Cannabis Use Disorder Or Cannabis Addiction

by lamsa.org | Jan 11, 2023 | CANNABIS

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The cannabis plant (Sativa/Indica) contains around 400 chemicals, among them two main active ingredients:

THC (delta-9-TetraHydroCannabinol), a mind-altering substance which produces the high. Higher THC concentrations have been associated with more harmful effects on the brain and a higher risk of psychosis
CBD (Cannabidiol), which is actually being studied for medical use

THC concentration in Cannabis has increased throughout the decades: during the Hippy movement (1970), it was only around 1.25% compared to 28% in 2018

Cannabis has an endless list of familiar names, nicknames and street names, based on different cultures, countries and age groups. Some of them are: pot, weed, herb, grass, joint, hash, Mary Jane, MJ, wax, dab, dope, loud, ganga, Dior, blunt, stinkweed, nuggets, 429, hay, rope, blunt, reefer, smoke, shatter, trees, bud, chronic, tobacco, gangster, skunk, boom, blaze, ashes, bock, boo, broccoli, burrito, Burnie, charge, etc.

Cannabis products include:

Marijuana: made from the dried leaves and flowering tops of the plant; it is usually smoked mixed to tobacco as a cigarette (joint), cigar (blunt) or in a pipe or waterpipe (bong)
Hashish (Hash) and Hash oil: both come from the resin of the flowers before their maturation. The resin is then dried to make these concentrated cannabis products, highly rich in THC; they are consumed by heating and inhaling the smoke

Cannabis can also be ingested as tea, mixed into food, candies, cookies and brownies, called edible cannabis

On another note, it is important to know that cannabis may not always be pure; it can be mixed to other substances (cocaine, etc.). Moreover, it is not always natural, but can be synthetic (fabricated in the laboratory and sprayed on plant materials), making it much more dangerous than the natural plant.

In Lebanon, up to 2.7% of students aged 16 to 17 years reported using cannabis (WHO)

Using cannabis has many effects on health and will depend on the concentration of THC, the ratio of THC/CBD, the quantity consumed and individual factors.

Short-term health effects appear each time cannabis is consumed and include:

Impairment of your ability to drive safely (up to 5 hours if smoked, 12 hours if ingested)
Impairment of your memory and attention, thus your performance at school/work
Anxiety and panic attack (Bad Trip)
Triggering of psychotic episodes (paranoia, false beliefs (delusions), hallucinations, etc.)

On the other hand, long-term health effects appear when cannabis is used regularly, daily or almost daily, or over a long period of time (months, years).They include:

Lung damage (effects similar to those of tobacco smoke)
Mental health disorders (anxiety, depression, psychosis, schizophrenia with high THC content)
Addiction

Note that brain development continues till age 25, making teens’ brains more vulnerable to cannabis use

Regular consumption of cannabis can result in varying degrees of impairment especially on the nervous system (intoxication delirium, psychotic disorder, anxiety disorder and sleep disorder). Moreover, Cannabis’ rewarding effect causes dependence and withdrawal symptoms upon cessation of use, which can include irritability, anger, aggression, nervousness, anxiety, sleep difficulty (i.e., insomnia, disturbing dreams), decreased appetite or weight loss, restlessness, and depressed mood.

Cannabis addiction or Marijuana addiction, medically known as Cannabis Use Disorder (CUD), is defined in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and ICD-10 as the “continued use of cannabis despite clinically significant distortion”.

Cannabis users can be diagnosed with CUD if they have been consuming the substance for at least one-year period and have chronic symptoms of significant impairment of functioning and distress, repeated failed efforts to discontinue or reduce the amount used, cravings, intrusive thoughts and images about cannabis, or olfactory perceptions, and tolerance to the substance.

Tolerance is defined by either one the following: a need to increase the amount of a substance to reach the desired effect or a markedly decreased effect while continuing to use the same amount (DSM-5)

Are at higher risk to develop CUD, consumers with a family history of chemical dependence and/or mental illness, unstable abusive family, a personal history of antisocial personality disorder, mental illness, low socio-economic status, poor academic performance, and use of recreational substances (tobacco, cannabis, pills, etc.) among social circle (particularly in adolescents).

Screening for cannabis use along with screening for underlying undiagnosed mental illness is an important step towards treatment and recovery. Many of the youth begin to consume cannabis as an auto-medication for a mental health symptom, like anxiety, stress, depression, etc.

Thus, each person with one or more risk factors for substance use should be properly evaluated by any health care professional. Patient history is important (mental health, family history for substance use, medications), and if indicated, laboratory testing of urine, blood, saliva, or hair should be ordered, to detect, in case of cannabis use, the most common active metabolite: THC. Is it also possible to quantify the tolerance status, by comparing the reported intake of cannabis to blood levels of THC.

A THC positive result can indicate usage but not necessarily a substance use disorder or intoxication. A negative result does not rule it out. Heavy or chronic cannabis smokers will take longer to clear THC compared to sporadic or one-time users

Treatment options for cannabis dependence are much fewer than for opiate or alcohol dependence. Most treatments are organized into the categories of psychological or psycho-therapeutical interventions, pharmacological interventions or treatment through peer support and environmental approaches, but psychotherapeutic models hold the most promise.

Screening and brief intervention sessions can be given in a variety of settings. Most cannabis users seek help through their general practitioner rather than a drug treatment service agency

The goal of medication therapy for cannabis use disorder is to target the stages of addiction: acute intoxication/binge, withdrawal/negative affect and preoccupation/anticipation. Three main treatment modalities are present:

Medication: No medications have been found effective for cannabis dependence. The FDA hasn’t approved any medicines, but studies are being done to see if medical therapy used to treat sleep disorders, anxiety, depression, irritability and insomnia can be an option.
Motivational incentives: also called “contingency management,” consist in rewarding patients for staying drug-free through a mental health therapist that helps them in committing to the behavioral changes.
Talk therapy (Cognitive Behavioral Therapy): helps patients understand the thoughts and behaviors that lead to drug abuse, regulate their emotions and find a way to bypass their distorted tendencies through coping mechanisms.

Long-term follow-up and evaluation are an important aspect of the clinical management. Remission is possible, and is classified as either an early remission (none of the criteria for CUD has been met for 3-12 months) or a sustained remission (none of the criteria for CUD has been met at any time > 12months).