Cannabis use and disorder: Clinical manifestations, course, assessment, and diagnosis
- David A Gorelick, MD, PhD
David A Gorelick, MD, PhD
- Professor of Psychiatry
- University of Maryland School of Medicine
Cannabis (also called marijuana) is the most commonly used illegal psychoactive substance worldwide . Its psychoactive properties are primarily due to one cannabinoid: delta-9-tetrahydrocannabinol (THC); THC concentration is commonly used as a measure of cannabis potency .
The legal status of cannabis use, for medical as well as recreational purposes, varies internationally as well as across the United States. The potency of cannabis has increased significantly around the world in recent decades, which may have contributed to increased rates of cannabis-related adverse effects. Cannabis use disorder develops in approximately 10 percent of regular cannabis users, and may be associated with cognitive impairment, poor school or work performance, and psychiatric comorbidity such as mood disorders and psychosis.
The clinical manifestations, course, assessment, and diagnosis of cannabis use disorder in adults are reviewed here. The epidemiology and health consequences of cannabis use and cannabis use disorder are reviewed separately. The pathogenesis, pharmacology, and treatment of cannabis use disorder in adults are also reviewed separately. Acute intoxication from cannabis and synthetic cannabinoids are also reviewed separately. (See "Cannabis use and disorder: Epidemiology, comorbidity, health consequences, and medico-legal status" and "Treatment of cannabis use disorder" and "Cannabis (marijuana): Acute intoxication" and "Synthetic cannabinoids: Acute intoxication".)
Acute cannabis intoxication — Acute cannabis intoxication generally occurs within two hours of cannabis use. The clinical presentation and management of acute intoxication are reviewed in detail separately. (See "Cannabis (marijuana): Acute intoxication".)
Acute intoxication generally presents with a specific constellation of one or more signs and symptoms, including subjective euphoria (“high”), sedation, anxiety, impaired judgment, social withdrawal, sensation of slowed time, impaired memory and concentration, increased appetite, impaired motor coordination, tachycardia, dry mouth, and conjunctival hyperemia (redness) [3,4]. Severe cases may include panic attacks, paranoia, and psychosis.
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