Cannabis use disorder
Cannabis use disorder is a maladaptive pattern of cannabis use meeting 2 or more of 11 substance use disorder criteria within 12 months, presenting with CB1-receptor-mediated intoxication, a real but not dangerous withdrawal syndrome, and cannabinoid hyperemesis syndrome in heavy users. There is no approved medication for the disorder itself; first-line treatment is motivational interviewing and cognitive behavioral therapy, with supportive care for withdrawal and cessation of cannabinoids for hyperemesis.
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What this article covers
- Overview
Definition: cannabis use disorder is a maladaptive pattern of cannabis (marijuana) use causing clinically significant impairment or distress, diagnosed using the same substance use disorder criteria applied to other drugs of abuse.
- Epidemiology
Common and rising: illicit drug use occurs in 9% of the U.S.
- Risk factors
Adolescent or young-adult onset of heavy, daily use: the strongest driver of a harder psychiatric course among vulnerable users.
- Pathophysiology
CB1 receptor agonism drives intoxication: cannabis and its cannabinoids act at cannabinoid (CB1) receptors, producing euphoria, altered perception, and impaired judgment.
- Clinical features
Intoxication: euphoria, anxiety, or paranoid delusions, impaired judgment, social withdrawal, impaired coordination, and a perception of slowed time, together with conjunctival injection, dry mouth, tachycardia, and increased appetite.
- Differential diagnosis
Alcohol and sedative intoxication: talkative, sullen, or moody behavior with slurred speech and unsteady gait, unlike cannabis intoxication's conjunctival injection and appetite stimulation without prominent dysarthria.
- Diagnosis
The diagnosis is clinical: it requires the 11-criterion count above, 2 or more within the same 12-month period, not a laboratory test; symptoms of tolerance and withdrawal from an appropriately…
- Management
First, for acute intoxication, manage supportively: there is no specific treatment for uncomplicated cannabis intoxication; observe until effects clear.
- Complications
Cannabinoid hyperemesis syndrome: a recognized complication of heavy cannabis use, causing recurrent nausea and vomiting.
- Prognosis
Intoxication clears without sequelae in most cases: supportive management is sufficient, and severe agitation or psychosis responds to benzodiazepines or antipsychotics when needed.
- Prevention
Universal screening in adults: the USPSTF recommends screening for illegal or nonprescribed psychoactive drug use, including cannabis, in all adults age 18 years and older when the physician can…
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