Understanding Cannabis Use Disorder

Addiction Medicine Physicians Heather Bell, MD, FAAFP, FASAM, and Kurt DeVine, MD, FASAM, answer frequently asked questions about cannabis.

According to a 2019 study from the Centers for Disease Control, 18 percent of Americans had used cannabis, otherwise known as marijuana, in the previous 12 months. The current discussions and debates that appear in the news across the country often lead to a perception that cannabis is safe. With so much risk known about fentanyl and methamphetamine, and overdose statistics being highlighted in society, cannabis is often not thought of as an addictive substance. However, cannabis use disorder can create negative physical and emotional outcomes.

According to the 2020 National Survey on Drug Use and Health, among people aged 12 or older, approximately 14.2 million people had a cannabis use disorder within the previous 12 months. Today, only 20 percent of high school students believe there is any risk to using cannabis.

Q: Is cannabis (marijuana) safe?

Dr. Devine: When we think about addiction, it is also important to look closely at genetics. While one person may try cannabis once and never again, another person might have a genetic predisposition to addiction and decide that they want to use it forever. The reward system in everyone’s brain is different and how any drug impacts an individual varies. Studies show that a child of a parent with any type of use disorder is eight times more likely to develop a use disorder including a cannabis use disorder.

Q: Is cannabis more potent now than it used to be?

Dr. Bell: In the 1960s, the THC level, which is the psychoactive part of cannabis, was three to four percent. Today those levels can be as high as 20 to 50 percent. For those with emotional disorders, this can further enhance their distress.

Q: Is using cannabis for relaxation effective?

Dr. DeVine: The fact is that even mild use can increase feelings of anxiety and paranoia which creates a cycle that can be very scary for an individual.

Q: What is cannabis use disorder?

Dr. Bell: Cannabis use disorder is diagnosed using the same criteria as for other use disorders such as opioid use disorder and alcohol use disorder. Many of the criteria include using a substance, like cannabis, despite negative impacts in one's life such as absenteeism, changes in personal relationships, as well as withdrawal symptoms. In addition, it can impact brain structure and function so that the person using cannabis starts to believe that other drugs such as opioids do not seem so bad.

Q: What are the signs of cannabis use disorder?

Dr. DeVine: The warning signs of cannabis use include:

• Anxiety
• Apathy
• Lethargy
• Paranoia
• Absenteeism
• Poor Performance
• Excessive Vomiting
• Delusions

Dr. Bell: When people think about drug treatment they often associate it with heroin or methamphetamine use. However, it is important that people know that there is support for those who want to stop using cannabis. Paying attention to the signs and symptoms of cannabis use disorder can help you or a loved one get the care needed to live a healthier and happier life.

Learn more about Addiction Medicine services available through CentraCare and Carris Health.