Patient education: Cannabis use disorder (The Basics)

What is cannabis? — 

This is a drug that comes from the leaves and flowers of the Cannabis plant. People often use the words "cannabis" and "marijuana" to mean the same thing.

In the US, cannabis is usually sold in the form of leaves and buds. In Europe, a different form called "hashish" is more common. It is made from a sticky substance that comes from the plant.

Cannabis can be used in different forms. The drug can be:

●Smoked

●Inhaled with a "vaping" device

●Eaten as "edible" products

●Taken as liquid or oil

The ingredient in cannabis that makes people feel "high" is called "THC." The other main ingredient is called cannabidiol, or "CBD."

Cannabis use is common worldwide. About 4 percent of people ages 15 to 64 in the world have used it in the last year. Younger people are more likely than older people to use it, and men are more likely than women to use it.

Is cannabis legal? — 

The answer can be confusing. The US federal government considers cannabis to be illegal. At the same time, states have their own laws, and in certain states, adults can buy cannabis. In some states, you can only buy cannabis for medical use with a doctor's prescription. In other states, you can buy it as a "recreational" drug.

Even though cannabis is legal in some places, it can still cause health problems. When a person uses cannabis regularly, it can be hard for them to stop, even if they want to.

What does cannabis do to the brain and body? — 

Cannabis can make you feel happy and relaxed. It can also make you feel less anxious, tense, and depressed. But it does bad things, too. It makes it hard to focus or remember things, or to think clearly. Plus, it slows your reaction time and impairs your judgement. Cannabis can also make you feel paranoid or suspicious of others.

Cannabis can also:

●Make your heart race

●Raise your blood pressure

●Make you breathe faster

●Make your eyes red

●Make your mouth dry

●Make you hungry

Cannabis can increase the risk of "psychosis." This is when a person cannot think normally and has trouble knowing what is real. They might see or hear things that aren't there.

Regular cannabis use might also increase the risk of schizophrenia. This is a brain disorder that keeps you from thinking clearly and can cause episodes of psychosis. The risk of developing schizophrenia seems greater if a person starts using cannabis at an early age, uses it every day, or uses a lot of it.

Regular cannabis use can sometimes also cause repeated episodes of severe belly pain, nausea, and vomiting. This is called "cannabis hyperemesis syndrome."

Sometimes, people use electronic "vaping" products that contain THC. This can be dangerous and lead to serious lung damage. While all forms of cannabis can cause health problems, this is especially true for vaping. That's because it's not always possible to know what is in these products, or what their long-term effects might be.

What is cannabis use disorder? — 

This is when a person's use of the drug causes problems. People used to think cannabis was not addictive, but that is not true.

People with cannabis use disorder have 2 or more of the following problems. The more of these they have, the more severe their disorder:

●They end up using more of the drug than they planned to, or they use it for longer than they planned to.

●They wish they could cut down on drugs, but they can't.

●They spend a lot of time trying to get drugs, getting high, or recovering from being high.

●They crave or have a strong desire or urge to use cannabis.

●Because of their cannabis use, they often don't do things that are expected of them, such as go to work or school, remember family events, and clean their home.

●They keep using cannabis even if it causes or worsens problems in their relationships or interactions with other people.

●They stop or cut back on important social, work, or fun activities they used to do.

●They keep using cannabis even in situations where it is dangerous to do so (such as while driving).

●They keep using the drug even when they know they have a physical or mental problem that was probably caused or made worse by their cannabis use.

●They need to use more and more to get the same effects they used to get with less. Or they get less effect from using the amount that used to get them high. This is called "tolerance."

●They have "withdrawal symptoms" if they stop using cannabis after using it for a long time. Withdrawal can make a person feel physically sick. It can also make them feel anxious, restless, or sad.

Cannabis use disorder can be mild, which means the person only has a few of the problems listed above. Or it can be more severe, which is when they have many of these problems.

What is withdrawal? — 

When people use a drug for a long time and then suddenly stop, they often get symptoms. These symptoms are called "withdrawal," and might include:

●Irritability, anger, or aggression

●Nervousness or anxiety

●Trouble sleeping (sometimes because of weird dreams)

●Decreased appetite, or weight loss

●Restlessness

●Sadness or depression

●At least 1 of these physical symptoms: stomach pain, shaking, sweating, fever, chills, and headache

Most of the time, these symptoms go away on their own. If you have severe symptoms from withdrawal, tell your doctor or nurse.

How is cannabis use disorder treated? — 

It depends. If you have problems with cannabis use, your doctor or nurse can work with you to figure out a treatment plan and set goals.

For people with mild cannabis use disorder, the first goal might be to cut back and use cannabis less often.

Treatment might involve:

●Cognitive behavioral therapy, or "CBT" – In this type of therapy, you talk with a psychologist or counselor about what you think and do. They work with you to understand when and how you use cannabis, and help you learn healthier behaviors instead.

●Motivational enhancement therapy – This is another type of counseling. It involves thinking about why you have certain behaviors and how to change them in a positive way.

If neither of the above works, your doctor might recommend combining them. Different techniques can also be added. For example, some involve earning rewards for specific behavior changes.

Support groups can also be helpful. In these groups, people share their experiences with each other. The most common of these is Marijuana Anonymous (www.marijuana-anonymous.org), but some people dislike how it involves God or a "higher power." There are other groups that do not have that as a focus.

Doctors usually do not recommend medicines for treating cannabis use disorder. But in some cases, they might try medicine if therapy does not help. One medicine is called acetylcysteine (brand name: Acetadote). In the US, it is sold over-the-counter as a nutritional supplement, but it can also be prescribed by a doctor. The other medicine is gabapentin (sample brand names: Neurontin, Gralise). This is sold only with a prescription. It is normally used to treat seizures or pain. There is not a lot of proof these medicines work, but some experts think it is worth trying 1 of them.

More on this topic

Patient education: Medical cannabis (The Basics)
Patient education: Cannabis hyperemesis syndrome (The Basics)
Patient education: Substance use disorder (The Basics)
Patient education: Treatment for substance use disorder (The Basics)