Is your patient’s cannabis use problematic?
Individuals who do not meet DSM-5 criteria for cannabis use disorder may still have problematic use. The screening tool and 5 interventions detailed here can help.
PRACTICE RECOMMENDATIONS
› Address underlying conditions for which patients use recreational cannabis to manage symptoms. B
› Consider discrete, in-office sessions of motivational interviewing and referral for cognitive behavioral therapy for patients with problematic cannabis use. B
› Provide counseling around harm reduction for all patients—especially those with problematic cannabis use. C
› Consider referral to an addiction specialist for patients with cannabis use disorder or other problematic cannabis use. C
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Family history of psychotic disorders. Cannabis is associated with a dose-dependent risk of schizophrenia, which is especially pronounced in patients with a family history of schizophrenia.35 Among patients with a history of psychosis, heavy cannabis use has been associated with increased hospitalizations, increased positive symptoms, and more frequent relapses.36-38
Pregnancy, current or planned. Some women turn to cannabis during pregnancy due to its antiemetic properties. However, perinatal exposure to cannabis is associated with significant risk to the offspring. Maternal cannabis use during the first and second trimesters of pregnancy is associated with decreased performance of the child on measures of function at 3 years of age.39 In addition, cannabis consumption during pregnancy is linked to increased frequency of childhood behavioral issues, inattention, hyperactivity, and impulsivity.40 Peripartum cannabis exposure can affect birth outcomes and is correlated with lower birth weight, incidence of preterm labor, and neonatal intensive care unit admission.15-17,41 Of note, the THC concentration in breast milk peaks at 1 hour after the nursing mother inhales cannabis and typically dissipates after 4 hours.42
Age < 25 years. Chronic heavy use of cannabis in those younger than 25 is associated with higher likelihood of developing CUD, lower IQ,9 lower level of educational attainment, lower income,43 and decreased executive function.8
Substance use disorder history. Recreational cannabis use can hinder recovery from other substance use disorders.44
Consider these 5 interventions
Physicians can address problematic cannabis use with a 5-pronged approach: (1) harm reduction, (2) motivational interviewing, (3) addressing underlying conditions, (4) mitigating withdrawal symptoms, and (5) referring to an addiction specialist (FIGURE).
Continue to: Harm reduction
