Cannabis use disorder
Alerts and Notices
Synopsis
Onset of effects occurs within minutes of inhalation and 1-4 hours of ingestion, and effects may last for hours. Effects in adults and adolescents may include a euphoria or "high," perceptual changes, and stimulated appetite as well as impaired attention, concentration, judgment, motor coordination, and short-term memory. Xerostomia, conjunctival injection, nystagmus, dysarthria, tachycardia, tachypnea, anxiety, and sleep disturbance may occur as well as hypertension or orthostatic hypotension in older adults.
It has been reported that the medicinal benefits of marijuana include sedative qualities and mood, appetite, nausea, anxiety, and pain management. Symptomatic relief for movement dysfunction disorders, multiple sclerosis, epileptic seizures, chronic pain, and adverse effects of cancer treatments has been reported.
The legal status of cannabis varies internationally, often achieving legal status first for medical usage, while maintaining illegal status for recreational use. Cannabis is still identified as a Schedule I substance under the US Controlled Substances Act, making it federally illegal to possess, despite its legalization in some states for medical and/or recreational use.
Pediatric Patient Considerations
Children who have ingested, smoked, or inhaled vapors of marijuana have more pronounced and variable findings including drowsiness, irritability, nausea, vomiting, euphoria, behavioral changes, nystagmus, ataxia, conjunctival injection, dysarthria, tachycardia, hypertension, bradycardia, miosis, and dilated pupils.
Severe cannabis overdose in children may lead to the life-threatening state of depressed respiration, central nervous system depression, hyperkinesis, apnea, seizure, lethargy, and deep coma.
Cannabis Use Disorder
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) combines the former concepts of cannabis abuse and cannabis dependence into a single diagnostic concept of cannabis use disorder, which refers to the habitual use of cannabis with behavioral and psychiatric impact over time. The condition can range from mild to severe. Diagnosis is based on the number of behaviors or conditions in the DSM-5 criteria list that are present in the cannabis user. These include a tendency toward increasing quantities, urges, craving, or time spent on cannabis activities; failure to stop using; interference with work, home, school, or previously enjoyed activities; awareness of and involvement in risky behaviors; and impaired personal relationships related to cannabis use. The individual may experience a growing tolerance and onset of withdrawal symptoms.
Cannabis use disorder is found to be associated with other comorbidities such as tobacco use and mood, anxiety, personality and psychotic disorders.
Cannabis Withdrawal
Adverse psychological and physical effects of cessation of cannabis use can occur following long-term use. Symptoms may be mood related (irritability, moodiness, depression, anxiety, nervousness, anger, aggression), gastrointestinal (abdominal pain, a feeling of nausea, decreased appetite), related to sleep disturbance, and/or physiologic (shakes, sweating, chills).
Other Complications
Cannabis use on its own is not associated with high morbidity and mortality relative to other substances of abuse; more severe effects and complications are seen when cannabis is combined with alcohol or other drugs. Inhalation of cannabis can exacerbate asthma and emphysema.
Studies have not shown significant fetal harm during pregnancy unless combined with smoking and other drugs; however, professional guidelines continue to advise against cannabis use during pregnancy and lactation due to unknown potential for neurodevelopmental impairment. Cannabis use may interfere with certain hormonal processes and suppress lactation or reduce sperm count.
Cannabinoid hyperemesis syndrome is a rare but severe complication involving episodic intractable vomiting, abdominal pain, and nausea.
E-cigarette or vaping product use-associated lung injury (EVALI) is a potentially life-threatening vaping-related condition thought to be associated with use of THC products containing the additive vitamin E acetate, which may impair lung function.
In early 2018, the Army Public Health Center released a public health alert warning that vaping products marketed as cannabidiol, also known as CBD oil, often contain synthetic cannabinoids, concentrated THC, and/or other hazardous compounds that may cause adverse health effects such as headache, nausea / vomiting, palpitations, dizziness / disorientation, and seizures. See synthetic cannabinoid adverse reaction.
Codes
ICD10CM:F12.20 – Cannabis dependence, uncomplicated
SNOMEDCT:
85005007 – Cannabis dependence
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Substance intoxication — stimulants, alcohol (see alcohol use disorder), hallucinogen use
- Brief psychotic disorder
- Anxiety disorder
- Panic disorder
- Primary hypersomnia
- Substance-induced mood disorder
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:10/17/2019
Last Updated:11/17/2019
Last Updated:11/17/2019