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 is more common. It is called "hashish" and 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 in the form of "edible" products

●Taken in the form of 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 your heart race

●Raise your blood pressure

●Make you breathe faster

●Make your eyes red

●Make your mouth dry

●Make you hungry

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? — "Cannabis use disorder" is a term for when a person's use of the drug causes problems. People used to think that 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 that 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 that they have a physical or mental problem that was probably caused or made worse by their cannabis use.

●They need to smoke more and more to get the same effects that 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 symptoms can 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 the following physical symptoms: stomach pain, shaking, sweating, fever, chills, headache

Cannabis use disorder can be mild, which means that 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.

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 ("CBT") – In this type of therapy, you talk with a psychologist or counselor about the things 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 the 2 types of therapy. Different techniques can also be added. For example, some involve earning rewards for specific behavior changes.

Some people also find support groups to be helpful. In these groups, people share their experiences with each other. The most common of these groups is Marijuana Anonymous (www.marijuana-anonymous.org), but some people dislike that 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). Gabapentin is sold only with a prescription. It is normally used to treat seizures or pain. There is not a lot of proof that 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)
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Patient education: Alcohol poisoning (The Basics)

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