Cannibis use disorder
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Cannabis Use Disorder: An Overview
Prevalence and Complications of Cannabis Use Disorder
Cannabis Use Disorder (CUD) Prevalence
Cannabis is one of the most widely used illicit drugs globally, with significant prevalence in both general and psychiatric populations. The disorder is characterized by the chronic and problematic use of cannabis, leading to clinically significant impairment or distress6.
Complications and Associated Syndromes
One notable complication of chronic cannabis use is Cannabinoid Hyperemesis Syndrome (CHS), which presents with cyclic vomiting and abnormal bathing behaviors, such as seeking relief through hot water bathing or showering. This syndrome is often misdiagnosed as a psychiatric illness or cyclic vomiting syndrome, but it is directly linked to the accumulation of cannabis metabolites in the brain1.
Cannabis Use and Psychiatric Disorders
Association with Mood Disorders
Patients with mood disorders, including Major Depressive Disorder (MDD) and Bipolar Disorder (BD), exhibit higher rates of cannabis use and CUD compared to the general population. The reasons for this association are not entirely clear, and the therapeutic effects of cannabis in these conditions remain uncertain. Current evidence suggests that psychotherapeutic treatments are more effective than pharmacological treatments for managing CUD in these patients3.
Impact on Mental Health
Cannabis use is associated with cognitive and psychosocial impairments and may exacerbate psychiatric conditions. It is crucial to understand the endocannabinoid system's role in mental illness to develop effective treatments for co-occurring cannabis use and psychiatric disorders6.
Treatment Approaches for Cannabis Use Disorder
Pharmacological Interventions
Cannabidiol (CBD), a non-psychoactive component of cannabis, has shown promise as a treatment for CUD. A phase 2a trial identified that doses of 400 mg and 800 mg of CBD were effective in reducing cannabis use, as evidenced by lower urinary THC-COOH:creatinine ratios and increased days of abstinence from cannabis. These doses were well-tolerated with no severe adverse events reported5.
Psychotherapeutic Strategies
Psychotherapeutic interventions, such as motivational interviewing, are commonly used alongside pharmacological treatments. These strategies aim to reduce cannabis use and manage withdrawal symptoms effectively5 7.
Synthetic Cannabinoid Use Disorder
Emerging Clinical Issue
Synthetic cannabinoid use disorder is becoming a significant clinical concern. Compared to natural cannabis, synthetic cannabinoids are associated with a more rapid development of dependence, increased psychiatric risks, and severe physical adverse effects, including seizures, cardiotoxicity, and death. These findings highlight the need for intensive management and psychotherapeutic strategies to mitigate use and harm7.
Conclusion
Cannabis use disorder presents a complex challenge with significant implications for mental health and addiction treatment. While psychotherapeutic approaches remain a cornerstone of treatment, emerging evidence supports the potential of cannabidiol as a pharmacological intervention. Further research is essential to understand the mechanisms underlying CUD and to develop more effective treatments for this pervasive disorder.
Sources and full results
Most relevant research papers on this topic
Cannabinoid hyperemesis presenting to a New Zealand hospital.
Chronic cannabis use can lead to cannabinoid hyperemesis, a syndrome of episodic cyclic vomiting, often relieved by hot water bathing or showering, which may be more common than previously recognized.
Case ReportCannabis and cannabinoid use in autism spectrum disorder: a systematic review
Cannabis and cannabinoids may have promising effects in treating symptoms related to autism spectrum disorder, but randomized, blind, placebo-controlled clinical trials are needed to confirm these findings.
Systematic ReviewCannabis and Mood Disorders
Cannabis use is associated with mood disorders, but more research is needed to understand the mechanisms and develop more effective treatments for this comorbidity.
Literature ReviewThe Endocannabinoid System and Cannabidiol's Promise for the Treatment of Substance Use Disorder
Cannabidiol (CBD) shows potential as a treatment for substance use disorder by impairing drug-reward memory, reducing drug cues, and inhibiting reward-facilitating effects of drugs.
Highly CitedCannabidiol for the treatment of cannabis use disorder: a phase 2a, double-blind, placebo-controlled, randomised, adaptive Bayesian trial.
Cannabidiol 400 mg and 800 mg doses effectively reduced cannabis use and increased days of abstinence, with the probability of being the most efficacious dose being higher than placebo.
RCT
Rigorous JournalHighly CitedCannabis Use and Psychiatric Disorders: Implications for Mental Health and Addiction Treatment
Cannabis use negatively impacts patients with major psychiatric disorders, and future studies should focus on the impact of legalization on these populations and the development of novel treatments for co-occurring cannabis use.
Synthetic cannabinoid use disorder: an update for general psychiatrists
Synthetic cannabinoid use is associated with rapid dependence, increased psychiatric risks, and serious physical adverse effects, requiring more intensive management.
Systematic ReviewA large-scale genome-wide association study meta-analysis of cannabis use disorder
Cannabis use disorder shares genetic liability with other psychopathology, but there is a distinction between genetic liability to cannabis use and cannabis use disorder.
Meta-AnalysisRigorous JournalHighly CitedCannabis use and cannabis use disorder
Cannabis use disorder affects 10% of global cannabis users, and while treatment options are limited, cognitive behavioral therapy and contingency management can significantly reduce cannabis use and related problems.
Highly CitedCannabis Use in Adults Who Screen Positive for Attention Deficit/Hyperactivity Disorder: CANreduce 2.0 Randomized Controlled Trial Subgroup Analysis
CANreduce 2.0 effectively reduces cannabis use and symptom severity in adults, regardless of whether they have attention deficit/hyperactivity disorder.
RCT
Large Human TrialRigorous Journal