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Cannabis potency is causing a dramatic rise in psychiatric disorders

Researchers from the University of Maryland School of Medicine (UMSOM) shed light on the concerning trend of cannabis-related psychiatric conditions.

As cannabis continues to gain widespread acceptance and its potency increases, there is an urgent need for doctors to screen for, diagnose, and treat patients experiencing symptoms of cannabis use disorder.

Dr. David A. Gorelick, Professor of Psychiatry at UMSOM and lead author, emphasizes the importance of recognizing the addictive effects of cannabis and understanding the signs and symptoms of cannabis use disorder.

Scope of cannabis use disorder

Nearly one in five Americans aged 12 and older used cannabis in 2021. Alarmingly, more than 16 million individuals met the criteria for cannabis use disorder, as outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).

Among young adults aged 18 to 25, over 14 percent had cannabis use disorder, demonstrating that this issue disproportionately affects this age group.

Dr. Gorelick emphasizes the need to dispel misconceptions about cannabis’s safety.

“There is a lot of misinformation in the public sphere about cannabis and its effects on psychological health, with many assuming that this drug is safe to use with no side effects.”

He stresses that cannabis can have addictive effects and urges physicians and the public to recognize the signs and symptoms of cannabis use disorder.

Diagnosing cannabis psychiatric disorders

Cannabis use disorder is defined as problematic marijuana use, with symptoms including craving the drug and an inability to control its use, even in the face of negative consequences.

The frequency and duration of cannabis use are primary risk factors for developing the disorder. Additionally, individuals with another substance use disorder or a psychiatric condition are at an increased likelihood of receiving a diagnosis.

“Almost 50 percent of people with cannabis use disorder have another psychiatric condition such as major depression, post-traumatic stress disorder, or generalized anxiety disorder,” said Dr. Gorelick. “It’s vital that patients seek the right psychiatric treatment to address their risk factors.”

Patients experiencing physical signs and symptoms of cannabis use disorder may exhibit yellowing of the fingertips, increased depression, and anxiety while using cannabis.

However, a clinical diagnosis requires meeting at least two criteria outlined in the DSM-5-TR.

These criteria include impaired performance at school or work, neglecting important family obligations due to cannabis use, experiencing withdrawal symptoms or cravings, among others.

Seeking professional diagnosis and treatment is paramount.

Treatment options and public awareness

Dr. Gorelick’s review aims to increase public awareness of cannabis use disorder, educating individuals about the symptoms and available treatment options.

While the FDA has not approved any medication to treat cannabis use disorder, different therapies have shown promise in managing symptoms and reducing or stopping cannabis use.

Cognitive-Behavioral Therapy (CBT) and Motivational Enhancement Therapy (MET) are often used. They help patients manage the thoughts and behaviors associated with cannabis use and understand the underlying reasons for their use.

For adolescents, family-based treatment options may yield additional benefits.

The review also highlights other dangers associated with excessive cannabis use. Cannabis is responsible for 10 percent of all drug-related emergency room visits in the United States and is associated with a 30 to 40 percent increased risk of car accidents.

Additionally, emergency department visits related to cannabis are highest among 18 to 25-year-olds. Dr. Mark T. Gladwin, Dean of UMSOM, underscores the urgency of understanding these risks.

“Approximately 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 Dr. Gladwin. 

“As use of this drug increases, we must delve deeply into basic research to understand the brain’s cannabinoid system. We must also design translational studies of therapies that target these brain mechanisms to help those with cannabis use disorder — particularly young adults and pregnant women — overcome their dependence on this drug.”

Addiction medicine for cannabis psychiatric disorders

UMSOM has made addiction medicine a priority, driving innovation in the field and exploring neurological differences that make individuals more susceptible to drug abuse and addiction.

To further this mission, UMSOM recently established the Kahlert Institute for Addiction Medicine, bringing together leading experts to study the underlying brain mechanisms of addiction and train future medical practitioners.

Dr. Asaf Keller, Associate Director of the Kahlert Institute, emphasizes the importance of pre-clinical research studies to better understand cannabis-related disorders and develop targeted treatments.

“There is still a lot we don’t understand about these conditions, including why some people experience cannabis-related disorders,” said Dr. Keller. “That is what we are trying to better understand through pre-clinical research studies. We are also working on developing treatments for cannabis -related disorders.”

Urgent need for screening and treatment

To address the growing prevalence of cannabis use disorder, the U.S. Preventive Services Task Force recommends screening adolescents and adults for cannabis use disorder, as well as other substance use disorders, in primary care settings.

Accessible diagnosis, treatment, and appropriate care are critical components of this approach. Ideally, screening can be integrated into healthcare visits using standalone or comprehensive health questionnaires.

In summary, as the use of cannabis becomes more prevalent, it is essential to be aware of the associated risks, specifically cannabis-related psychiatric conditions.

This research underscores the urgent need for physicians to be proactive in screening and treating patients exhibiting symptoms of cannabis use disorder, as well as the importance of public awareness and education.

By recognizing the addictive effects of cannabis and understanding the signs and symptoms of cannabis use disorder, we can ensure that individuals receive timely and appropriate treatment.

The ongoing efforts of institutions like UMSOM and the Kahlert Institute are essential in advancing addiction medicine and improving the lives of those affected by cannabis use disorder.

More about cannabis potency

As discussed above, the increasing potency of cannabis has become a notable trend in recent years, sparking both interest and concern among users, healthcare professionals, and policymakers.

Historically, cannabis, primarily known for its psychoactive component, tetrahydrocannabinol (THC), was much less potent.

In the 1960s and 1970s, the average THC content in marijuana was about 1-3%. Fast forward to today, and the average THC content has soared, often exceeding 15%, with some samples reaching as high as 30%.

Advancements in cannabis cultivation

The primary driver behind this surge in potency is the advancement in agricultural practices and genetic selection. Growers have become more sophisticated, employing techniques that enhance THC concentration.

They selectively breed strains for higher potency, focusing on those that produce more THC. Additionally, the rise of hydroponic systems, which allow for controlled environments, has led to stronger plants.

Implications of higher potency

This increased potency has its benefits and drawbacks. On one hand, medical users may find higher potency cannabis more effective for pain relief, muscle spasms, and other health issues.

On the other hand, there are concerns about the health impacts, particularly on young, inexperienced, or infrequent users.

Higher THC levels have been linked to increased risks of anxiety, paranoia, and in extreme cases, psychotic episodes.

Regulatory challenges

Furthermore, the rise in potency raises questions about regulation and standardization. With the legalization of cannabis in various parts of the world, governments and regulatory bodies face the challenge of setting standards for THC levels, much like alcohol content in beverages.

In summary, the increasing potency of cannabis is a complex issue with both positive and negative facets. It reflects advancements in cannabis cultivation and a growing market demand for stronger products.

However, it also necessitates a closer look at the health implications and regulatory frameworks to ensure safe and responsible use.

The full study was published in the New England Journal of Medicine.


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