Study shows increase in psychiatric disorders linked to increased cannabis use

Widespread use of cannabis (marijuana) and its increased potency are associated with an increase in cannabis-related psychiatric disorders, according to a new review article from the University of Maryland School of Medicine (UMSOM) published in the New England Journal of Medicine. This highlights the urgent need for doctors to screen and treat patients who have symptoms of cannabis use disorder, meaning they are experiencing significant problems related to their drug use.

Nearly one in five Americans ages 12 and older used cannabis in 2021, according to the article, and more than 16 million met criteria for cannabis use disorder, as defined in the Diagnostic and Diagnostic Manual. American Psychiatric Association Health Disorders Statistics (DSM-5-TR). Young adults aged 18 to 25 are disproportionately affected. The review found that more than 14% of people in this age group suffered from cannabis use disorder.

“There is a lot of misinformation in the public sphere about cannabis and its effects on psychological health, with many assuming that this medication is safe to use and without side effects,” said David A. Gorelick, MD, Ph.D. , professor of Psychiatry at UMSOM who wrote the review article. “It is important that doctors and the public understand that cannabis can be addictive and recognize the signs and symptoms in order to be properly diagnosed and treated.”

Cannabis use disorder is defined as problematic use of marijuana. Symptoms include a craving for the medication and an inability to control its use despite negative side effects such as problems at work or school. It is more common among people who use cannabis more than four days a week. Although the main risk factors are the frequency and duration of cannabis use, having another substance use disorder or psychiatric problem also increases the likelihood of diagnosis.

“Nearly 50% of people with cannabis use disorder have another psychiatric problem such as major depression, post-traumatic stress disorder, or generalized anxiety disorder,” said Dr. Gorelick. “It is essential that patients seek the appropriate psychiatric treatment to address their risk factors.”

Physical signs and symptoms of cannabis use disorder can range from yellowing of the fingertips to increased depression and anxiety when using cannabis. However, to be properly diagnosed by a clinician, patients must meet at least two criteria for cannabis use disorder, as outlined by the DSM-5-TR. These include poor performance at school or work or failure to fulfill important family obligations due to cannabis use. Other symptoms include withdrawal symptoms or cravings for cannabis.

Dr. Gorelick, who is also editor-in-chief of the Journal of Cannabis Research, conducted an in-depth study aimed at informing doctors about the range of health problems that can be associated with short- and long-term cannabis use, as increasing numbers of people use cannabis products . It also aimed to raise awareness about cannabis use disorder, both in terms of recognizing its symptoms and understanding treatment options.

The paper also highlights other dangers of excessive cannabis use: Cannabis use accounts for 10% of all drug-related emergency room visits in the United States and is associated with an increased risk of car crashes. 30 to 40%. In 2022, 18- to 25-year-olds accounted for the highest rate of cannabis-related emergency room visits.

“About one in ten people who use cannabis will become addicted, and for those who start before age 18, the rate rises to one in six,” said Mark T. Gladwin, MD, John Z. and Akiko K. Bowers. and UMSOM Dean and Vice President for Medical Affairs, University of Maryland, Baltimore.

“As consumption of this drug increases, we need to do more basic research to understand the cannabinoid system in the brain. We also need to design translational studies of therapies targeting these brain mechanisms to help people with cannabis use disorders, particularly young adults and pregnant women. overcome their dependence on this medication.

A key part of UMSOM’s mission is to drive innovation in the field of addiction medicine and learn more about the neurological differences in the brain that make some people more susceptible to drug abuse and to addiction. As part of this mission, the school recently opened the Kahlert Institute for Addiction Medicine, which brings together leading addiction experts to collaborate on the study of the brain mechanisms underlying addiction and to form a new generation of doctors in the field of addiction medicine.

“There is still much we don’t understand about these conditions, including why some people suffer from cannabis-related disorders,” said Asaf Keller, Ph.D., associate director of the Kahlert Institute and professor emeritus. Donald E. Wilson, MD, MACP. and Chair of Neurobiology at UMSOM. “This is what we are trying to better understand through preclinical research studies. We are also working to develop treatments for cannabis-related disorders.”

There are currently seven recognized disorders linked to cannabis use. Some include: cannabis-induced anxiety disorder, cannabis-induced psychotic disorder, cannabis-induced sleep disorder, and cannabis-induced delirium, which manifests as hyperactivity, agitation, and disorientation accompanied by hallucinations. Often their symptoms can closely resemble those of their non-cannabis counterparts.

To properly diagnose cannabis use disorders in patients, the U.S. Preventive Services Task Force recommends that adolescents and adults be screened for cannabis use disorders (and other disorders related to substance use) in primary care settings, provided that services allowing accurate diagnosis, treatment and appropriate care can be offered or referred.

Screening is best done using a standalone health questionnaire or as part of a broader health questionnaire during a doctor’s visit.

Although the FDA has not approved any drugs as effective for the treatment of cannabis use disorder, certain therapies can help people with cannabis use disorder manage their symptoms and reduce or stop their use of cannabis. These include interactive cognitive therapy (CBT) and motivational enhancement therapy (MET), which help patients manage the thoughts and behaviors that trigger their cannabis use and better understand why they consume cannabis. Adolescents may receive additional benefits from family-based treatment options.

Therapy is increasingly accessible through telehealth services, but stigma surrounding mental illness and addiction as well as a shortage of mental health professionals still create barriers to treatment for many patients, Gorelick said.