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The widespread use of cannabis (marijuana) and its increased potency are associated with a rise in cannabis-related psychiatric conditions, according to a new University of Maryland School of Medicine (UMSOM) review article that was recently published in the New England Journal of Medicine. It highlights the urgent need for doctors to screen for and treat patients who are experiencing symptoms of cannabis use disorder, which means they are experiencing significant problems from their use of the drug.

Nearly one in five Americans ages 12 and older used cannabis in 2021, according to the article, and more than 16 million met the criteria for cannabis use disorder as outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Health Disorders (DSM-5-TR). Young adults ages 18 to 25 are disproportionately affected. The review found more than 14 percent of those in this age group had cannabis use disorder.

Misconceptions and Risks of Cannabis Use

Cannabis use disorder is defined as problematic marijuana use. Symptoms include craving the drug and failing to control its use despite experiencing negative side effects like problems at work or school. It is most prevalent in people who use cannabis more than four days a week. While the primary risk factors are the frequency and duration of cannabis use, having another substance use disorder or other psychiatric condition also increases the likelihood of the diagnosis.

Psychiatric Conditions and Physical Symptoms

Almost half of people with cannabis use disorder have another psychiatric condition such as major depression, post-traumatic stress disorder, or generalized anxiety disorder. Physical signs and symptoms of cannabis use disorder can range from yellowing of the fingertips to increased depression and anxiety while using cannabis. Patients must meet two or more criteria for cannabis use disorder as outlined by the DSM-5-TR. These include doing poorly at school or work or missing important family obligations due to cannabis use. Experiencing withdrawal symptoms or cravings for cannabis are other symptoms.

Educational Efforts and Public Awareness

Cannabis use accounts for 10 percent of all drug-related emergency room visits in the U.S. and is associated with a 30 to 40 percent increased risk of car accidents. In 2022, 18 to 25-year-olds accounted for the highest rate of cannabis-related emergency department visits.

Addiction Research and Potential Therapies

A key part of ongoing research is to drive innovation in the field of addiction medicine, and to learn more about neurological differences in the brain that make some people more susceptible to drug abuse and addiction. The University of Maryland recently opened the Kahlert Institute for Addiction Medicine, which brings together leading addiction experts to collaborate on studying the brain mechanisms underlying addiction and to train a new generation of medical practitioners in the field of addiction medicine.

Understanding and Treating Cannabis-Related Disorders

There are currently seven recognized disorders related to cannabis use. Some include cannabis-induced anxiety disorder, cannabis-induced psychotic disorder, cannabis-induced sleep disorder, and cannabis-induced delirium, which manifests as hyperactivity, agitation, and disorientation with hallucinations. Often, their symptoms can closely resemble those of their non-cannabis-related counterpart disorders.

Screening and Treatment Options

To properly diagnosis patients for cannabis use disorder, the U.S. Preventive Services Task Force recommends that adolescents and adults be screened 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. While the FDA has not approved any medication as effective for the treatment of cannabis use disorder, certain therapies can help those with cannabis use disorder manage symptoms and reduce or stop their cannabis use. These include Cognitive Interactive Therapy (CBT) and Motivational Enhancement Therapy (MET), which help patients manage thoughts and behaviors that trigger their use of cannabis and better understand why they use cannabis. Adolescents may gain additional benefits from family-based treatment options.

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