Cannabis Use Disorder

Question 1

What is the diagnostic criteria for cannabis use disorder?

Answer 1

a problematic pattern of cannabis use leading to clinically significant impairment or distress, as manifested by 2 or more of the following:
-cravings/strong desire to use
-using large amounts/long period
-desire to quit but unsuccessful efforts
-using in hazardous situations
-interpersonal or social problems
-withdrawing from activities
-failure to fulfill obligations
-continued used despite knowledge of problem
-tolerance
-withdrawal
-great deal of time spent obtaining/using/recovering

Question 2

What is a screening tool for cannabis use disorder?

Answer 2

Cannabis Use Disorder Identification Test (CUDIT-R)

Question 3

What are important scores to know from CUDIT-R?

Answer 3

8 or greater: indicate hazardous cannabis use
12 or greater: indicate possible CUD

Question 4

What are the acute psychological effects of cannabis?

Answer 4

inhalation:
-acute peak 5-10 mins
-effects last 2-4 h
ingestion:
-acute peak 1-4 h after admin
-effects last 6-8 h
negative acute effects:
-paranoia
-anxiety
-dry mouth
-impaired attention
-impaired short term memory
-drowsiness

Question 5

What are the chronic psychological effects of cannabis?

Answer 5

studies suggesting increased risk of psychotic disorders and schizophrenia

Question 6

What are the limitations of data on the psych effects of cannabis?

Answer 6

majority of data is observational, experimental studies needed
potential confounders difficult to address
questions that remain:
-effect size (dose response, potency ratios)
-causality
-differential effects of various cannabinoids

Question 7

Describe the toxicology of cannabis.

Answer 7

t1/2 of THC with infrequent use: 1.3 days
t1/2 of THC with frequent use: 5-13 days
heavy use of THC can be detectable up to 30 days in urine

Question 8

What is the treatment for cannabis use disorder?

Answer 8

acute supportive care
longer term psychological approaches
-CBT + motivational interviewing
symptomatic treatment
-benzos for anxiety
-antipsychotics for psychosis
no established pharmacotherapy for CUD
-negative trials for SSRI/SNRI/bupropion/buspirone/ATX/NAC
-maybe gabapentin: study found to decrease use
-naltrexone: controversial

Question 9

What is the role of cannabis replacement treatment?

Answer 9

dronabinol: synthetic cannabinoid
-decreased withdrawal sx and improved tx retention but not clinically significant
-further research needed
nabiximols: buccal spray of THC or CBD
-borderline SS for benefit
not typically used

Question 10

What are 10 recommendations to use cannabis more safely?

Answer 10

1. only way to avoid risks is not to use
2. delay using until later in life
3. choose low strenght, more CBD/less THC
4. dont use synthetic cannabis
5. most harm = smoking
6. if smoking dont hold breath/inhale deeply
7. limit use as much as possible
8. dont engage in activities after use
9. avoid if pregnant or psychosis hx
10. avoid combining the above