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Cannabis Abuse

Cannabis abuse is the misuse of the drug cannabis, which is derived from the Cannabis sativa Linnaeus plant. It is sought out for its effects of relieving anxiety and producing euphoria. In the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), cannabis abuse is part of cannabis use disorder.


Presentation

In the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), cannabis abuse constitutes one part of cannabis use disorder (CUD). The subsequent component of CUD is cannabis dependence. There are certain criteria used to diagnose the disorder, and these incorporate both the acute and chronic effects of cannabis use.

A mental status examination (MSE) should be carried out, as cannabis use alters mentation. There are specific aspects of mental function that are typically affected. These include mood, affect, thoughts, and cognition. Mood and affect manifestations differ acutely and chronically. In acute intoxication, patients may display a relaxed or euphoric mood, excessive laughter, and congruent affect. In chronic cases, the mood may be negative, for example, depressed, irritable, anhedonic, suicidal or homicidal. The affect is often restricted. Thought and perceptual disturbances include loosening of associations, and in some cases, hallucinations and delusions. Cannabis abuse can also lead to reversible cognitive impairment, compromising both memory and concentration [1] [2]. Furthermore, individuals often demonstrate a decreased interest in daily activities and a low level of motivation.

The hallmark signs of acute cannabis use, appearing hours after smoking, are redness of the eyes, dry mouth, and increased appetite [3]. In addition, tachycardia is also common. Other physical signs and symptoms include visual disturbances, sweating, headaches, and impaired motor abilities. Psychiatric effects include anxiety, paranoia, labile mood, forgetfulness, poor concentration, and psychotic features. Symptoms disappear after 2 to 3 hours.

Cannabis abuse may interfere with various aspects of life, such as social interactions and financial stability. It is often used by drug abusers as a second drug, in combination with other drugs [4].

The complications of cannabis abuse include the worsening of pre-existing psychiatric disorders, as well as the occurrence of new psychotic disorders, such as schizophrenia. The risk of schizophrenia is magnified with earlier onset of use, especially before the age of 15 years [5]. Further, depression and dependence are recognized complications of cannabis use [6]. The latter particularly poses a challenge to treatment [7]. Moreover, there is an increased lifetime risk of both depression and anxiety disorders in users. Cannabis dependence can lead to withdrawal symptoms, but these are usually less severe in comparison to various drugs of abuse [8]. This is more commonly seen in long-term users [8].

Systemically, it has been shown that there is temporary damage to the respiratory system, that resolves upon cessation of smoking cannabis [9]. There is, however, no confirmed link between cannabis use and acquiring chronic obstructive pulmonary disease (COPD) or lung cancer.

Pathologist
  • Pathologists said there was nothing wrong with her vital organs. Her inquest heard that Gemma, from Bournemouth, smoked half a joint a night. BNPS Her mum Kim Furness told the hearing: “For years she smoked it every day.[thesun.co.uk]
Throat Irritation
  • Throat irritation. Abdominal pain (upper), oral mucosal discolouration, oral mucosal disorder, oral mucosal exfoliation, stomatitis, tooth discolouration. Application site irritation.[patient.info]
Overeating
  • Abuse did not increase significantly over a 1-year period. Cannabis abusers were found to be more often polydrug abusers than NCAs.[ncbi.nlm.nih.gov]
  • Overdose deaths involving opioid analgesics have increased dramatically over the past decade.[norml.org]
  • Around 9% of users become addicted, although some studies estimate that over 50% of users have "impaired control" over their use of cannabis. Of the 70 million Americans estimated to have tried the drug, around two million use it daily.[thegooddrugsguide.com]
Increased Appetite
  • The hallmark signs of acute cannabis use, appearing hours after smoking, are redness of the eyes, dry mouth, and increased appetite. In addition, tachycardia is also common.[symptoma.com]
  • They treat nausea caused by chemotherapy and increase appetite in patients who have severe weight loss from HIV/AIDS. Scientists are doing more research with marijuana and its ingredients to treat many diseases and conditions.[icdlist.com]
  • Signs of cannabis use include: Increased appetite Lack of motivation Paranoia Lack of concern for personal safety Inability to express thoughts/feelings The first change, increased appetite, can take several forms.[crehab.org]
  • Palpitations Impairment of working memory Impairment of short-term memory Impairment of concentration More rapid breathing Talkativeness Drowsiness Loss of inhibitions Decreased nausea Increased appetite Loss of co-ordination Anxiety and paranoia Dryness[castlecraig.co.uk]
Recurrent Vomiting
  • In this case report, we describe a twenty-two year-old-male with a history of chronic cannabis abuse presenting with recurrent vomiting, intense nausea and abdominal pain.[ncbi.nlm.nih.gov]
Tachycardia
  • In addition, tachycardia is also common. Other physical signs and symptoms include visual disturbances, sweating, headaches, and impaired motor abilities.[symptoma.com]
  • Use with caution in patients with pre-existing heart disease, arrhythmias, cardiac failure, poorly controlled hypertension, bradycardia, tachycardia and postural hypotension.[patient.info]
  • "In some cases, reported side effects of THC include elation, anxiety, tachycardia, short-term memory recall issues, sedation, relaxation, pain-relief and many more," said A.J.[livescience.com]
Photophobia
  • Its symptoms consisted of: "yawning, anorexia, piloerection, irritability, tremors and photophobia" (Jones and Benowtiz, 1976).[health.gov.au]
Red Eye
  • Extensive research has shown that smoking marijuana can lead to some physical and psychological consequences such as: Changes in appetite Mood swings Red eyes Sleep disturbances Increased heart rate Difficulty concentrating Memory problems Dry mouth A[addictions.com]
Delusion
  • Delusions in the pair ceased quickly and a return to cohabitation did not result in relapse in the absence of cannabis abuse.[ncbi.nlm.nih.gov]
  • Thought and perceptual disturbances include loosening of associations, and in some cases, hallucinations and delusions. Cannabis abuse can also lead to reversible cognitive impairment, compromising both memory and concentration.[symptoma.com]
Fear
  • After the couple were separated the wife feared that she would be killed and assaulted her child and mother. Delusions in the pair ceased quickly and a return to cohabitation did not result in relapse in the absence of cannabis abuse.[ncbi.nlm.nih.gov]
  • But fears that she had suffered a cardiac arrest triggered by the drug could not be proved. Pathologists said there was nothing wrong with her vital organs. Her inquest heard that Gemma, from Bournemouth, smoked half a joint a night.[thesun.co.uk]
  • New phobias, fears or avoidances should be seen as a possible warning sign of drug abuse or addiction. Lack of concern for personal safety is a common theme with those who abuse drugs.[crehab.org]
  • When monitoring for symptoms of weed use, there may be reactions of anxiety, fear or panic, especially if they are new to the drug or taking it in an unsettling location.[narconon.org]
  • Cannabis Use Disorder and Social Anxiety Mental health professionals use the term social anxiety to refer to unusually strong feelings of dread or fear that arise in common social situations.[lucidatreatment.com]
Depersonalization
  • A. ( 1986 ) Prolonged depersonalization following cannabis abuse. British Journal of Addiction, 81, 140 – 142. Linszman, D. H., Dingemans, P. M. & Lenior, M. E. ( 1994 ) Cannabis abuse and the course of recent-onset schizophrenic disorders.[cambridge.org]
  • A. ( 1986 ) Prolonged depersonalization following cannabis abuse . British Journal of Addiction , 81 , 140 – 142 . Linszman , D. H. , Dingemans , P. M. & Lenior , M. E. ( 1994 ) Cannabis abuse and the course of recent-onset schizophrenic disorders .[doi.org]
  • Panic attacks or acute anxiety may occur, and SCHIZOPHRENIA, MANIA, DEPERSONALIZATION or confusional psychoses have been precipitated. Persistent heavy users may become apathetic and show loss of interest and concern (amotivational syndrome).[medical-dictionary.thefreedictionary.com]
Anhedonia
  • In particular, these participants were more likely to have experienced suicidal ideation and anhedonia during the follow-up period.[ncbi.nlm.nih.gov]
  • Individuals who regularly use cannabis often report physical and mental lethargy and an inability to experience pleasure when not intoxicated (known as "anhedonia").[minddisorders.com]
  • Cross-sectional studies have attempted to look at the types of symptoms that might be elicited by marijuana: positive (perceptual anomalies, magical or paranoid ideation), and negative (asociality, anhedonia) in non-clinical samples.[primarypsychiatry.com]
  • These further factors identified in cross-sectional studies may affect the likelihood of developing dependence, for instance, trait anxiety, physical anhedonia, borderline personality disorder, psychological distress, avoidant coping, suicidal ideation[karger.com]
Euphoric Mood
  • In acute intoxication, patients may display a relaxed or euphoric mood, excessive laughter, and congruent affect. In chronic cases, the mood may be negative, for example, depressed, irritable, anhedonic, suicidal or homicidal.[symptoma.com]
  • Depression, disorientation, dissociation, euphoric mood. Amnesia, balance disorder, disturbance in attention, dysarthria, dysgeusia, lethargy, memory impairment somnolence. Blurred vision. Vertigo.[patient.info]
Sexual Dysfunction
  • dysfunction and reproductive problems, including irregular sperm and lowered sperm count in men and menstrual and ovulatory disruption in women Weakening of the immune system Increased risk of cancer and lung damage Increased blood pressure and risk[cesar.umd.edu]
  • The association of sexual dysfunction and substance use among a community epidemiological sample. Arch Sex Behav. 2004;33:55–63. PubMed Google Scholar 115.• Simonetto DA, Oxentenko AS, Herman ML, et al.[doi.org]
Insomnia
  • Heavy users of either gender risk well-documented harms such as mental illness, insomnia and attention problems, the Australian Medical Association warns.[smh.com.au]
  • Withdrawal Symptoms and Weed Addiction If you are a regular cannabis smoker (every day) and you stop smoking, you will experience some of the following withdrawal symptoms: restlessness, irritability, mild agitation, insomnia, nausea, sleep disturbance[thegooddrugsguide.com]
Agitation
  • Withdrawal Symptoms and Weed Addiction If you are a regular cannabis smoker (every day) and you stop smoking, you will experience some of the following withdrawal symptoms: restlessness, irritability, mild agitation, insomnia, nausea, sleep disturbance[thegooddrugsguide.com]
  • You may have more than one of the following: Decreased appetite and weight loss Night sweats and trouble sleeping Craving for cannabis Irritability Feeling agitated, anxious, or restless Depressed or negative mood How is cannabis abuse diagnosed and treated[drugs.com]
  • Cannabis Withdrawal Symptoms of withdrawal from cannabis include agitation, insomnia, irritability; nausea, sweating, tremors, and weight loss. The most common cannabis withdrawal symptom is low-grade anxiety.[treatment4addiction.com]
Lethargy
  • Stealing/lying/valuables going missing Increased risk to self and others Low motivation Anxiety and depression Paranoia Psychosis – hearing voices, hallucinating Physical signs your teenager may be using drugs or alcohol Bloodshot eyes Tiredness and lethargy[clinical-partners.co.uk]
  • Amnesia, balance disorder, disturbance in attention, dysarthria, dysgeusia, lethargy, memory impairment somnolence. Blurred vision. Vertigo.[patient.info]
  • Individuals who regularly use cannabis often report physical and mental lethargy and an inability to experience pleasure when not intoxicated (known as "anhedonia").[minddisorders.com]
  • Laughter and glee when it is not warranted Euphoria Strongly increased appetite for snack foods or sweets Foggy, slow memory Artificially increased tendency to chatter or be sociable Lowered inhibitions Impaired judgment Dizziness Sedation, slow movement Lethargy[narconon.org]
Ataxia
  • Ataxia and shaking in a 2-year-old girl: acute marijuana intoxication presenting as seizure. Pediatr Emerg Care. 2005;21:527–8. PubMed Google Scholar 98. Lozsadi DA, Forster A, Fletcher NA. Cannabis-induced propriospinal myoclonus.[doi.org]
Dysarthria
  • Amnesia, balance disorder, disturbance in attention, dysarthria, dysgeusia, lethargy, memory impairment somnolence. Blurred vision. Vertigo.[patient.info]

Workup

Cannabis abuse, as part of cannabis use disorder, is categorized into mild, moderate, and severe. The diagnostic procedures include a physical examination as well as an MSE. The DSM-5 definition and criteria for cannabis use disorder stipulate that an individual must have clinically significant impairment of functioning in two or more areas, for at least one year. The list of criteria includes: taking increasingly large amounts of the drug, cravings, strained interpersonal relationships, a significant amount of time dedicated to use of the drug, tolerance, development of dependence, and the occurrence of withdrawal symptoms upon withdrawal of the drug.

Treatment

  • Despite that, only a minority seek assistance from a health professional, but the demand for treatment is now increasing internationally. Trials of treatment have been published but to our knowledge, there is no published systematic review .[ncbi.nlm.nih.gov]
  • The approach to treatment has been, historically, rooted in adult treatment approaches.[breakingthecycles.com]
  • The effectiveness of a treatment program specific for cannabis abuse (cognitive behavioral treatment pharmacological treatment) compared to standard treatment (pharmacological treatment psychoeducation) in patients with first episodes psychosis (FEP)[clinicaltrials.gov]

Prognosis

  • […] impact both in the acute and advanced stages of these conditions. 2,4,35 Prevention strategies in primary care, integrated treatment efforts, and the performance of longitudinal studies should be encouraged in order to gather more evidence and improve prognosis[scielo.br]
  • Prognosis According to the DSM-IV-TR, cannabis dependence and abuse tend to develop over a period of time. It may, however, develop more rapidly among young people with other emotional problems.[minddisorders.com]

Etiology

  • Our patient has lead us to conclude that in patients seen for chronic severe vomiting and abdominal pain which has no obvious structural or chemical etiology and which is accompanied by compulsive showering and/or bathing behavior a diagnosis of cyclic[ncbi.nlm.nih.gov]
  • Thus, researchers have advocated for the integration of the cannabinoid system into the current etiological hypotheses of schizophrenia. 2,20 2.[scielo.br]
  • The issue of causality is a difficult one to answer when it comes to conditions such as psychosis which can have multiple etiologies.[primarypsychiatry.com]
  • Withdrawal symptoms were measured with greater confidence in their underlying etiology, as compared to ambiguity in the outpatient setting as a result of less controlled factors.[doi.org]

Epidemiology

  • The present study utilizes data on criteria for cannabis abuse and dependence from a large, nationally representative sample (National Epidemiological Survey on Alcohol and Related Conditions) of 8172 lifetime cannabis users to investigate whether gender[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • RATIONALE/OBJECTIVES: There is a high prevalence of substance use disorder (SUD) in first-episode schizophrenia (SZ), but its contribution to the underlying SZ pathophysiology remains unclear.[ncbi.nlm.nih.gov]
  • Pathophysiology Cannabis can be smoked or ingested - eg, herbal tea, butter paste. When cannabis is ingested it produces cannabinoids which results in its psychological and physical effects. The most active of these is tetrahydrocannabinol (THC).[patient.info]
  • Rui Rodrigues, Diogo Lourenço, Sara Paulo, Joana Mateus, Miguel Ferreira, Francisco Mouro, João Moreira, Filipa Ribeiro, Ana Sebastião and Sara Xapelli, Cannabinoid Actions on Neural Stem Cells: Implications for Pathophysiology, Molecules, 10.3390/molecules24071350[oadoi.org]

Prevention

  • Understanding developmental pathways by which maltreatment experiences increase risk for substance abuse and dependence symptoms in youth has far-reaching implications for the treatment and prevention of substance use disorders.[ncbi.nlm.nih.gov]

References

Article

  1. Sharma P, Murthy P, Bharath MM. Chemistry, metabolism, and toxicology of cannabis: clinical implications. Iran J Psychiatry. 2012;7(4):149-156.
  2. Rabin RA, Zakzanis KK, Daskalakis ZJ, George TP. Effects of cannabis use status on cognitive function, in males with schizophrenia. Psychiatry Res. 2013;206(2-3):158-165.
  3. Saugy M, Avois L, Saudan C, et al. Cannabis and sport. Br J Sports Med. 2006;40(Suppl 1):i13-i15.
  4. Epstein DH, Preston KL. Review Does cannabis use predict poor outcome for heroin-dependent patients on maintenance treatment? Past findings and more evidence against. Addiction. 2003;98(3):269-279.
  5. Evins AE, Green AI, Kane JM, Murray RM. Does using marijuana increase the risk for developing schizophrenia? J Clin Psychiatry. 2013;74(4):e08.
  6. Cannabis and mental health. Royal College of Psychiatrists. http://www.rcpsych.ac.uk/healthadvice/problemsanddisorders/cannabis.aspx. Published February, 2009. Accessed 21 October, 2017.
  7. Danovitch I, Gorelick DA. State of the art treatments for cannabis dependence. Psychiatr Clin North Am. 2012;35(2):309-326.
  8. Budney AJ. Are specific dependence criteria necessary for different substances: how can research on cannabis inform this issue? Addiction. 2006;101(Suppl 1):125-133.
  9. Joshi M, Joshi A, Bartter T. Marijuana and lung diseases. Curr Opin Pulm Med. 2014;20(2):173-179.

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Last updated: 2019-07-11 22:04