A recent review article published in the New England Journal of Medicine by the University of Maryland School of Medicine (UMSOM) has shed light on the concerning rise in cannabis-related psychiatric conditions. The study, which focuses on the widespread use of cannabis and its increased potency, underscores the urgent need for doctors to screen for and treat cannabis use disorder.
According to the article, nearly one in five Americans aged 12 and older used cannabis in 2021. Alarmingly, over 16 million people met the criteria for cannabis use disorder as per the American Psychiatric Association’s Diagnostic and Statistical Manual of Health Disorders (DSM-5-TR). The disorder is particularly prevalent among young adults aged 18 to 25, with more than 14 percent affected.
David A. Gorelick, MD, PhD, a Professor of Psychiatry at UMSOM and the author of the review, highlights the widespread misconception about cannabis being a harmless substance. “There is a lot of misinformation about cannabis and its effects on psychological health,” he said. “Many assume this drug is safe with no side effects. It’s crucial for both physicians and the public to understand the addictive effects of cannabis and to recognize the signs and symptoms for proper diagnosis and treatment.”
Cannabis use disorder is characterized by problematic marijuana use, with symptoms like craving and inability to control its use despite negative consequences. The disorder is most prevalent among individuals who use cannabis more than four days a week. Other risk factors include having another substance use disorder or psychiatric condition.
Dr. Gorelick noted that nearly half of the individuals with cannabis use disorder also have another psychiatric condition, such as major depression, post-traumatic stress disorder, or generalized anxiety disorder. This co-morbidity underscores the importance of seeking appropriate psychiatric treatment.
Physical signs of cannabis use disorder can include yellowing of the fingertips and increased depression and anxiety while using cannabis. Diagnosis requires meeting two or more criteria outlined by the DSM-5-TR, such as poor performance at work or school due to cannabis use or experiencing withdrawal symptoms.
Dr. Gorelick’s review also aims to educate physicians on the health issues associated with cannabis use and to raise public awareness about cannabis use disorder. The paper highlighted other dangers of excessive cannabis use, including its contribution to 10 percent of all drug-related emergency room visits in the U.S. and a 30 to 40 percent increased risk of car accidents. Young adults aged 18 to 25 account for the highest rate of cannabis-related emergency department visits.
Mark T. Gladwin, MD, Dean of UMSOM, emphasized the need for research into the brain’s cannabinoid system and the development of therapies targeting these mechanisms. “Approximately one in ten people who use cannabis will become addicted, with the rate rising to one in six for those who start before age 18,” he said.
UMSOM is at the forefront of innovation in addiction medicine, recently establishing the Kahlert Institute for Addiction Medicine. The institute focuses on studying brain mechanisms underlying addiction and training a new generation of medical practitioners in addiction medicine.
Asaf Keller, PhD, Associate Director of the Kahlert Institute, spoke about the ongoing efforts to understand cannabis-related disorders and develop effective treatments. “There is still a lot we don’t understand about these conditions, including why some people experience cannabis-related disorders,” he said.
There are currently seven recognized disorders related to cannabis use, including cannabis-induced anxiety disorder, psychotic disorder, sleep disorder and delirium. Symptoms of these disorders often resemble those of non-cannabis-related counterpart disorders.
To diagnose cannabis use disorder, the U.S. Preventive Services Task Force recommends screening adolescents and adults in primary care settings. While the FDA has not approved any medication for treating cannabis use disorder, Cognitive Interactive Therapy (CBT) and Motivational Enhancement Therapy (MET) can help manage symptoms and reduce or stop cannabis use. Adolescents may benefit from family-based treatment options.
Despite the availability of therapy through telehealth services, barriers to treatment remain, including stigma around mental illness and addiction and a shortage of mental healthcare professionals, according to Gorelick.
This comprehensive study by UMSOM marks a crucial step in acknowledging and addressing the rising issue of cannabis use disorder, highlighting the need for increased awareness, research and accessible treatment options.