Cannabis use disorder: Epidemiology, comorbidity, and pathogenesis
- John A Bailey, MD
John A Bailey, MD
- Clinical Assistant Professor of Psychiatry
- University of Florida
- Robert L DuPont, MD
Robert L DuPont, MD
- Clinical Professor of Psychiatry
- Georgetown University School of Medicine
- Scott A Teitelbaum, MD
Scott A Teitelbaum, MD
- Professor of Psychiatry
- University of Florida
Cannabis is the most commonly used illegal substance worldwide . Approximately 160 million people or approximately four percent of the world’s population between the ages of 15 and 64 years have been estimated to use cannabis at least once in the past year.
The psychoactive properties of cannabis are primarily due to delta-9-tetrahydrocannabinol (THC) . The THC content of marijuana has increased significantly since the late 1960s from approximately 1 to 5 percent to as much as 10 to 15 percent . This increased potency may contribute to increased rates of cannabis use disorder.
The psychiatric diagnoses, cannabis abuse and cannabis dependence, in DSM-IV-TR were replaced by one diagnosis, cannabis use disorder, in DSM-5 . Although the crosswalk between DSM-IV and DSM-5 disorders is imprecise, cannabis dependence is approximately comparable to cannabis use disorder, moderate to severe subtype, while cannabis abuse is similar to the mild subtype.
The epidemiology, comorbidity, and pathogenesis of cannabis use, disorder in adults will be reviewed here. Other issues related to cannabis use disorder are discussed separately. Treatment of medical conditions such as chemotherapy-induced emesis and cancer pain with cannabinoids are discussed separately. (See "Cannabis use disorder: Clinical features and diagnosis" and "Characteristics of antiemetic drugs" and "Characteristics of antiemetic drugs", section on 'Cannabinoids' and "Cancer pain management: Adjuvant analgesics (coanalgesics)", section on 'Cannabis and cannabinoids' and "Cannabis use disorder: Treatment, prognosis, and long-term medical effects" and "Cannabis (marijuana): Acute intoxication".)
Slang terms used for marijuana or cannabis include “pot,” “reefer,” “Mary Jane,” “hash,” “weed,” “hemp,” “blunt,” “ganja,” “roach,” “nail,” and “dube” . Synthetic cannabinoids such as CP-47, 497, JWH-073, and JWH-175 have street names that include “K2,” “spice,” “Zohai,” and “eclipse” .
- Leggett T, United Nations Office on Drugs and Crime. A review of the world cannabis situation. Bull Narc 2006; 58:1.
- Ashton CH. Pharmacology and effects of cannabis: a brief review. Br J Psychiatry 2001; 178:101.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, American Psychiatric Association, Washington DC 2000.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
- Hamilton NL, Brantley LB, Tims FM, et al. Family Support Network for Adolescent Cannabis Users, Cannabis Youth Treatment (CYT) Series, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD 2001. Vol 3.
- Wells DL, Ott CA. The "new" marijuana. Ann Pharmacother 2011; 45:414.
- Degenhardt L, Chiu WT, Sampson N, et al. Toward a global view of alcohol, tobacco, cannabis, and cocaine use: findings from the WHO World Mental Health Surveys. PLoS Med 2008; 5:e141.
- Anthony, JC, Warner, LA, Kessler, RC. Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: basic findings from the National Comorbidity Survey. Exp Clin Psychopharmacol 1994; 2:244.
- Degenhardt L, Chiu WT, Sampson N, et al. Epidemiological patterns of extra-medical drug use in the United States: evidence from the National Comorbidity Survey Replication, 2001-2003. Drug Alcohol Depend 2007; 90:210.
- Hasin DS, Saha TD, Kerridge BT, et al. Prevalence of Marijuana Use Disorders in the United States Between 2001-2002 and 2012-2013. JAMA Psychiatry 2015; 72:1235.
- Kandel D, Chen K, Warner LA, et al. Prevalence and demographic correlates of symptoms of last year dependence on alcohol, nicotine, marijuana and cocaine in the U.S. population. Drug Alcohol Depend 1997; 44:11.
- von Sydow K, Lieb R, Pfister H, et al. The natural course of cannabis use, abuse and dependence over four years: a longitudinal community study of adolescents and young adults. Drug Alcohol Depend 2001; 64:347.
- Poulton R, Moffitt TE, Harrington H, et al. Persistence and perceived consequences of cannabis use and dependence among young adults: implications for policy. N Z Med J 2001; 114:544.
- Degenhardt L, Hall W, Lynskey M. The relationship between cannabis use and other substance use in the general population. Drug Alcohol Depend 2001; 64:319.
- Grant BF, Pickering R. The relationship between cannabis use and DSM-IV cannabis abuse and dependence: results from the National Longitudinal Alcohol Epidemiologic Survey. J Subst Abuse 1998; 10:255.
- Lynskey MT, Heath AC, Bucholz KK, et al. Escalation of drug use in early-onset cannabis users vs co-twin controls. JAMA 2003; 289:427.
- Kaminer, Y. Adolescent substance abuse. In: The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th ed, Galanter, M, Kleber HD (Ed), American Psychiatric Publishing, Washington, DC 2008. p.527.
- Conway KP, Compton W, Stinson FS, Grant BF. Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2006; 67:247.
- Ross, S. The mentally ill substance abuser. In: The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th ed, Galanter, M, Kleber HD (Eds), American Psychiatric Publishing, Washington, DC 2008. p.540.
- Clapper JR, Mangieri RA, Piomelli D. The endocannabinoid system as a target for the treatment of cannabis dependence. Neuropharmacology 2009; 56 Suppl 1:235.
- Cooper ZD, Haney M. Cannabis reinforcement and dependence: role of the cannabinoid CB1 receptor. Addict Biol 2008; 13:188.
- Hasin DS, Keyes KM, Alderson D, et al. Cannabis withdrawal in the United States: results from NESARC. J Clin Psychiatry 2008; 69:1354.
- Lichtman AH, Martin BR. Cannabinoid tolerance and dependence. Handb Exp Pharmacol 2005; :691.
- Koob, GF. Neurobiology of addiction. In: The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th ed, Galanter, M, Kleber HD (Eds), American Psychiatric Publishing, Washington, DC 2008. p.4.
- Kendler KS, Karkowski LM, Neale MC, Prescott CA. Illicit psychoactive substance use, heavy use, abuse, and dependence in a US population-based sample of male twins. Arch Gen Psychiatry 2000; 57:261.
- Sartor, CE, Grant, JD, Bucholz, KK, et al. Common genetic contributions to alcohol and cannabis use and dependence symptomatology. Alcohol Clin Exp Res 2010; 34:1.
- Hopfer CJ, Lessem JM, Hartman CA, et al. A genome-wide scan for loci influencing adolescent cannabis dependence symptoms: evidence for linkage on chromosomes 3 and 9. Drug Alcohol Depend 2007; 89:34.
- Agrawal A, Lynskey MT. Candidate genes for cannabis use disorders: findings, challenges and directions. Addiction 2009; 104:518.
- Lynskey MT, Heath AC, Nelson EC, et al. Genetic and environmental contributions to cannabis dependence in a national young adult twin sample. Psychol Med 2002; 32:195.
- Hyman SM, Sinha R. Stress-related factors in cannabis use and misuse: implications for prevention and treatment. J Subst Abuse Treat 2009; 36:400.