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, and cannabis withdrawal are also reviewed separately. (See "Cannabis use and disorder: Epidemiology, comorbidity, health consequences, and medico-legal status" and "Cannabis use and disorder: Pathogenesis and pharmacology" and "Treatment of cannabis use disorder" and "Cannabis (marijuana): Acute intoxication" and "Synthetic cannabinoids: Acute intoxication".)
The defining manifestation of cannabis use disorder is a persisting pattern of cannabis use that results in clinically significant functional impairment in two or more domains within a period of 12 months . Typical manifestations of cannabis use disorder include impairment in school or work function, giving up of previously enjoyed social and recreational activities, and use of cannabis in potentially hazardous situations, eg, while driving.
The differential diagnosis from nonproblematic cannabis use relies on a careful assessment of the presenting problems or impairments, not on the absolute intensity (quantity and frequency) of cannabis use. Key features suggesting the diagnosis of cannabis use disorder include patient denial of cannabis-related problems in the face of reports from reliable collateral sources (eg, family, school, employer) and patient denial of cannabis use in the face of objective evidence to the contrary (eg, urine drug testing).
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