowed in many states, remember that your workplace can still have rules about its use.
