According to a new University of Maryland School of Medicine (UMSOM) review research published in the New England Journal of Medicine, the widespread use of cannabis (marijuana) and its growing potency are associated with an increase in cannabis-related psychiatric illnesses. It emphasizes the critical necessity for doctors to screen for and treat patients who have symptoms of cannabis use disorder, which suggests they are having severe issues as a result of their drug use.
According to the story, over one in every five Americans aged 12 and up used cannabis in 2021, and more than 16 million matched the criteria for cannabis use disorder as established in the American Psychiatric Association’s Diagnostic and Statistical Manual of Health Disorders (DSM-5-TR). Young adults between the ages of 18 and 25 are disproportionately affected. According to the study, more than 14% of persons in this age range had cannabis use disorder.
“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.” David A. Gorelick, MD, PhD, Professor of Psychiatry at UMSOM
Problematic marijuana use is described as cannabis use disorder. Symptoms include a desire for the drug and an inability to control its usage despite unfavorable side effects such as troubles at work or school. It is especially common in cannabis users who consume it more than four days per week. While the frequency and duration of cannabis use are the key risk factors, having another drug use disorder or another psychiatric disease increases the likelihood of the diagnosis.
“Almost 50 percent 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 manifestations of cannabis use disorder range from yellowing of the fingertips to increased melancholy and anxiety while consuming cannabis. To be appropriately diagnosed by a physician, patients must meet two or more DSM-5-TR criteria for cannabis use disorder. These include performing poorly in school or at work, as well as missing essential family commitments as a result of cannabis use. Other effects include withdrawal symptoms and cannabis cravings.
Dr. Gorelick, who is also the Editor-in-Chief of the Journal of Cannabis Research, performed the lengthy research to educate clinicians on the variety of health risks that may be related with short-term and long-term cannabis usage as the use of cannabis products grows. He also hoped to raise public knowledge of cannabis user disorder, both in terms of recognizing symptoms and knowing treatment choices.
Other risks of excessive cannabis usage were also mentioned in the paper: Cannabis usage accounts for 10% of all drug-related emergency department visits in the United States and is linked to a 30% to 40% increased risk of car accidents. In 2022, those aged 18 to 25 had the highest rate of cannabis-related emergency department visits.
“Approximately one in every ten people who use cannabis will become addicted, and for those who start before the age of 18, the rate rises to one in every six,” said Mark T. Gladwin, MD, the John Z. and Akiko K. Bowers Distinguished Professor and Dean of UMSOM, and Vice President for Medical Affairs at the University of Maryland, Baltimore. “As the use of this drug grows, we must conduct extensive basic research to better understand the brain’s cannabinoid system.” We must also conduct translational research on medicines that target these brain pathways in order to help people with cannabis use disorder, particularly young adults and pregnant women, overcome their addiction to the drug.”
UMSOM’s aim includes driving innovation in the field of addiction medicine and learning more about neurological abnormalities in the brain that make some people more vulnerable to substance abuse and addiction. As part of this mission, the school 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 a new generation of addiction medicine practitioners.
“There is still a lot we don’t understand about these conditions, including why some people experience cannabis-related disorders,” said Asaf Keller, PhD, Kahlert Institute Associate Director and Donald E. Wilson, MD, MACP Distinguished Professor and Chair of Neurobiology at UMSOM. “That is what we are attempting to learn more about through pre-clinical research studies.” We are also focusing on therapy options for cannabis-related diseases.”
There are now seven identified cannabis-related diseases. Cannabis-induced anxiety disorder, cannabis-induced psychotic disorder, cannabis-induced sleep problem, and cannabis-induced delirium, which appears as hyperactivity, agitation, and disorientation with hallucinations, are just a few examples. Their symptoms frequently match those of non-cannabis-related comparable diseases.
The U.S. Preventive Services Task Force recommends screening adolescents and adults for cannabis use disorder (and other substance use disorders) in primary care settings as long as services for accurate diagnosis, treatment, and appropriate care can be offered or referred. Screening is best done at a healthcare visit as a standalone or as part of a comprehensive health questionnaire. While the FDA has not approved any medication for the treatment of cannabis use disorder, various therapies can assist persons with cannabis use disorder in managing symptoms and reducing or discontinuing cannabis usage. Cognitive Interactive Therapy (CBT) and Motivational Enhancement Therapy (MET) are two therapies that help patients regulate the thoughts and actions that trigger their cannabis use and better understand why they use cannabis. Adolescents may benefit more from family-based therapeutic approaches.
Therapy is becoming more widely available through telemedicine programs, but stigma associated with mental illness and addiction, as well as a shortage of mental healthcare specialists, continue to be hurdles to treatment for many individuals, according to Gorelick.
Read more: Cannabis-Related Disorders and Toxic Effects, The New England Journal of Medicine, https://doi.org/10.1056/NEJMra2212152
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