Recreational cannabinoid use: The hazards behind the “high”

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Applied Evidence

Recreational cannabinoid use: The hazards behind the “high”

J Fam Pract. 2016 November;65(11):770-773,778-779

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References

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Cannabis Use Disorder

About 9% of those who try cannabis develop Cannabis Use Disorder, which is characterized by continued use of the substance despite significant distress or impairment.⁵³ Cannabis Use Disorder is essentially an addiction. Primary risk factors include male gender, younger age at marijuana initiation, and personal or family history of other substance or psychiatric problems.⁵³

Although cannabis use often precedes use of other addiction-prone substances, it remains unclear if it is a “gateway” to the use of other illicit drugs.⁵⁴ Marijuana withdrawal is relatively minor and is comparable to that for tobacco.⁵⁵ While there are no known effective pharmacotherapies for discontinuing cannabis use, addiction therapy—including cognitive behavioral therapy and trigger management—is effective.⁵⁶

SIDEBAR
Cannabinoids: A diverse group of chemicalsCannabis, the genus name for 3 species of marijuana plant (sativa, indica, ruderalis), has come to mean any psychoactive part of the plant and is used interchangeably with “marijuana.” There are at least 85 different cannabinoids in the native plant.⁷

Cannabinoids are a diverse group of chemicals that have activity at cannabinoid receptors. Δ-9-tetrahydrocannabinol (THC), a partial agonist of the CB1 receptor, is the primary psychoactive component and is found in larger quantities in Cannabis sativa, which is preferred by non-medical users. Cannabidiol (CBD), a weak partial CB1 antagonist, exhibits few, if any, psychotropic properties and is more plentiful in Cannabis indica.

Synthetic cannabinioids are a heterogeneous group of manufactured drugs that are full CB1 agonists and that are more potent than THC, yet are often assumed to be safe by users. Typically, they are dissolved in solvents, sprayed onto inert plant materials, and marketed as herbal products like “K2” and “spice.”

So how should the evidence inform your care?

Screen all patients for use of cannabinoids and other addiction-prone substances.⁵⁷ Follow any affirmative answers to your questions about cannabis use by asking about potential negative consequences of use. For example, ask patients:

How often during the past 6 months did you find that you were unable to stop using cannabis once you started?
How often during the past 6 months did you fail to do what was expected of you because of using cannabis? (For more questions, see the Cannabis Use Disorder Identification Test available at: http://www.otago.ac.nz/nationaladdictioncentre/pdfs/cudit-r.pdf.)