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Cannabis Use Disorder: Recent Findings and Future Directions

  • Cannabis (D D'Souza and P Skosnik, Section Editors)
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Abstract

Purpose of Review

The purpose of this review was to examine the definition of cannabis use disorder (CUD) and recent findings regarding the risks for developing CUD and the associated outcomes.

Recent Findings

Frequent use of cannabis, use of other substances, and mental health disorders are associated with CUD. Although few individuals seek treatment, addressing CUD is associated with improved health outcomes and quality of life.

Summary

Public health officials and policymakers need to be aware of the potential consequences of more permissive cannabis use policies and to take the appropriate intervention and prevention actions to improve overall health and social outcomes.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Curran HV, Freeman TP, Mokrysz C, Lewis DA, Morgan CJ, Parsons LH. Keep off the grass? Cannabis, cognition and addiction. Nat Rev Neurosci. 2016;17(5):293–306. https://doi.org/10.1038/nrn.2016.28.

    Article  CAS  PubMed  Google Scholar 

  2. Hoch E, Bonnetn U, Thomasius R, Ganzer F, Havemann-Reinecke U, Preuss UW. Risks associated with the non-medicinal use of cannabis. Dtsch Arztebl Int. 2015;112(16):271–8. https://doi.org/10.3238/arztebl.2015.0271.

    Article  PubMed  PubMed Central  Google Scholar 

  3. ProCon.org. 29 Legal Medical Marijuana States and DC. 2018. http://medicalmarijuana.procon.org/view.resource.php?resourceID=000881. Accessed July 16, 2018.

  4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Arlington: American Psychiatric Association; 2013.

    Book  Google Scholar 

  5. • 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(12):1235–42. https://doi.org/10.1001/jamapsychiatry.2015.1858. This study shows increases in cannabis use and related changes in CUD between 2001–2002 and 2012–2013 using National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) data

    Article  PubMed  PubMed Central  Google Scholar 

  6. •• Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration 2017 Contract No.: HHS Publication No. SMA 17-5044, NSDUH Series H-52. This national report summarizes key findings from the 2016 National Survey on Drug Use and Health (NSDUH) for indicators of substance use and mental health among people aged 12 years old or older in the civilian, non-institutionalized population of the USA.

  7. Hasin DS, Grant B. Nesarc findings on increased prevalence of marijuana use disorders—consistent with other sources of information. JAMA Psychiatry. 2016;73(5):532. https://doi.org/10.1001/jamapsychiatry.2015.3158.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Grucza RA, Agrawal A, Krauss MJ, Cavazos-Rehg PA, Bierut LJ. Recent trends in the prevalence of marijuana use and associated disorders in the United States. JAMA Psychiatry. 2016;73(3):300–1. https://doi.org/10.1001/jamapsychiatry.2015.3111.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Goldstein RB, Chou SP, Smith SM, Jung J, Zhang H, Saha TD, et al. Nosologic comparisons of DSM-IV and DSM-5 alcohol and drug use disorders: results from the National Epidemiologic Survey on alcohol and related conditions–III. J Stud Alcohol Drugs. 2015;76(3):378–88. https://doi.org/10.15288/jsad.2015.76.378.

    Article  PubMed  PubMed Central  Google Scholar 

  10. •• Johnston LD, Miech RA, O’Malley PM, Bachman JG, Schulenberg JE, Patrick ME. Monitoring the Future national survey results on drug use, 1975–2017: overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, the University of Michigan 2018. Monitoring the Future (MTF) is a long-term study of substance use and related factors among US adolescents, college students, and adult high school graduates through age 55. It is conducted annually and supported by the National Institute on Drug Abuse. MTF findings identify emerging substance use problems, track substance use trends, and inform national policy and intervention strategies.

  11. Center for Behavioral Health Statistics and Quality. Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration2017.

  12. van der Pol P, Liebregts N, de Graaf R, Korf DJ, van den Brink W, van Laar M. Predicting the transition from frequent cannabis use to cannabis dependence: a three-year prospective study. Drug Alcohol Depend. 2013;133(2):352–9. https://doi.org/10.1016/j.drugalcdep.2013.06.009.

    Article  PubMed  Google Scholar 

  13. • Dierker L, Mendoza W, Goodwin R, Selya A, Rose J. Marijuana use disorder symptoms among recent onset marijuana users. Addict Behav. 2017;68:6–13. https://doi.org/10.1016/j.addbeh.2017.01.009. This study evaluates the link between nicotine dependence and cannabis use disorders symptoms controlling for level of exposure to both substances using NSDUH data from 2009 to 2015 to provide additional evidence that nicotine dependence may indicate sensitivity to cannabis use disorder symptoms across a potentially wide range of cannabis use behaviors. These results indicate there is a developmental mechanism that recognizes symptoms associated with one type of substance use disorder as a sign or signal for symptoms of another substance use disorder regardless of levels of exposure to either substance

    Article  PubMed  PubMed Central  Google Scholar 

  14. • Fairman BJ, Furr-Holden CD, Johnson RM. When marijuana is used before cigarettes or alcohol: demographic predictors and associations with heavy use, cannabis use disorder, and other drug-related outcomes. Prev Sci :Off J Soc Prev Res. 2018; https://doi.org/10.1007/s11121-018-0908-3. Although other studies have examined the order of substance initiation, a methodological innovation in this study allowed the research team to better differentiate the sequence of marijuana, cigarette, and alcohol onset when individuals self-report using two or more of these substances at the same age. Pointed follow-up questions allowed for a more precise determination of the order in the drug-using sequence

  15. ElSohly MA, Mehmedic Z, Foster S, Gon C, Chandra S, Church JC. Changes in cannabis potency over the last 2 decades (1995-2014): analysis of current data in the United States. Biol Psychiatry. 2016;79(7):613–9. https://doi.org/10.1016/j.biopsych.2016.01.004.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Smart R, Caulkins JP, Kilmer B, Davenport S, Midgette G. Variation in cannabis potency and prices in a newly legal market: evidence from 30 million cannabis sales in Washington state. Addiction. 2017;112(12):2167–77. https://doi.org/10.1111/add.13886.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Jikomes N, Zoorob M. The cannabinoid content of legal cannabis in Washington state varies systematically across testing facilities and popular consumer products. Sci Rep. 2018;8(1):4519. https://doi.org/10.1038/s41598-018-22755-2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Freeman TP, Winstock AR. Examining the profile of high-potency cannabis and its association with severity of cannabis dependence. Psychol Med. 2015;45(15):3181–9. https://doi.org/10.1017/S0033291715001178.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Caulkins JP, Bao Y, Davenport S, Fahli I, Guo Y, Kinnard K, et al. Big data on a big new market: insights from Washington State’s legal cannabis market. Int J Drug Policy. 2018;57:86–94. https://doi.org/10.1016/j.drugpo.2018.03.031.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kilmer B, Pacula RL. Understanding and learning from the diversification of cannabis supply laws. Addiction. 2017;112(7):1128–35. https://doi.org/10.1111/add.13623.

    Article  PubMed  Google Scholar 

  21. Carlini BH, Garrett SB, Harwick RM. Beyond joints and brownies: marijuana concentrates in the legal landscape of WA state. Int J Drug Policy. 2017;42:26–9. https://doi.org/10.1016/j.drugpo.2017.01.004.

    Article  PubMed  Google Scholar 

  22. Vandrey R, Raber JC, Raber ME, Douglass B, Miller C, Bonn-Miller MO. Cannabinoid dose and label accuracy in edible medical cannabis products. JAMA. 2015;313(24):2491–3. https://doi.org/10.1001/jama.2015.6613.

    Article  CAS  PubMed  Google Scholar 

  23. Morean ME, Kong G, Camenga DR, Cavallo DA, Krishnan-Sarin S. High school students’ use of electronic cigarettes to vaporize cannabis. Pediatrics. 2015;136(4):611–6. https://doi.org/10.1542/peds.2015-1727.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Englund A, Freeman TP, Murray RM, McGuire P. Can we make cannabis safer? The Lancet Psychiatry. 2017;4(8):643–8. https://doi.org/10.1016/s2215-0366(17)30075-5.

    Article  PubMed  Google Scholar 

  25. Kerr DC, Tiberio SS, Capaldi DM. Contextual risks linking parents' adolescent marijuana use to offspring onset. Drug Alcohol Depend. 2015;154:222–8. https://doi.org/10.1016/j.drugalcdep.2015.06.041.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hill M, Sternberg A, Suk HW, Meier MH, Chassin L. The intergenerational transmission of cannabis use: associations between parental history of cannabis use and cannabis use disorder, low positive parenting, and offspring cannabis use. Psychology of Addictive Behaviors Psychol Addict Behav 2017. doi:https://doi.org/10.1037/adb0000333, 2018.

  27. Abajobir AA, Najman JM, Williams G, Strathearn L, Clavarino A, Kisely S. Substantiated childhood maltreatment and young adulthood cannabis use disorders: a pre-birth cohort study. Psychiatry Res. 2017;256:21–31. https://doi.org/10.1016/j.psychres.2017.06.017.

    Article  PubMed  PubMed Central  Google Scholar 

  28. LeTendre ML, Reed MB. The effect of adverse childhood experience on clinical diagnosis of a substance use disorder: results of a nationally representative study. Subst Use Misuse. 2017;52(6):689–97. https://doi.org/10.1080/10826084.2016.1253746.

    Article  PubMed  PubMed Central  Google Scholar 

  29. • Hines LA, Morley KI, Rijsdijk F, Strang J, Agrawal A, Nelson EC, et al. Overlap of heritable influences between cannabis use disorder, frequency of use and opportunity to use cannabis: trivariate twin modelling and implications for genetic design. Psychol Med. 2018:1–8. https://doi.org/10.1017/S0033291718000478. There are significant genetic contributions to lifetime cannabis abuse/dependence, but a large proportion of this overlaps with influences acting on opportunity and frequency of use. This highlights the importance of cannabis availability on subsequent behavior and potential development of policies to mitigate public health impacts of permissive cannabis laws

  30. Haberstick BC, Young SE, Zeiger JS, Lessem JM, Hewitt JK, Hopfer CJ. Prevalence and correlates of alcohol and cannabis use disorders in the United States: results from the national longitudinal study of adolescent health. Drug Alcohol Depend. 2014;136:158–61. https://doi.org/10.1016/j.drugalcdep.2013.11.022.

    Article  PubMed  Google Scholar 

  31. • Kerridge BT, Pickering R, Chou P, Saha TD, Hasin DS. DSM-5 cannabis use disorder in the National Epidemiologic Survey on Alcohol and Related Conditions-III: gender-specific profiles. Addict Behav. 2018;76:52–60. https://doi.org/10.1016/j.addbeh.2017.07.012. This study provided the first nationally representative information on gender-specific DSM-5 CUD using the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) dataset

    Article  PubMed  Google Scholar 

  32. Hall W. What has research over the past two decades revealed about the adverse health effects of recreational cannabis use? Addiction. 2015;110(1):19–35. https://doi.org/10.1111/add.12703.

    Article  PubMed  Google Scholar 

  33. Bagot KS, Milin R, Kaminer Y. Adolescent initiation of cannabis use and early-onset psychosis. Subst Abus. 2015;36(4):524–33. https://doi.org/10.1080/08897077.2014.995332.

    Article  PubMed  Google Scholar 

  34. Volkow ND, Baler RD, Compton WM, Weiss SR. Adverse health effects of marijuana use. N Engl J Med. 2014;370(23):2219–27. https://doi.org/10.1056/NEJMra1402309.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Hayley AC, Stough C, Downey LA. DSM-5 cannabis use disorder, substance use and DSM-5 specific substance-use disorders: evaluating comorbidity in a population-based sample. Eur Neuropsychopharmacol. 2017;27(8):732–43. https://doi.org/10.1016/j.euroneuro.2017.06.004.

    Article  CAS  PubMed  Google Scholar 

  36. Dierker L, Braymiller J, Rose J, Goodwin R, Selya A. Nicotine dependence predicts cannabis use disorder symptoms among adolescents and young adults. Drug Alcohol Depend. 2018;187:212–20. https://doi.org/10.1016/j.drugalcdep.2018.02.037.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Badiani A, Boden JM, De Pirro S, Fergusson DM, Horwood LJ, Harold GT. Tobacco smoking and cannabis use in a longitudinal birth cohort: evidence of reciprocal causal relationships. Drug Alcohol Depend. 2015;150:69–76. https://doi.org/10.1016/j.drugalcdep.2015.02.015.

    Article  PubMed  Google Scholar 

  38. • Metrik J, Gunn RL, Jackson KM, Sokolovsky AW, Borsari B. Daily patterns of marijuana and alcohol co-use among individuals with alcohol and cannabis use disorders. Alcohol Clin Exp Res. 2018;0(0) https://doi.org/10.1111/acer.13639. This study uses event-level data to examine daily associations between marijuana and alcohol use in a clinical population from the Veterans Health Administration with high base rates of use of these substances

  39. Farmer RF, Seeley JR, Kosty DB, Gau JM, Duncan SC, Lynskey MT, et al. Internalizing and externalizing psychopathology as predictors of cannabis use disorder onset during adolescence and early adulthood. Psychol Addict Behav. 2015;29(3):541–51. https://doi.org/10.1037/adb0000059.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Verplaetse TL, Moore KE, Pittman BP, Roberts W, Oberleitner LM, Smith PH, et al. Intersection of stress and gender in association with transitions in past year DSM-5 substance use disorder diagnoses in the United States. Chronic Stress (Thousand Oaks). 2018;2:247054701775263. https://doi.org/10.1177/2470547017752637.

    Article  Google Scholar 

  41. Epstein KA, Kumra S. White matter fractional anisotropy over two time points in early onset schizophrenia and adolescent cannabis use disorder: a naturalistic diffusion tensor imaging study. Psychiatry Res. 2015;232(1):34–41. https://doi.org/10.1016/j.pscychresns.2014.10.010.

    Article  PubMed  Google Scholar 

  42. Hjorthoj C, Albert N, Nordentoft M. Association of substance use disorders with conversion from schizotypal disorder to schizophrenia. JAMA Psychiatry. 2018;75:733–9. https://doi.org/10.1001/jamapsychiatry.2018.0568.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Nielsen SM, Toftdahl NG, Nordentoft M, Hjorthøj C. Association between alcohol, cannabis, and other illicit substance abuse and risk of developing schizophrenia: a nationwide population based register study. Psychol Med. 2017;47(9):1668–77. https://doi.org/10.1017/S0033291717000162.

    Article  CAS  PubMed  Google Scholar 

  44. Borges G, Bagge CL, Orozco R. A literature review and meta-analyses of cannabis use and suicidality. J Affect Disord. 2016;195:63–74. https://doi.org/10.1016/j.jad.2016.02.007.

    Article  PubMed  Google Scholar 

  45. Kimbrel NA, Meyer EC, DeBeer BB, Gulliver SB, Morissette SB. The impact of cannabis use disorder on suicidal and nonsuicidal self-injury in Iraq/Afghanistan-era veterans with and without mental health disorders. Suicide Life Threat Behav. 2018;48(2):140–8. https://doi.org/10.1111/sltb.12345.

    Article  PubMed  Google Scholar 

  46. Ramaekers JG. Driving under the influence of cannabis: an increasing public health concern. JAMA. 2018;319(14):1433–4. https://doi.org/10.1001/jama.2018.1334.

    Article  PubMed  Google Scholar 

  47. Hartman RL, Huestis MA. Cannabis effects on driving skills. Clin Chem. 2013;59(3):478–92. https://doi.org/10.1373/clinchem.2012.194381.

    Article  CAS  PubMed  Google Scholar 

  48. Choi NG, DiNitto DM, Marti CN. Older adults driving under the influence: associations with marijuana use, marijuana use disorder, and risk perceptions. J Appl Gerontol 2017;0(0):733464817745379. doi:https://doi.org/10.1177/0733464817745379.

  49. Kerridge BT, Mauro PM, Chou SP, Saha TD, Pickering RP, Fan AZ, et al. Predictors of treatment utilization and barriers to treatment utilization among individuals with lifetime cannabis use disorder in the United States. Drug Alcohol Depend. 2017;181:223–8. https://doi.org/10.1016/j.drugalcdep.2017.09.032.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Casajuana C, Lopez-Pelayo H, Balcells MM, Miquel L, Colom J, Gual A. Definitions of risky and problematic cannabis use: a systematic review. Subst Use Misuse. 2016;51(13):1760–70. https://doi.org/10.1080/10826084.2016.1197266.

    Article  PubMed  Google Scholar 

  51. Brezing CA, Choi CJ, Pavlicova M, Brooks D, Mahony AL, Mariani JJ, et al. Abstinence and reduced frequency of use are associated with improvements in quality of life among treatment-seekers with cannabis use disorder. Am J Addict. 2018;27(2):101–7. https://doi.org/10.1111/ajad.12660.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Gates PJ, Sabioni P, Copeland J, Le Foll B, Gowing L. Psychosocial interventions for cannabis use disorder. Cochrane Database Syst Rev. 2016;5:CD005336. https://doi.org/10.1002/14651858.CD005336.pub4.

    Article  Google Scholar 

  53. Cooper K, Chatters R, Kaltenthaler E, Wong R, Library NJ, National Institute for Health R. Psychological and psychosocial interventions for cannabis cessation in adults : a systematic review short report 2015.

  54. Mason MJ, Zaharakis NM, Russell M, Childress V. A pilot trial of text-delivered peer network counseling to treat young adults with cannabis use disorder. J Subst Abus Treat. 2018;89:1–10. https://doi.org/10.1016/j.jsat.2018.03.002.

    Article  Google Scholar 

  55. Sherman BJ, Baker NL, Squeglia LM, McRae-Clark AL. Approach bias modification for cannabis use disorder: a proof-of-principle study. J Subst Abus Treat. 2018;87:16–22. https://doi.org/10.1016/j.jsat.2018.01.012.

    Article  Google Scholar 

  56. Marshall K, Gowing L, Ali R, Le Foll B. Pharmacotherapies for cannabis dependence. Cochrane Database Syst Rev 2014;12(12):CD008940. doi:https://doi.org/10.1002/14651858.CD008940.pub2.

  57. Lundahl LH, Greenwald MK. Effect of oral THC pretreatment on marijuana cue-induced responses in cannabis dependent volunteers. Drug Alcohol Depend. 2015;149:187–93. https://doi.org/10.1016/j.drugalcdep.2015.01.046.

    Article  CAS  PubMed  Google Scholar 

  58. Trigo JM, Soliman A, Quilty LC, Fischer B, Rehm J, Selby P, et al. Nabiximols combined with motivational enhancement/cognitive behavioral therapy for the treatment of cannabis dependence: a pilot randomized clinical trial. PLoS One. 2018;13(1):e0190768. https://doi.org/10.1371/journal.pone.0190768.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Balter RE, Cooper ZD, Haney M. Novel pharmacologic approaches to treating cannabis use disorder. Curr Addict Rep. 2014;1(2):137–43. https://doi.org/10.1007/s40429-014-0011-1.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Budney AJ, Borodovsky JT. The potential impact of cannabis legalization on the development of cannabis use disorders. Prev Med. 2017;104:31–6. https://doi.org/10.1016/j.ypmed.2017.06.034.

    Article  PubMed  PubMed Central  Google Scholar 

  61. •• National Academies of Sciences E, Medicine. The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. Washington, DC: The National Academies Press; 2017. With support from a host of federal, state, philanthropic and non-governmental organizations, the National Academies of Sciences, Engineering, and Medicine convened an ad hoc, expert committee to develop a comprehensive, in depth review of the most recent evidence regarding health effects of using cannabis and cannabis-derived products. In this report, the committee presents nearly 100 research conclusions. The committee also formulated recommendations to expand and improve the quality of cannabis research efforts, enhance data collection efforts to support the advancement of research, and address the current barriers to cannabis research

    Google Scholar 

  62. Kilmer B. Recreational cannabis - minimizing the health risks from legalization. N Engl J Med. 2017;376(8):705–7. https://doi.org/10.1056/NEJMp1614783.

    Article  PubMed  Google Scholar 

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Acknowledgements

Dr. Kimmel and Dr. Lopez are both NIH employees, so we do not have any funding support to declare.

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Authors and Affiliations

  1. Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Blvd, Bethesda, MD, 20892, USA

    Heather L. Kimmel & Marsha F. Lopez

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  1. Heather L. Kimmel
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Correspondence to Heather L. Kimmel.

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This article is part of the Topical Collection on Cannabis

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Kimmel, H.L., Lopez, M.F. Cannabis Use Disorder: Recent Findings and Future Directions. Curr Addict Rep 5, 397–402 (2018). https://doi.org/10.1007/s40429-018-0223-x

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