Cannabis Use Disorder

Cannabis Use Disorder: Basics - Ganja Genesis

• Source: Cannabis sativa/indica plants.
• Active Compounds:
  • $\Delta^9$-Tetrahydrocannabinol (THC): Psychoactive ("high").
  • Cannabidiol (CBD): Non-psychoactive, therapeutic potential.
• Routes: Inhalation (smoking, vaping - rapid onset); Oral (bhang, edibles - slower onset, longer effect).
• Indian Context: Forms: ganja (flowers), charas (resin), bhang (leaves/seeds). High prevalence in young adults.

⭐ Key endocannabinoid system components include CB1 receptors (primarily in CNS) and CB2 receptors (periphery, immune cells), and endogenous ligands like anandamide and 2-arachidonoylglycerol (2-AG).

Cannabis Use Disorder: Neurobiology & Clinical Dx - High Times & Lows

• Neurobiology:
  • THC (Δ⁹-tetrahydrocannabinol) binds CB1 (brain) & CB2 receptors; mimics endocannabinoid anandamide.
• Acute Intoxication ("High"):
  • Euphoria, relaxation, altered perception (time, senses), ↑ appetite.
  • Physical: Conjunctival injection, dry mouth, tachycardia.
  • Adverse: Anxiety, paranoia, impaired coordination/memory.
• Withdrawal:
  • (See ⭐ below for DSM-5 criteria details).
• Cannabis Use Disorder (CUD) - DSM-5:
  • Problematic pattern: ≥2 criteria in 12 months.
  • Categories: Impaired control, social impairment, risky use, pharmacological (tolerance, withdrawal).
  • Severity: Mild (2-3), Moderate (4-5), Severe (≥6 symptoms).

⭐ Cannabis withdrawal (DSM-5 criteria: irritability, anxiety, sleep difficulty, decreased appetite, restlessness, depressed mood, plus physical symptoms like abdominal pain, shakiness/tremors, sweating, fever, chills, or headache) is a recognized syndrome that can significantly impair functioning.

Cannabis Use Disorder: Complications - Reefer Risks

• Respiratory System:
  • Chronic bronchitis, cough, wheezing.
  • ↑ Tar & carcinogens vs. tobacco (📌 "Tar Wars").
  • Potential ↑ risk of lung cancer with long-term heavy use.
• Cardiovascular System:
  • Acute: Tachycardia, ↑BP, orthostatic hypotension.
  • Chronic: Possible ↑ risk of MI, stroke in susceptible individuals.
• Mental Health:
  • ↑ Risk of anxiety, depression.
  • Cannabis-induced psychotic disorder.
  • Amotivational syndrome: Apathy, ↓ drive (debated).
  • ⭐ > Early and heavy cannabis use in adolescence is associated with an increased risk of developing psychotic disorders, such as schizophrenia, and persistent cognitive deficits.
• Cognitive Impairment:
  • Deficits in attention, memory, executive functions.
  • Persistent effects possible, especially with early, heavy use.
• Other Complications:
  • Cannabinoid Hyperemesis Syndrome (CHS): Cyclical nausea, vomiting, abdominal pain; relieved by hot showers.
  • Dependence and withdrawal symptoms.

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Cannabis Use Disorder: Management - Kicking the Habit

• Goal: Abstinence or harm reduction.
• Initial Approach: Screening (e.g., ASSIST, CUDIT-R) & Brief Intervention (BI).

• Psychosocial Therapies (First-line):

  • Motivational Enhancement Therapy (MET): Explores ambivalence, enhances motivation to change.
  • Cognitive Behavioral Therapy (CBT): Identifies triggers, develops coping skills.
  • Contingency Management (CM): Reinforces abstinence with tangible rewards.

  ⭐ Psychosocial interventions, particularly Motivational Enhancement Therapy (MET), Cognitive Behavioral Therapy (CBT), and Contingency Management (CM), are the cornerstones of Cannabis Use Disorder treatment.

• Pharmacotherapy:

  • No FDA-approved medications specifically for CUD.
  • Focus on treating co-occurring psychiatric disorders (e.g., depression, anxiety).
  • Short-term anxiolytics/hypnotics for severe withdrawal (cautiously).
  • N-acetylcysteine (NAC) & Gabapentin: Emerging evidence, not standard.

• Special Populations:

  • Adolescents: Family-based therapies, MET/CBT.
  • Pregnant women: Psychosocial interventions are primary; avoid cannabis due to risks to fetus.

• Relapse Prevention: Crucial component; ongoing support, coping strategies. 📌 HALT (Hungry, Angry, Lonely, Tired) as relapse triggers awareness.

High‑Yield Points - ⚡ Biggest Takeaways

• Cannabis Use Disorder (CUD): Problematic cannabis use causing significant impairment/distress.
• Key features: Tolerance, withdrawal, craving, and impaired control over use.
• Cannabis withdrawal: Irritability, anxiety, sleep issues, ↓appetite, restlessness.
• Amotivational syndrome: Associated with chronic heavy use, characterized by apathy and ↓ drive.
• Synthetic cannabinoids ("Spice", "K2"): Risk of severe, unpredictable effects, including psychosis.
• Treatment: Primarily psychosocial interventions (CBT, MET); limited role for pharmacotherapy.
• Risks: Respiratory issues (if smoked), potential trigger/worsening of psychotic disorders.