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Cannabis use and disorder: Epidemiology, comorbidity, health consequences, and medico-legal status

Author
David A Gorelick, MD, PhD
Section Editor
Andrew J Saxon, MD
Deputy Editor
Richard Hermann, MD

INTRODUCTION

Cannabis (also called marijuana) is the most commonly used illegal psychoactive substance worldwide [1]. Its psychoactive properties are primarily due to one cannabinoid: delta-9-tetrahydrocannabinol (THC); THC concentration is commonly used as a measure of cannabis potency [2].

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 medico-legal context, epidemiology, comorbidity, and health consequences of cannabis use and cannabis use disorder in adults are reviewed here. The pathogenesis, pharmacology, clinical manifestations, course, assessment, diagnosis, and treatment of cannabis use disorder are reviewed separately. Acute cannabis intoxication is also reviewed separately. (See "Cannabis use and disorder: Pathogenesis and pharmacology" and "Cannabis use and disorder: Clinical manifestations, course, assessment, and diagnosis" and "Treatment of cannabis use disorder" and "Cannabis (marijuana): Acute intoxication".)

EPIDEMIOLOGY

Cannabis grows in nearly every country in the world.

Cannabis use — Cannabis was used by an estimated 182 million people (range 128 to 234 million) worldwide in 2014, approximately 3.8 percent (range 2.7 to 4.9 percent) of the global population age 15 to 64 years [1]. Cannabis use is most prevalent in West and Central Africa (12.4 percent, 30.6 million users), North America (12.1 percent, 38.5 million users), and Oceania (10.2 percent, 2.6 million users), and least prevalent in East and South-East Asia (0.6 percent, 10.2 million users), Eastern and South-Eastern Europe (2.4 percent, 5.5 million users), the Caribbean (2.5 percent, 700 thousand users), and Central America (2.9 percent, 810 thousand users) [1].

                             

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