Cannabis Abuse
Disease Details
Family Health Simplified
- Description
- Cannabis abuse is a pattern of cannabis use leading to significant impairment or distress, including health issues, personal problems, and failure to fulfill responsibilities.
- Type
- Cannabis abuse is classified as a behavioral disorder. It does not follow a specific pattern of genetic transmission, as its development is influenced by a complex interplay of genetic, environmental, and social factors. While genetic predisposition can increase the risk, it is not inherited in a Mendelian fashion.
- Signs And Symptoms
- Cannabis use is sometimes comorbid for other mental health problems, such as mood and anxiety disorders, and discontinuing cannabis use is difficult for some users. Psychiatric comorbidities are often present in dependent cannabis users including a range of personality disorders.Based on annual survey data, some high school seniors who report smoking daily (nearly 7%, according to one study) may function at a lower rate in school than students that do not. The sedating and anxiolytic properties of tetrahydrocannabinol (THC) in some users might make the use of cannabis an attempt to self-medicate personality or psychiatric disorders.
- Prognosis
- Cannabis abuse, also known as cannabis use disorder, can have varying prognoses depending on the individual and the severity of the disorder. Some individuals may experience significant improvement with appropriate treatment, which can include behavioral therapy, counseling, and support groups. Early intervention typically leads to better outcomes. Long-term prognosis can be complicated if cannabis abuse co-occurs with other substance use disorders or mental health issues. Sustained abstinence and adherence to a treatment plan are key factors in a positive prognosis. Without treatment, individuals may experience persistent cognitive, emotional, and social impairments.
- Onset
- The onset of cannabis abuse can vary widely among individuals. It typically begins in adolescence or early adulthood, often linked to social or environmental factors. Repeated use over time, especially in the face of negative consequences, indicates the development of abuse.
- Prevalence
- Cannabis abuse, also referred to as cannabis use disorder, affects a significant portion of the population. Data suggest that approximately 30% of those who use cannabis may have some degree of cannabis use disorder. The prevalence is higher among young adults and adolescents, with rates ranging from 10% to 20% among those who use cannabis regularly.
- Epidemiology
- According to the 2022 National Survey on Drug Use and Health, cannabis is one of the most widely used drugs in the world. Research by the Pew Research Center from 2012 claims 42% of the US population have claimed to use cannabis at some point. According to the 2019 National Survey on Drug Use and Health, 46% of U.S. adults say they have ever used marijuana. An estimated 9% of those who use cannabis develop dependence.In the U.S., cannabis is the most commonly identified illicit substance used by people admitted to treatment facilities. Most of these people were referred there by the criminal justice system. Of admittees 16% either went on their own, or were referred by family or friends.Of Australians aged 14 years and over 34.8% have used cannabis one or more times in their life.In the European Union (data as available in 2018, information for individual countries was collected between 2012 and 2017), 26.3% of adults aged 15–64 used cannabis at least once in their lives, and 7.2% used cannabis in the last year. The highest prevalence of cannabis use among 15 to 64 years old in the EU was reported in France, with 41.4% having used cannabis at least once in their life, and 2.17% used cannabis daily or almost daily. Among young adults (15–34 years old), 14.1% used cannabis in the last year.Among adolescents (15–16 years old) in a European school based study (ESPAD), 16% of students have used cannabis at least once in their life, and 7% (boys: 8%, girls: 5%) of students had used cannabis in the last 30 days.Globally, 22.1 million people (0.3% of the worlds population) were estimated to have cannabis dependence.
- Intractability
- Cannabis abuse can be challenging to manage but is not considered intractable. With appropriate treatment, such as counseling, behavioral therapies, and support groups, many individuals can reduce or stop their use. Some may also benefit from medications to help manage withdrawal symptoms or co-occurring disorders.
- Disease Severity
- The severity of cannabis abuse can vary widely depending on frequency of use, individual susceptibility, and the presence of any co-occurring mental health disorders. While it may not lead to severe physical dependency like some other substances, chronic and heavy use can result in significant psychological dependence. Potential consequences include impairments in cognitive function, motivation, and daily functioning, and an increased risk of mental health issues such as anxiety, depression, and psychosis.
- Healthcare Professionals
- Disease Ontology ID - DOID:9505
- Pathophysiology
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Cannabis abuse primarily affects the brain's endocannabinoid system, which consists of neurotransmitters that bind to cannabinoid receptors. When cannabis is consumed, its active compound, tetrahydrocannabinol (THC), binds to these receptors in the brain and alters normal neurotransmitter release. This can disrupt various physiological processes, including mood regulation, cognition, and perception.
Repeated and heavy use of cannabis may lead to alterations in this system, potentially causing dependence and tolerance. Chronic exposure to high levels of THC can also affect the structure and function of certain brain regions, such as the prefrontal cortex and hippocampus, impairing memory, attention, and executive function. The neuroadaptive changes that occur with persistent use contribute to the compulsive drug-seeking behavior and difficulty in controlling usage that characterize cannabis abuse. - Carrier Status
- Cannabis abuse pertains to the excessive or compulsive use of cannabis, leading to negative health, social, and functional consequences. It is not caused by a transmissible agent, so there is no carrier status associated with it.
- Mechanism
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Cannabis abuse primarily involves the endocannabinoid system, which consists of cannabinoid receptors (CB1 and CB2), endogenous cannabinoids like anandamide and 2-arachidonoylglycerol (2-AG), and enzymes that synthesize and degrade these cannabinoids.
1. **Mechanism**:
- When cannabis is consumed, delta-9-tetrahydrocannabinol (THC), the primary psychoactive compound, binds to the CB1 receptors in the brain.
- Activation of CB1 receptors by THC results in the modulation of neurotransmitter release, particularly inhibiting the release of GABA and glutamate.
- This activation creates the psychoactive effects such as euphoria, altered perception, and relaxation.
2. **Molecular Mechanisms**:
- **Binding to Receptors**: THC binds to CB1 receptors located primarily in the brain and central nervous system, and to a lesser extent, CB2 receptors found in the immune system and peripheral tissues.
- **Signal Transduction**: Binding of THC to CB1 receptors activates G-protein coupled receptors, which in turn inhibit adenylate cyclase. This decreases cyclic AMP (cAMP) levels, leading to reduced activity of protein kinase A (PKA) and modulation of ion channels.
- **Neurotransmitter Modulation**: THC-induced CB1 receptor activation reduces the release of several neurotransmitters, including GABA, glutamate, dopamine, and serotonin. This can disrupt normal synaptic function and plasticity.
- **Gene Expression**: Chronic cannabis use can lead to changes in gene expression, including the upregulation or downregulation of genes associated with synaptic plasticity, neurotransmission, and neuroinflammation.
Repeated exposure to THC and activation of CB1 receptors can lead to the desensitization and downregulation of these receptors, contributing to tolerance and the brain's adaptation to the presence of THC. This mechanism underlies the development of cannabis dependence and the challenges associated with cannabis abuse. - Treatment
- Clinicians differentiate between casual users who have difficulty with drug screens, and daily heavy users, to a chronic user who uses multiple times a day. In the US, as of 2013, cannabis is the most commonly identified illicit substance used by people admitted to treatment facilities. Demand for treatment for cannabis use disorder increased internationally between 1995 and 2002. In the United States, the average adult who seeks treatment has consumed cannabis for over 10 years almost daily and has attempted to quit six or more times.Treatment options for cannabis dependence are far fewer than for opiate or alcohol dependence. Most treatment falls into the categories of psychological or psychotherapeutic, intervention, pharmacological intervention or treatment through peer support and environmental approaches. No medications have been found effective for cannabis dependence, but psychotherapeutic models hold promise. Screening and brief intervention sessions can be given in a variety of settings, particularly at doctor's offices, which is of importance as most cannabis users seeking help will do so from their general practitioner rather than a drug treatment service agency.The most commonly accessed forms of treatment in Australia are 12-step programmes, physicians, rehabilitation programmes, and detox services, with inpatient and outpatient services equally accessed. In the EU approximately 20% of all primary admissions and 29% of all new drug clients in 2005, had primary cannabis problems. And in all countries that reported data between 1999 and 2005 the number of people seeking treatment for cannabis use increased.
- Compassionate Use Treatment
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Cannabis abuse generally refers to the problematic use of cannabis that leads to significant impairment or distress. While there are no FDA-approved medications specifically for cannabis use disorder, certain off-label or experimental treatments are being explored:
1. **N-acetylcysteine (NAC)**: An antioxidant used in treating psychiatric disorders, including substance abuse, has shown some promise in reducing cannabis use, particularly in adolescents.
2. **Gabapentin**: A medication traditionally used for neuropathic pain and epilepsy, this has demonstrated potential in reducing cannabis withdrawal symptoms and usage.
3. **Drugs targeting the endocannabinoid system**: Rimonabant, a CB1 receptor antagonist, was researched for its effects on cannabinoid addiction, although it's not approved due to psychiatric side effects.
4. **Psychotherapy**: Cognitive-behavioral therapy (CBT) and motivational enhancement therapy (MET) are common non-pharmacological approaches often recommended for managing cannabis use disorder.
While these treatments show some promise, more research is needed to fully establish their efficacy and safety in treating cannabis abuse. - Lifestyle Recommendations
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For individuals dealing with cannabis abuse, the following lifestyle recommendations may be helpful:
1. **Seek Professional Help:** Engage with a healthcare provider, therapist, or a counselor specializing in addiction.
2. **Join Support Groups:** Participate in support groups like Marijuana Anonymous or other community-based recovery programs.
3. **Healthy Coping Mechanisms:** Develop and practice coping strategies such as exercise, meditation, or engaging in hobbies.
4. **Avoid Triggers:** Stay away from environments, people, and situations that may tempt the use of cannabis.
5. **Set Goals:** Focus on setting short-term and long-term recovery goals to maintain motivation.
6. **Educate Yourself:** Learn about the effects of cannabis abuse on mental and physical health to understand the importance of managing it.
7. **Monitor Progress:** Keep a journal to track usage patterns, feelings, and progress over time.
8. **Nutritional Health:** Maintain a balanced diet to support overall well-being during recovery.
9. **Stay Active:** Regular physical activity can improve mood and reduce cravings.
10. **Sleep Hygiene:** Ensure adequate rest and follow a consistent sleep schedule to enhance emotional and physical health.
These steps can assist in managing and overcoming cannabis abuse. - Medication
- As of 2020, there is no single medication that has been proven effective for treating cannabis use disorder; research is focused on three treatment approaches: agonist substitution, antagonist, and modulation of other neurotransmitter systems. More broadly, the goal of medication therapy for cannabis use disorder centers around targeting the stages of the addiction: acute intoxication/binge, withdrawal/negative affect, and preoccupation/anticipation.For the treatment of the withdrawal/negative affect symptom domain of cannabis use disorder, medications may work by alleviating restlessness, irritable or depressed mood, anxiety, and insomnia. Bupropion, which is a norepinephrine–dopamine reuptake inhibitor, has been studied for the treatment of withdrawal with largely poor results. Atomoxetine has also shown poor results, and is as a norepinephrine reuptake inhibitor, though it does increase the release of dopamine through downstream effects in the prefrontal cortex (an area of the brain responsible for planning complex tasks and behavior). Venlafaxine, a serotonin–norepinephrine reuptake inhibitor, has also been studied for cannabis use disorder, with the thought that the serotonergic component may be useful for the depressed mood or anxious dimensions of the withdrawal symptom domain. While venlafaxine has been shown to improve mood for people with cannabis use disorder, a clinical trial in this population actually found worse cannabis abstinence rates compared to placebo. It is worth noting that venlafaxine is sometimes poorly tolerated, and infrequent use or abrupt discontinuation of its use can lead to withdrawal symptoms from the medication itself, including irritability, dysphoria, and insomnia. It is possible that venlafaxine use actually exacerbated cannabis withdrawal symptoms, leading people to use more cannabis than placebo to alleviate their discomfort. Mirtazapine, which increases serotonin and norepinephrine, has also failed to improve abstinence rates in people with cannabis use disorder.People sometimes use cannabis to cope with their anxiety, and cannabis withdrawal can lead to symptoms of anxiety. Buspirone, a serotonin 1A receptor (5-HT1A) agonist, has shown limited efficacy for treating anxiety in people with cannabis use disorder, though there may be better efficacy in males than in females. Fluoxetine, a selective serotonin reuptake inhibitor, has failed to show efficacy in adolescents with both cannabis use disorder and depression. SSRIs are a class of antidepressant drugs that are also used for the treatment of anxiety disorders, such as generalized anxiety disorder. Vilazodone, which has both SSRI and 5-HT1A agonism properties, also failed to increase abstinence rates in people with cannabis use disorder.Studies of divalproex have found no significant benefit, though some studies have found mixed results. Baclofen, a GABAB receptor agonist and antispasmodic medication, has been found to reduce cravings but without a significant benefit towards preventing relapse or improving sleep. Zolpidem, a GABAA receptor agonist and "Z-hypnotic" medication, has shown some efficacy in treating insomnia due to cannabis withdrawal, though there is a potential for misuse. Entacapone was well tolerated and decreased cannabis cravings in a trial on a small number of patients. Topiramate, an antiepileptic drug, has shown mixed results in adolescents, reducing the volume of cannabis consumption without significantly increasing abstinence, with somewhat poor tolerability. Gabapentin, an indirect GABA modulator, has shown some preliminary benefit for reducing cravings and cannabis use.The agonist substitution approach is one that draws upon the analogy of the success of nicotine replacement therapy for nicotine addiction. Dronabinol, which is synthetic THC, has shown benefit in reducing cravings and other symptoms of withdrawal, though without preventing relapse or promoting abstinence. Combination therapy with dronabinol and the α2-adrenergic receptor agonist lofexidine have shown mixed results, with possible benefits towards reducing withdrawal symptoms. However, overall, the combination of dronabinol and lofexidine is likely not effective for the treatment of cannabis use disorder. Nabilone, a synthetic THC analogue, has shown benefits in reducing symptoms of withdrawal such as difficulty sleeping, and decreased overall cannabis use. Despite its psychoactive effects, the slower onset of action and longer duration of action of nabilone make it less likely to be abused than cannabis itself, which makes nabilone a promising harm reduction strategy for the treatment of cannabis use disorder. The combination of nabilone and zolpidem has been shown to decrease sleep-related and mood-related symptoms of cannabis withdrawal, in addition to decreasing cannabis use. Nabiximols, a combined THC and cannabidiol (CBD) product that is formulated as an oral (buccal) spray, has been shown to improve withdrawal symptoms without improving abstinence rates. Oral CBD has not shown efficacy in reducing the signs or symptoms of cannabis use, and likely has no benefit in cannabis use withdrawal symptoms. The CB1 receptor antagonist rimonabant has shown efficacy in reducing the effects of cannabis in users, but with a risk for serious psychiatric side effects.Naltrexone, a μ-opioid receptor antagonist, has shown mixed results for cannabis use disorder—both increasing the subjective effects of cannabis when given acutely, but potentially decreasing the overall use of cannabis with chronic administration. N-acetylcysteine (NAC) has shown some limited benefit in decreasing cannabis use in adolescents, though not with adults. Lithium, a mood stabilizer, has shown mixed results for treating symptoms of cannabis withdrawal, but is likely ineffective. Quetiapine, a second-generation antipsychotic, has been shown to treat cannabis withdrawal related insomnia and decreased appetite at the expense of exacerbating cravings. Oxytocin, a neuropeptide that the body produces, has shown some benefit in reducing the use of cannabis when administered intranasally in combination with motivational enhancement therapy sessions, though the treatment effect did not persist between sessions.CB1 antagonists such as rimonabant have been tested for utility in CUD.
- Repurposable Drugs
- Currently, there are no specific repurposable drugs that have been clinically validated and widely accepted for the treatment of cannabis abuse.
- Metabolites
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In the context of cannabis abuse, "metabolites" typically refer to the byproducts produced when the body breaks down cannabis. The primary metabolites of THC (the active ingredient in cannabis) are:
1. **11-Hydroxy-THC (11-OH-THC)**: An active metabolite that can produce psychoactive effects.
2. **11-Nor-9-carboxy-THC (THC-COOH)**: An inactive metabolite commonly tested for in drug screens.
These metabolites can be detected in various biological samples such as urine, blood, saliva, and hair. Quantifying these metabolites is often expressed in nanograms per milliliter (ng/mL). - Nutraceuticals
- Currently, there is limited evidence on the effectiveness of nutraceuticals specifically for addressing cannabis abuse. Nutraceuticals such as omega-3 fatty acids, vitamins, and minerals may offer general support for brain health and overall well-being, but they are not approved treatments for cannabis use disorder. Standard approaches to managing cannabis abuse typically involve behavioral therapies and, in some cases, medications under research. It is important to consult healthcare professionals for appropriate interventions.
- Peptides
- Cannabis abuse primarily affects neurochemical pathways rather than being directly associated with peptide levels. As for "nan," it seems to be a typographical error or refers to a non-applicable term in this context. If you meant "nanoparticles" or any other specific term, please clarify for a more precise answer.