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Cannabis Dependence


Introduction

Polysubstance use or abuse is the most common risk factor that increases the chance of overdosing; this involves taking multiple drugs to attain a desired high. Certain drug combinations can be deadly, and the consequences increase especially when marijuana is combined with alcohol. Marijuana and alcohol consumed together is the most frequently encountered substance combination implicated in car accidents. Though the mechanisms aren’t entirely clear, beyond the obvious risks introduced from combining two distinct intoxicants, alcohol may increase the level of marijuana’s primary psychoactive element, THC, in the blood


DEFINITION

Cannabis Dependence refers to the side effects seen as a result of the active ingredient found in cannabis known as delta-9-tetrohydrocannabinol or THC. There are three forms of cannabis which are the flower, resin and the hash oil. The most widely consumed form of cannabis is marijuana, which contains the most amount of THC. While cannabis has previously been taken for illegal recreational purposes, recently the drug has been legalized in some countries for medicinal purposes. Easily obtainable, it mainly comes from the cannabis plant, and is mostly smoked, though it can also be eaten or drank in a tea. Taking cannabis can result in a range of physical and mental issues stemming from increased hunger to psychosis and hallucinations. THC binds to cannabinoid brain receptors. Once these receptors are activated, it interferes with the normal sequence of brain functioning, producing the effects.


Symptoms of Cannabis Dependence

Symptoms of cannabis dependence can include acute and chronic effects. These include increased hunger, sleepiness, impaired cognition and perception, disorientation, and even acute psychosis. According to DSM-5, a diagnosis of cannabis dependence should include recent history of cannabis, exhibiting clinically considerable challenging behavioral or psychological changes, such as euphoria, impaired judgment, and motor skills, which have taken place since cannabis use. In addition, there should be at least two of the following, which occur about two hours after using cannabis: Red eyes, dry mouth, increased appetite, tachycardia, as well as symptoms that are not indicative of any other condition, whether medical or a mental disorder.


Diagnosis of Cannabis Dependence

One of the main features of cannabis dependence is that any behavioral or psychological changes should take place while using or right after using cannabis. Dependence usually starts with a period where the patient feels high, along with symptoms that include euphoria, issues with short-term memory, being unable to accomplish mental tasks, lethargy, excessive drowsiness, and impaired judgment. In some cases, severe anxiety can be present, and social withdrawal transpires. Along with these psychoaffective effects, at least two or more of the subsequent signs should be seen two hours using cannabis. These are immense hunger, dry mouth, conjuctival injection/red eye, and tachycardia.


Dependence occurs in a matter of minutes after smoking cannabis, but can take longer, up to a few hours, if cannabis is consumed by mouth. The effects of cannabis dependence remain ongoing for about three to four hours when smoked, but intoxication can be longer when cannabis is consumed orally.


There are multiple ways of measuring THC and detecting cannabinoids. These include urine testing, blood testing, hair analysis, and saliva testing. While a urine sample is quick and cheap, it may be difficult during acute intoxication, with a blood test being the preferred option. High levels of THC are normally found in the blood within three to ten minutes after inhaling cannabis.


Risk Factors for Cannabis Dependence

The main risk factor for cannabis dependence is the dose/levels of active ingredient THC found in the consumed form of cannabis. Other risk factors include the method of administration, as well as the uniqueness of the individual using cannabis, like tolerance, absorption rate and sensitivity. Since the active ingredient THC, is fat-soluble like most cannabinoids, the effects of cannabis intoxication can normally carry on or reoccur for twelve to twenty four hours because of the time-consuming release of the psychoactive substances into circulation in the body.


Risk factors for cannabis use in general should be considered as well. These include behavioral disorders such as childhood conduct disorder and antisocial personality disorder. The use of other substances such as alcohol and history of intoxication with other substances can increase the risk of cannabis use and intoxication.


Treatment of Cannabis Dependence

Treating cannabis dependence requires a combination of medical care and consultations. The acute phase of cannabis intoxication usually resolves within four to six hours.

The main aspects of medical care involve constant support and preservation of a non hostile setting, decreased stimuli, having a specific nurse keep the patient calm, and the well thought out use of medications like benzodiazepines to treat anxiety. Using short-term benzodiazepines such as lorazepam are recommended for significant anxiety alone. This is because any cannabis related anxiety should ultimately resolve even without medication. When giving lorazepam, the patient’s vital signs should be adequately monitored, as it can depress all aspects of the Central Nervous System.


Warning Signs of Cannabis Dependence

According to the DSM-5, the presence of at least two of the following symptoms, occurring within a period of 12 months, indicates you may be using marijuana in a way that might cause you problems:

  • Continuing to use it even when it's causing social or relationship problems for you, and/or even when you've developed a physical or psychological problem related to using it

  • Craving (strongly desiring to use) marijuana

  • Developing a tolerance for it — needing more and more of it to achieve the same effects

  • Experiencing withdrawal symptoms when you "run out" of or don't have access to marijuana

  • Giving up or doing less of activities you used to enjoy because you'd rather use marijuana

  • Using it in larger amounts and over a longer period than you intended

  • Using it in situations that could be hazardous or even dangerous

  • Using the drug so often, or getting so intoxicated by it, that you can't get important things done

  • Spending a lot of time seeking and using the drug and recovering from its effects

  • Thinking a lot about cutting back or stopping your marijuana use, without success

Comorbidity of Cannabis Dependence

Other disorders have similar presentations as cannabis intoxication, so it is important to make the differentiation. Two commonly experienced psychiatric issues seen with cannabis intoxication are panic and anxiety attacks, and are jointly known as cannabis-induced anxiety disorder . These contribute greatly to the stoppage of the use of cannabis. Frequently seen are acute psychotic episodes, which present with symptoms such as delusions, confusions, hallucinations, hostility, paranoid ideation and labile affect. Normally these symptoms should disappear a week after the cessation of cannabis and dependence. In some instances, the psychotic episodes may continue for a significant amount of time after the acute experience. Similarities with acute schizophreniform disorders may also be present.


Another commonly seen comorbidity is delirium. It is important to distinguish cannabis intoxication delirium, from that of other substances or a medical condition. The key feature lies in the individual having a recent history of cannabis use, and experiencing a decreased ability of awareness and focus as well as issues with cognition.


Cannabis-induced sleep disorder can also develop quickly after cannabis dependence. In some situations, this may last even up to a month, due to acute withdrawal or severe dependence. Understanding this presentation should be helpful in treating the sleep disturbance.

Cannabis use can affect an individual’s daily functioning, and affect both work and social lives. This is especially true as a result of the impaired mental functioning and motor skills, as well as impacting memory and judgment. An individual with cannabis intoxication may be unable to perform at a higher level, and be out of touch with reality.


Living with Cannabis Dependence

Cannabis dependence is not a chronic event. Given its long term effect on an individual’s health, including affecting cardiovascular health, and social implications, it is important to assist individuals with a history of cannabis dependence. This helps prevent subsequent ones, and helps restore cognitive abilities that can negatively impact both occupational, social and family lives.