Cannabis Related Disorders

Cannabis Related Disorders

OverviewPreparationsEpidemiology & other factorsPharmacologyDiagnosis Clinical attributesLaboratory ExaminationTreatment

PlantCannabis SativaOccurs in male & Female formsCannabinoids (Delta-9-tetrahydocannabinol)Found in resin that covers flowering top & upper leaves of the female plant

PreparationsMarijuana: Dried flowering top & leaves of the plant (Concentration of THC 3% TO 23%).

Kief: Powder rich in trichomes, which can be derived from leaves & flowers of the cannabis plant. Consumed in powder form or compressed to produce cakes of hashish.

Hashish: Concentrated resin cake or ball produced from pressed Kief. (Concentration of THC 2% TO 8%)

Preparations Tincture: Cannabinoids can be extracted from cannabis plant matter using high proof spirit to create a tincture often regarded as green dragon.

Hash Oil: obtained from cannabis plant by solvent extraction and contains cannabinoids present in natural oils of cannabis flowers & leaves. The solvents are evaporated to leave behind a very concentrated oil. (15% to 20% THC)InfusionsAdulterated CannabisCommon Name: Weed/Pot/Herb/Grass/Reefer/Mary Jane/Dagga/Dope/Bhang/Skunk/Boom/Gangster/Kif/Hash

Method of UseSmoking (Joint)VaporizerOil Mixed with different edibles

EpidemiologyLife time prevalence:12 to 17 years: 17.3 %18 to 25 years: 52.4%26 years Plus: 40.6%Males: 44.3%Females: 35.5%(National survey on drug use & health 2006)

Correlates of cannabis useAgeGenderIncomeSocio-economic statusEthnicityAvailabilityLegal status

Pharmacology of CannabinoidsPrimary psychoactive constituent is THC (Delta-9-Tetrahydrocannabinol.Cannabinoid signaling system (CB1 & CB2)CB1 mediated the psychological & behavioral effects CB2 mediated immune system & appears to modulate inflammatory responseCB1 found in large numbers in hippocampusTHC & cannabidiol can be neuro-protective through their antioxidative activity.

Pharmacology of CannabinoidsTypical joint of between 0.5 & 1 gm of cannabis contains between 5 to 150 mgs of THC.20 to 70% of THC is found in the smoke & 5 to 24% of it reached bloodstream.While smoked the effect starts within minutes, peak reached within 10 min & decline to 5 to 10% of their initial levels starts within hour.When swallowed it takes 1 to 3 hours for TCH to enter bloodstream. THC & its metabolites are fat soluble thus remain in the body for longer periods.

Cannabis Related DisordersCannabis Use DisorderCannabis IntoxicationCannabis WithdrawalOther Cannabis Induced DisordersUnspecified Cannabis Related Disorders

Cannabis Use DisorderProblematic pattern of Opioid useClinically significant impairment or distressWithin 12 months periodAs manifested by any two of the following

Cannabis Use DisorderTaken in large amounts or over a longer period than was intended.Persistent desire & unsuccessful efforts to cut down or controlGreat deal of time spent (Obtaining, using& recovering)CarvingFailure to fulfill major role obligationContinued use despite having persistent or recurrent problems

Cannabis Use DisorderImportant activities given up or reducedRecurrent use in a situation which is physically hazardousContinued use despite knowledge of having a persistent or recurrent physical or psychological problemsTolerance Withdrawal

Specify ifIn early remission: None of criterion (Except of craving) met for more than three months but less than 12 months after meeting of full criterion

In sustained remission: 12 months or longer

Controlled Environment

Current severity

Cannabis IntoxicationRecent use of cannabisClinically significant problematic behavioral or psychological changes that developed during or shortly after useTwo or more of the following signs within 2 hoursConjunctival injectionIncreased appetiteDry mouthTachycardiaSigns or symptoms are attributable to other mental disorder or substanceSpecify if with perceptual disturbance (Hallucination with intact reality testing or illusion)Intoxication delirium

Cannabis Withdrawal Cessation of cannabis use that has been heavy and prolongedThree or more signs or symptoms develop within approximately one week afterIrritability, anger or aggressionNervousness or anxietySleep difficultyDecreased appetite or weight lossRestlessnessDepressed moodAtleast one of the following physical symptoms causing significant discomfort: abdominal pain, shakiness/tremors, sweating, fever, chills & headache

Cannabis WithdrawalAbove symptoms causing clinically significant distress or impairment in various areas of functioningSigns & symptoms are not attributable to another medical condition/ mental disorder/ intoxication or withdrawal of other substanceMost withdrawal following prolong use start within 24-72 hours of cessation, peak with in week & last for 1-2 weeks

Other Cannabis Induced DisorderCannabis Induced Psychotic DisorderCannabis Induced Anxiety DisorderCannabis Induced Sleep Disorder

Unspecified DisorderAmotivational SyndromeCognitive ImpairmentEffect on Adolescent DevelopmentFlashbacks

Common ComorbiditiesOther Substance use disorder (2 to 48%)Major depressive disorder (11%)Anxiety Disorder (24%)Bipolar I Disorder (13%)

Laboratory ExaminationCan be detected in head hair, pubic hair, urine, blood, saliva & sweat of the users.In some cases it can be detected up to 11 weeks in urine after use.Blood level of THC may range between 0 to 500 ng/mL depending on the potency & time since use. The detection of THC in blood above 10 to 15 ng/Ml indicates recent use.

TreatmentCannabis Dependence: Many users can quit on their own without any professional help, those who find it difficult can be assistedTreatment is mainly symptomaticVarious research have focused on different psychotherapeutic approach with good results. Individual, Group & supportive therapies have been explored.

Therapeutic Effects AnalgesiaNausea & vomitingWasting syndrome & appetite stimulation in HIV/AIDSMuscle SpasticityMovement DisordersEpilepsyGlaucoma

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