Cannabis Related Disorders

Question 1

where are CB1 receptors found

Answer 1

primarily in brain and spinal cord but not around respiratory centers of CNS

Question 2

where are CB2 receptors found

Answer 2

mostly in immune system, mast cells, macrophages

Question 3

can THC cross the BBB or placenta

Answer 3

can cross both

Question 4

why does THC have such a long half life (up to several days to a week)

Answer 4

highly lipophilic, can accumulate in fat

Question 5

what is considered a “heavy” cannabis user

Answer 5

more than 3 joints per week

Question 6

how long might it take a heavy cannabis user to clear THC from fatty tissues including the brain

Answer 6

can take months, up to a year

Question 7

do more men or women have cannabis use disorder

Answer 7

2:1 men

Question 8

what age group has the highest incidence of cannabis use disorder

Answer 8

18-29–> 4.4%

Question 9

what is the heritability of cannabis use disorder

Answer 9

30-80%

*common genetic basis for teen substance use + conduct problems

Question 10

list psychological + environmental RFs for cannabis use disorder

Answer 10

hx conduct disorder or ASPD

externalizing and internalizing disorders during childhood/adolescence

youth with high behavioural disinhibition scores

adverse childhood

tobacco smoking

cannabis use among family

family hx SUD

ease of availability

Question 11

when does cannabis withdrawal start

Answer 11

1-3 days after cessation of cannabis

Question 12

when does cannabis withdrawal peak

Answer 12

within first week

Question 13

how long does cannabis withdrawal last

Answer 13

1-2 weeks

Question 14

how long might sleep difficulty due to cannabis withdrawal last

Answer 14

can last up to a month or more

Question 15

when is cannabis use disorder most common

Answer 15

teens/young adulthood

Question 16

early onset (before age 14) of cannabis use disorder is a ROBUST predictor of what other disorders

Answer 16

development of CUD, SUD, AUD as young adult

likely related to externalizing problems

Question 17

list physiological signs of cannabis intoxication

Answer 17

conjunctival injection

dry mouth

tachycardia–> can do 20-50bpm above baseline!!, this is amplified with alcohol use

increased appetite

sometimes orthostatic hypotension due to lower PVR

Question 18

list subjective/psychological signs of cannabis intoxication

Answer 18

high feeling, then euphoria, inappropriate laughter, grandiosity

sedation, lethargy, impaired judgment

difficulty with complex mental processes, impaired motor performance

distorted sensory perceptions

sense of time passing slowly

can also get dysphoria, anxiety, social withdrawal

Question 19

are cannabis withdrawal symptoms usually severe enough to require clinical attention

Answer 19

no

Question 20

list symptoms of cannabis withdrarwal

Answer 20

initially decreased appetite, insomnia

fatigue, yawning, difficulty concentrating

can then have rebound hypersomnia, increased appetite

Question 21

what is the prevalence of cannabis hyperemesis syndrome

Answer 21

up to 32%

Question 22

list the major features of cannabis hyperemesis syndrome

Answer 22

severe cyclical N/V

resolution with cannabis cessation

relief of symptoms with HOT SHOWERS or baths

abdo pain

daily use of cannabis

Question 23

how do you manage cannabis hyperemesis syndrome

Answer 23

complete abstinence from cannabis combined with supportive management

standard antiemetics to resolve N/V are NOT EFFECTIVE

limited evidence indicates some relief from LORAZEPAM and HALDOL as well as TOPICAL CAPSAICIN cream

Question 24

what syndrome can accompany cannabis use disorder

Answer 24

amotivation syndrome–> can mimic PDD

Question 25

those with a mental health disorder are how much more likely to have a cannabis use disorder than the general population

Answer 25

2-3x more likely

Question 26

is cannabis a gateway drug?

Answer 26

it seems so–> cocaine, opioids

higher rates of AUD, TUD, likely other SUDs

Question 27

in those seeking treatment for cannabis use disorder what % have another SUD

Answer 27

74%

–most common is alcohol, then cocaine, meth, opioids

Question 28

what is the most commonly comorbid personality disorder with cannabis use disorder

Answer 28

ASPD (then OCPD, paranoid)

Question 29

what is the most commonly comorbid psych disorder with cannabis use disorder

Answer 29

any anxiety disorder (24%)

MDD (11%)

bipolar (13%)

60% have an externalizing disorder like ADHD, conduct

Question 30

are there any meds approved for treatment of cannabis use disorder

Answer 30

no

Question 31

what meds may be helpful in treating cannabis use disorder

Answer 31

gabapentin–> possibly helpful, esp with withdrawal

NAC

naltrexone (equivocal results)

replacement theory is not great

Question 32

list the 3 most helpful primary psychosocial interventions for cannabis use disorder

Answer 32

CBT

motivation enhancement therapy

contingency management