Cannabis Addiction

Cannabis is the active substance in marijuana, also commonly referred to as weed, pot, grass, bud, herb, ganja and mary jane. It is derived from dried leaves, flowers, stems and seeds of Cannabis sativa, which contains the psychoactive chemical delta-9-tetrahydrocannabinol (THC), as well as related chemicals. Marijuana is among the most commonly used substances in the United States and usually smoked in a rolled joint, blunt or pipe. It may also be consumed as an edible or with a vape pen.

THC rapidly enters the bloodstream from the lungs and is transported to the brain where mind-altering effects take place. Addictive properties of cannabis are still present when THC is consumed as an edible or with a vaping device. Regardless of the route of exposure, THC exerts powerful effects on the brain’s cannabinoid receptors and can harm brain development and function within days of first exposure.

Cannabis use results in hyperactivation of the endocannabinoid system, producing a variety of effects such as altered perceptions in mood, impaired coordination, difficulty with thinking and preserving problem, learning disability, memory loss and decreased appetite. Research has shown that marijuana is a gateway drug that often leads to serious substance use and exacerbates problems in daily life that most people manage without difficulty. Chronic daily users often report fatigue, relationship problems, poor academic performance, inability to perform optimally at work and lack of professional achievement.

Marijuana use can lead to development of problem use, known as cannabis use disorder, which takes the form of addiction in severe cases. About 30% of people who use marijuana may have some degree of cannabis use disorder. People who begin using marijuana before age 18 are four to seven times more likely to develop cannabis use disorder than adults. Cannabis use disorders are often associated with chemical dependence, in which a person experiences withdrawal symptoms when not taking the drug. Those who use marijuana frequently report irritability, mood disturbances, insomnia, decreased appetite, cravings, restlessness, and physical discomfort that peaks within the first week after quitting and last two weeks. Marijuana dependence results from the brain’s adaptation to large amounts of the drug by reducing production of and sensitivity to its own endocannabinoid neurotransmitters.

Cannabis use disorder appears similar to other substance use disorders, although long-term outcomes may be less severe. Patients seeking treatment for cannabis use disorder frequently report daily or almost daily use for more than 10 years and have attempted to quit more than six times. These patients also tend to suffer from other psychiatric disorders such as anxiety, depression, PTSD or bipolar disorder. They may report occasional or regular use of other substances, such as cocaine or alcohol. Effective treatment of co-existing mental health disorders usually involves medical management and behavioral therapies may help reduce marijuana use, particularly among with a history of heavy use and chronic mental disorders.

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Cannabis use disorder is characterized by continued use of the substance despite negative consequences. Estimates of the number of people addicted to marijuana are debatable, because epidemiological studies of substance use often use dependence as a proxy for addiction. About 10% of people who use marijuana will become dependent on it, rising to about 17% in those whose start using cannabis as a teenager. In 2015, about four million people in the United States met diagnostic criteria for cannabis use disorder and 138,000 were treated for their addiction.

Fortunately, effects of chronic daily marijuana use may be reversible with prompt diagnosis and timely intervention. We offer several treatments that may help people who are dependent on cannabis. Effective treatment may include mirtazapine, naltrexone, nicotinamide adenine dinucleotide and N-acetylcysteine.

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The following behavioral therapies show promise in treating cannabis use disorder:

• Cognitive-behavioral therapy is psychotherapy that educates people on strategies that identify and correct problematic behaviors to enhance self-control, stop drug use, and approach a range of other problems that tend to occur with them.

• Contingency management is therapeutic approach based on monitoring of target behavior and employment or removal of tangible rewards when target behavior occurs or does not occur.

• Motivational enhancement therapy is a systematic form of intervention designed to produce internally motivated change. Therapy does not attempt to treat the person, but instead mobilize internal resources that promote change and engagement in treatment.

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The FDA has not approved medications for the treatment of cannabis use disorder, but research is active in the treatment of cannabis addiction. Because insomnia is prominent in marijuana withdrawal, studies examining effectiveness of medications that aid in sleep are currently in progress. The sleep aid zolpidem, an anti-anxiety/anti-stress medication called buspirone, and an anti-epileptic drug called gabapentin may improve sleep and executive function in patients with cannabis use disorder.