Cannabis use induces a variety of acute psychological and physiological effects that vary in intensity and duration according to the dose, the route of administration, and the degree of tolerance in the user. Acute psychological effects include euphoria (“high”), relaxation, and sedation (usually desired by persons who use cannabis recreationally), increased appetite (“munchies”) and impaired short-term memory, concentration, and psychomotor coordination. Some people experience increased anxiety, panic attacks, or paranoia, especially at higher doses. Psychotic symptoms, such as perceptual alterations, hallucinations, and delusions, are less common. Acute physical effects include impaired motor coordination, slurred speech, dry mouth, conjunctival injection (“red eye”), tachycardia, orthostatic hypotension, and horizontal nystagmus. Smoked cannabis induces cough, wheezing, and dyspnea; increases sputum production; and exacerbates asthma.
Diagnostic Criteria for Cannabis Use Disorder
Impaired control over cannabis use
1. Using cannabis for longer periods of time than intended or using larger amounts than intended
2. Unsuccessful in reducing or controlling cannabis use, despite wanting to do so
3. Spending a great deal of time getting or using cannabis or recovering from its use
4. Strong desire or craving to use cannabis
Social impairment due to cannabis use
5. Failure to fulfill major role obligations at work, school, or with family due to cannabis use
6. Continued cannabis use despite having persistent cannabis-related interpersonal or social problems
7. Giving up or reducing time spent on important activities because of cannabis use
Risky use of cannabis
8. Repeated use of cannabis in physically dangerous situations
9. Continued use of cannabis even though the person is aware that use is likely to be causing or worsening a cannabis-related physical or psychological problem
Pharmacologic indicators
10. Tolerance. With chronic cannabis use, the effects of cannabis decrease when it is repeatedly used in the same amount, or the amount of cannabis needed to achieve the same effects must be increased
11. Withdrawal. Either a typical cannabis withdrawal syndrome or use of cannabis to avoid experiencing a withdrawal syndrome
Cannabis use disorder requires meeting 2 or more criteria within a 12-month period. Mild cannabis use disorder requires meeting 2 to 3 criteria, moderate cannabis use disorder requires meeting 4 to 5 criteria, and severe cannabis use disorder requires meeting 6 or more criteria. Partial remission is defined as no longer meeting any criteria for cannabis use disorder for 3 months. Full remission is defined as no longer meeting any criteria for 12 months.
References:
- Gorelick DA. Cannabis-Related Disorders and Toxic Effects. N Engl J Med. 2023 Dec 14;389(24):2267-2275. [Medline]
- Connor JP, Stjepanović D, Le Foll B, Hoch E, Budney AJ, Hall WD. Cannabis use and cannabis use disorder. Nat Rev Dis Primers. 2021 Feb 25;7(1):16. [Medline]
Created May 02, 2024.
