The increased potency and pervasive use of cannabis (marijuana) are associated with an increase in cannabis-related psychiatric disorders, according to a new review article published in the New England Journal of Medicine by the University of Maryland School of Medicine (UMSOM). It emphasizes the critical necessity for physicians to promptly identify and manage patients exhibiting symptoms consistent with cannabis use disorder, a condition in which the substance contributes significantly to the patient’s problems.
According to the review, nearly one in five Americans aged 12 and older used cannabis in 2021, and over sixteen million met the Diagnostic and Statistical Manual (DSM-5-TR) criteria for cannabis use disorder, as published by the American Psychiatric Association. Youths between the ages of 18 and 25 are impacted disproportionately. More than fourteen percent of those in this age group had cannabis use disorder, according to the review.
“There is a lot of misinformation in the public sphere about cannabis and its effects on psychological health with many assuming that this drug is safe to use with no side effects. It is important for physicians and the public to understand that cannabis can have addictive effects and to recognize signs and symptoms in order to get properly diagnosed and treated,”
said the review article’s author David A. Gorelick, MD, Ph.D., Professor of Psychiatry at UMSOM.
Cannabis Use Disorder
Cannabis use disorder is defined as problematic marijuana use. Symptoms include craving the drug and failing to control its use despite experiencing negative side effects like problems at work or school. It is most prevalent in people who use cannabis more than four days a week.
While the frequency and duration of cannabis use are the primary risk factors, having another substance use disorder or other psychiatric condition also increases the likelihood of the diagnosis.
“Almost 50% of people with cannabis use disorder have another psychiatric condition such as major depression, post-traumatic stress disorder, or generalized anxiety disorder,” said Dr. Gorelick. “It’s vital that patients seek the right psychiatric treatment to address their risk factors.”
Physical signs and symptoms of cannabis use disorder can range from yellowing of the fingertips to increased depression and anxiety while using cannabis.
In order to receive an accurate clinical diagnosis, patients must satisfy two or more criteria specified in the DSM-5-TR for cannabis use disorder. These include missing significant family obligations or performing inadequately in school or the workplace as a result of cannabis use. Other possible indications include the development of cannabis cravings or withdrawal symptoms.
Therapy Translational Studies Needed
As the number of individuals who use cannabis products continues to rise, Dr. Gorelick, who is also Editor-in-Chief of the Journal of Cannabis Research, conducted an exhaustive assessment to inform physicians about the variety of health problems that may be associated with short-term and long-term cannabis use. Furthermore, his objective was to enhance public consciousness regarding cannabis use disorder, encompassing knowledge of its treatment alternatives and the identification of its symptoms.
The paper also highlighted other dangers of excessive cannabis use: Cannabis use accounts for 10% of all drug-related emergency room visits in the U.S. and is associated with a 30 to 40 percent increased risk of car accidents. In 2022, 18 to 25-year-olds accounted for the highest rate of cannabis-related emergency department visits.
“Approximately one in 10 people who use cannabis will become addicted, and for those who start before age 18, the rate rises to one in six. As use of this drug increases, we must delve deeply into basic research to understand the brain’s cannabinoid system. We must also design translational studies of therapies that target these brain mechanisms to help those with cannabis use disorder — particularly young adults and pregnant women—overcome their dependence on this drug,”
said Mark T. Gladwin, MD, the John Z. and Akiko K. Bowers Distinguished Professor and Dean, UMSOM, and Vice President for Medical Affairs, University of Maryland, Baltimore.
Screening for Cannabis-related Disorders
There are currently seven recognized disorders related to cannabis use. Some include:
- cannabis-induced anxiety disorder
- cannabis-induced psychotic disorder
- cannabis-induced sleep disorder
- cannabis-induced delirium, which manifests as hyperactivity, agitation and disorientation with hallucinations
Often, their symptoms can closely resemble those of their non-cannabis-related counterpart disorders.
The U.S. Preventive Services Task Force advises that adolescents and adults be screened for cannabis use disorder (as well as other substance use disorders) in primary care settings, provided that services for accurate diagnosis, treatment, and appropriate care are available or referred to, in order to ensure accurate patient diagnosis.
Screening is best done with a standalone or within a larger health questionnaire during a health care visit.
Although no medication has been designated by the FDA as an effective treatment for cannabis use disorder, certain therapies can assist individuals with the disorder in reducing or quitting cannabis use and managing symptoms.
Motivational Enhancement Therapy (MET) and Cognitive Interactive Therapy (CBT) assist patients in regulating the thoughts and actions that precipitate their cannabis use and in gaining a deeper comprehension of the underlying reasons for their cannabis consumption. Alternatives involving the family may provide adolescents with additional advantages.
Therapy is becoming more widely available through telehealth services, but the stigma around mental illness and addiction and the shortage of mental health care professionals still create barriers to treatment for many patients, Gorelick said.
Reference:
- David A. Gorelick. Cannabis-Related Disorders and Toxic Effects. N Engl J Med 2023; 389:2267-2275 DOI: 10.1056/NEJMra2212152