The use of cannabis, also known as marijuana, has become increasingly widespread in recent years, and this trend is associated with a rise in cannabis-related psychiatric conditions, according to a review article conducted by the University of Maryland School of Medicine (UMSOM). The article, published in the New England Journal of Medicine, emphasizes the urgent need for doctors to screen for and treat patients who are experiencing symptoms of cannabis use disorder.
The review states that nearly one in five Americans aged 12 and older used cannabis in 2021, with over 16 million meeting the criteria for cannabis use disorder outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) published by the American Psychiatric Association. Young adults aged 18 to 25 are particularly affected, with more than 14% in this age group experiencing cannabis use disorder.
Dr. David A. Gorelick, a Professor of Psychiatry at UMSOM and the author of the review article, highlights the prevalence of misinformation regarding the safety of cannabis use, leading many people to assume that the drug is harmless. He emphasizes that it is crucial for both physicians and the general public to understand that cannabis can have addictive effects and to recognize the signs and symptoms in order to seek proper diagnosis and treatment.
Cannabis use disorder is defined as problematic marijuana use that leads to negative consequences and an inability to control or stop using the drug. Symptoms include craving for the drug, problems at work or school, and an inability to fulfill family obligations. The disorder is most prevalent in individuals who use cannabis more than four days a week. The review also suggests that having another substance use disorder or psychiatric condition increases the likelihood of a cannabis use disorder diagnosis.
Furthermore, approximately 50% of individuals with cannabis use disorder also have another psychiatric condition such as major depression, post-traumatic stress disorder, or generalized anxiety disorder. Dr. Gorelick emphasizes the importance of seeking appropriate psychiatric treatment to address these risk factors.
Physical indications of cannabis use disorder can range from yellowing of the fingertips to increased depression and anxiety while using the drug. However, a diagnosis by a clinician requires patients to meet two or more criteria outlined in the DSM-5-TR. These criteria include poor performance at work or school, missing important family obligations due to cannabis use, experiencing withdrawal symptoms, or having cravings for cannabis.
Dr. Gorelick’s extensive review aims to educate physicians about the various health issues associated with short-term and long-term cannabis use, given the growing number of individuals using cannabis products. It also aims to raise public awareness about cannabis use disorder, including recognizing its symptoms and understanding available treatment options.
In addition to the risks associated with cannabis use disorder, the review also highlights 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. Cannabis-related emergency department visits are highest among 18 to 25-year-olds.
Approximately one in ten individuals who use cannabis become addicted, with the rate rising to one in six for those who start using the drug before the age of 18. Dr. Mark T. Gladwin, the Dean of UMSOM, emphasizes the need for further research on the brain’s cannabinoid system to better understand addiction mechanisms and design therapies to help individuals with cannabis use disorder overcome their dependence on the drug.
UMSOM is dedicated to driving innovation in the field of addiction medicine and aims to understand the neurological differences in the brain that make some individuals more vulnerable to drug abuse and addiction. In this pursuit, UMSOM recently established the Kahlert Institute for Addiction Medicine, which brings together leading addiction experts to collaborate on studying the brain mechanisms underlying addiction and training the next generation of medical practitioners in addiction medicine.
However, Dr. Asaf Keller, Associate Director of the Kahlert Institute, acknowledges that there is still much to learn about cannabis-related disorders and why some individuals are more susceptible. He explains that pre-clinical research studies are being conducted to better understand these conditions and to develop treatments for cannabis-related disorders.
Currently, there are seven recognized disorders related to cannabis use, including cannabis-induced anxiety disorder, cannabis-induced psychotic disorder, cannabis-induced sleep disorder, and cannabis-induced delirium. These disorders may present symptoms similar to their non-cannabis-related counterparts.
To ensure accurate diagnosis and appropriate care, the U.S. Preventive Services Task Force recommends that adolescents and adults be screened for cannabis use disorder, along with other substance use disorders, during primary care visits. Screening can be conducted through standalone screenings or as part of a larger health questionnaire.
Although no medication has been approved by the FDA for the treatment of cannabis use disorder, certain therapies, such as Cognitive Behavioral Therapy (CBT) and Motivational Enhancement Therapy (MET), can assist individuals in managing their symptoms and reducing or stopping their cannabis use. Family-based treatment options may also be beneficial for adolescents.
While therapy is becoming more accessible through telehealth services, the stigma surrounding mental illness and addiction, along with a shortage of mental health professionals, continue to create barriers to treatment. Dr. Gorelick emphasizes the need for increased access to mental health care for patients with cannabis use disorder.
Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it