In recent years, cannabis, also known as marijuana, has become more prevalent and accepted in many societies around the world. With the legalization of cannabis for medical and recreational use in several states and countries, its consumption has significantly increased.

While cannabis can offer medical benefits and recreational enjoyment, there is a growing concern about the increasing prevalence of Cannabis Use Disorder (CUD). This disorder can lead to negative health outcomes, making it crucial for individuals to seek guidance from physicians to manage their use and avoid adverse effects.

Understanding Cannabis Use Disorder

Cannabis Use Disorder is a medical condition characterized by the problematic use of cannabis, leading to significant impairment or distress. It includes a range of symptoms such as craving, withdrawal, and continued use despite negative consequences.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), CUD can be classified into mild, moderate, or severe, depending on the number of symptoms an individual exhibits¹.

The Rising Trend of Cannabis Use

The legalization of cannabis in various regions has made it more accessible to the public. This increased availability has led to a small rise in the number of users and a vast increase in the amount and potency of cannabis being used².

Many people are using cannabis for its perceived benefits, such as relaxation, pain relief, and improved mood.  However, many people are using this medicine without the guidance of medical professionals and this appears to be leading to an explosion of CUD³.

During the period of prohibition in the United States, estimates of the prevalence of CUD were approximately 7-9%^4-5.  Those who start using cannabis at a younger age (< 25 years) have a risk of approximately 18%⁴.

More recent studies, done since recreational legalization, paint a very much more concerning picture of CUD between 21-34%^3,6.  These same studies show that cannabis users who identify as medical patients have reduced risk, though it is not yet known whether this reduction is due to the guidance and supervision of the practitioner or other factors.  Nonetheless, medical cannabis patients appear to be getting benefit with lesser risk.

Health Implications of Cannabis Use Disorder

CUD can have several negative health implications. One of the most concerning aspects is its impact on mental health. Chronic cannabis use has been associated with anxiety, depression, and even psychosis in some individuals. These mental health issues can severely affect a person's quality of life, relationships, and overall well-being⁷.

Moreover, cannabis use can impair cognitive functions such as memory, attention, and learning. This is particularly concerning for young people, whose brains are still developing. Prolonged use during adolescence can lead to lasting cognitive deficits and reduced academic or occupational achievement⁸.

The Role of Physicians in Managing Cannabis Use

Given the potential risks associated with CUD, it is essential for individuals to seek guidance from healthcare professionals. Physicians play a critical role in helping patients manage their cannabis use and mitigate negative outcomes. Here are several reasons why physician guidance is vital:

• Accurate Information and Education: Physicians can provide patients with accurate and unbiased information about the effects of cannabis and the risks associated with its use. They can debunk myths and help individuals make informed decisions about their consumption.  Sadly the internet and dispensaries have been found to be poor sources of information⁹.  Most information about cannabis on the internet is not credible and dispensaries have been found to give self-servicing advice on medical care for which they are not qualified¹⁰.

• Monitoring and Assessment: Regular visits to a healthcare provider can help monitor the patient's cannabis use and assess for signs of CUD. Early detection is crucial for preventing the disorder from becoming severe¹¹. Moreover, particularly with inhaled approaches to cannabis use, users are often not aware of the amounts they are taking or see dose escalation as it happens. Review of the regimen with the physician often reveals patterns that are concerning but not obvious to the patient^12-13.

• Personalized Treatment Plans: Physicians can develop personalized treatment plans that cater to the individual's needs. In the case of patients with CUD, this may include counseling, behavioral therapies, and, if necessary, medication to help manage withdrawal symptoms and reduce cravings¹⁴. However, developing a personalized treatment plan from the outset will reduce the risk of developing CUD while improving the benefits to the patient.

• Addressing Underlying Issues: Often, individuals use cannabis to self-medicate for underlying medical or mental health issues such as pain, anxiety, or insomnia. A physician can ensure that the appropriate medical work-up is completed to find the root cause(s) and, if possible, treat those directly. It is critical that subtle disease like early cancer or hormonal dysregulation are not ignored by self-treating with cannabis.  

• Support and Resources: Physicians can provide support and resources to patients and their families. This may include referrals to support groups, mental health professionals, and rehabilitation programs.

Conclusion

The increasing prevalence of Cannabis Use Disorder highlights the need for individuals to seek guidance from physicians to avoid negative health outcomes. While cannabis can offer benefits, its misuse can lead to significant physical and mental health issues.

By providing accurate information, monitoring use, developing personalized treatment plans, addressing underlying issues, and offering support, physicians can play a crucial role in helping individuals manage their cannabis use responsibly. With proper guidance, individuals can enjoy the benefits of cannabis while minimizing the risks.

For more on Cannabis Use Disorder, watch Casual Conversations episode #6 here.

References:

1. Volkow, N. D., Baler, R. D., Compton, W. M., & Weiss, S. R. B. (2014). Adverse health effects of marijuana use. New England Journal of Medicine, 370(23), 2219-2227.
2. Murray, R. M., Quigley, H., Quattrone, D., Englund, A., & Di Forti, M. (2016). Traditional marijuana, high-potency cannabis and synthetic cannabinoids: Increasing risk for psychosis. World Psychiatry, 15(3), 195-204.
3. Lapham, G. T., Matson, T. E., Bobb, J. F., Luce, C., Oliver, M. M., Hamilton, L. K., & Bradley, K. A. (2023). Prevalence of Cannabis Use Disorder and Reasons for Use Among Adults in a US State Where Recreational Cannabis Use Is Legal. JAMA Network Open, 6(8), e2328934. https://doi.org/10.1001/jamanetworkopen.2023.28934
4. Robson, P. (2011). Abuse potential and psychoactive effects of δ-9-tetrahydrocannabinol and cannabidiol oromucosal spray (Sativex), a new cannabinoid medicine. Expert Opinion on Drug Safety, 10(5), 675–685. https://doi.org/10.1517/14740338.2011.575778
5. Hasin, D. S., Saha, T. D., Kerridge, B. T., Goldstein, R. B., Chou, S. P., Zhang, H., ... & Grant, B. F. (2015). Prevalence of marijuana use disorders in the United States between 2001-2002 and 2012-2013. JAMA Psychiatry, 72(12), 1235-1242.
6. Gelberg, L., Beck, D., Koerber, J., Akabike, W. N., Dardick, L., Lin, C., … Javanbakht, M. (2024). Cannabis Use Reported by Patients Receiving Primary Care in a Large Health System. JAMA Network Open, 7(6), e2414809. https://doi.org/10.1001/jamanetworkopen.2024.14809
7. Turna, J., Patterson, B., & Van Ameringen, M. (2019). Is cannabis treatment for anxiety, mood, and related disorders ready for prime time? Depression and Anxiety, 36(11), 1001-1010.
8. Meier, M. H., Caspi, A., Ambler, A., Harrington, H., Houts, R., Keefe, R. S., ... & Moffitt, T. E. (2012). Persistent cannabis users show neuropsychological decline from childhood to midlife. Proceedings of the National Academy of Sciences, 109(40), E2657-E2664.
9. Boatwright, K. D., & Sperry, M. L. (2020). Accuracy of Medical Marijuana Claims Made by Popular Websites. Journal of Pharmacy Practice, 33(4), 457–464. https://doi.org/10.1177/0897190018818907
10. Cameron, J. D., Dhalla, R., & Lougheed, T. (n.d.). An examination of cannabis-related information typically asked by consumers at retail cannabis locations: A Canadian survey of budtenders and managers. https://doi.org/10.1177/17151635231164997
11. Thomasius R, Paschke K, Arnaud N. Substance-Use Disorders in Children and Adolescents. Dtsch Arztebl Int. 2022 Jun 24;119(25):440-450. doi: 10.3238/arztebl.m2022.0122. PMID: 35635442; PMCID: PMC9549893.
12. van der Pol P, Liebregts N, de Graaf R, Korf DJ, van den Brink W, van Laar M. Validation of self-reported cannabis dose and potency: an ecological study. Addiction. 2013 Oct;108(10):1801-8. doi: 10.1111/add.12226. Epub 2013 May 30. PMID: 23627816.
13. Goulette, M., Schlienz, N. J., Case, A. A., Hansen, E., Rivard, C., Ashare, R. L., … Smith, D. M. (2024). Self-reported knowledge of tetrahydrocannabinol and cannabidiol concentration in cannabis products among cancer patients and survivors. Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer, 32(4), 210. https://doi.org/10.1007/s00520-024-08374-w
14. Substance Abuse and Mental Health Services Administration. (2020). Treatment for substance use disorder. Retrieved from https://www.samhsa.gov/find-help/treatment.