Cannabis use disorder - Revision history

Aidan: /* Clinical Presentation */

2020-07-18T23:35:40Z

Clinical Presentation

← Older revision		Revision as of 23:35, 18 July 2020
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	*Concurrent mental health disorders		*Concurrent mental health disorders

	==Clinical ~~Presentation~~==		==Clinical Manifestations==

	===Acute intoxication===		===Acute intoxication===
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	*Essentially impossible to overdose		*Essentially impossible to overdose

	=== Cannabis hyperemesis syndrome ===		===Cannabis hyperemesis syndrome===

	* Complicates as much as 30% of chronic, daily cannabis use		*Complicates as much as 30% of chronic, daily cannabis use
	* Causes severe cyclic nausea and vomiting, resolution with cannabis cessation, abdominal pain		*Causes severe cyclic nausea and vomiting, resolution with cannabis cessation, abdominal pain
	* Symptoms improve with hot showers or baths		*Symptoms improve with hot showers or baths
	* Minor features include age less than 50 years, weight loss more than 5 kg, morning symptoms, normal bowel habits, and a negative diagnostic evaluation		*Minor features include age less than 50 years, weight loss more than 5 kg, morning symptoms, normal bowel habits, and a negative diagnostic evaluation
	* The only treatment is abstinence from cannabis		*The only treatment is abstinence from cannabis
	** Standard antiemetics are typically unhelpful		**Standard antiemetics are typically unhelpful
	** May improve with [[lorazepam]], [[haloperidol]], and topical [[capsaicin]] cream		**May improve with [[lorazepam]], [[haloperidol]], and topical [[capsaicin]] cream

	===Withdrawal===		===Withdrawal===

	*~~Typically~~ ~~occurs~~ after heavy, prolonged use		*Occurs in about a third of people after heavy, prolonged use
	*Requires three or more of the following, within 1 week of cessation		*Requires three or more of the following, within 1 week of cessation
	**Irritability, anger, or aggression		**Irritability, anger, or aggression
	**Nervousness or anxiety		**Nervousness or anxiety
	**Sleep difficulty (insomnia, disturbing dreams		**Sleep difficulty (insomnia, disturbing dreams)
	**Decreased appetite or weight loss		**Decreased appetite or weight loss
	**Restlessness		**Restlessness

Aidan: /* Clinical Presentation */ added hyperemesis syndrome

2020-07-09T14:02:51Z

Clinical Presentation: added hyperemesis syndrome

@@ Line 28: / Line 28: @@
 *Negative effects include paranoia, dry mouth, tachycardia (especially with alcohol coingestion), anxiety, drowsiness, impaired short-term memory, poor attention, and decreased coordination and balance
 *Essentially impossible to overdose
 ===Withdrawal===

Aidan: /* Treatment */

2020-07-09T13:57:05Z

Treatment

← Older revision		Revision as of 13:57, 9 July 2020
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	== Background ==		==Background==

	* Cannabis refers to the plants within the Cannabaceae family (marijuana), which includes ''Cannabis indica'' and ''C. sativa''		*Cannabis refers to the plants within the Cannabaceae family (marijuana), which includes ''Cannabis indica'' and ''C. sativa''
	* Cannabis products are being prescribed for adjunctive management of chronic pain		*Cannabis products are being prescribed for adjunctive management of chronic pain
	* Some people who use cannabis can develop a [[substance use disorder]]		*Some people who use cannabis can develop a [[substance use disorder]]

	=== Pathophysiology ===		===Pathophysiology===

	* The primary psychoactive chemical is tetrahydrocannabinol (THC)		*The primary psychoactive chemical is tetrahydrocannabinol (THC)
	** THC content of cannabis has increased from 3% in the 1970s to 12% mroe recently		**THC content of cannabis has increased from 3% in the 1970s to 12% mroe recently
	* Half-life with occasional use is 1.3 days, but with frequent use increases to 5 to 13 days due to sequestration in fat		*Half-life with occasional use is 1.3 days, but with frequent use increases to 5 to 13 days due to sequestration in fat

	=== Risk Factors ===		===Risk Factors===

	* Younger age		*Younger age
	* Male sex		*Male sex
	* Lower socioeconomic status		*Lower socioeconomic status
	* Early onset of cannabis use		*Early onset of cannabis use
	* Other substance use concerns, including nicotine, alcohol, cocaine, and opioids		*Other substance use concerns, including nicotine, alcohol, cocaine, and opioids
	* Family history of substance use disorders		*Family history of substance use disorders
	* Concurrent mental health disorders		*Concurrent mental health disorders

	== Clinical Presentation ==		==Clinical Presentation==

	=== Acute intoxication ===		===Acute intoxication===

	* Positive effects include relaxation, euphoria, heightened perception, sociability, sensation of time slowing, increased appetite, and decreased pain		*Positive effects include relaxation, euphoria, heightened perception, sociability, sensation of time slowing, increased appetite, and decreased pain
	* Negative effects include paranoia, dry mouth, tachycardia (especially with alcohol coingestion), anxiety, drowsiness, impaired short-term memory, poor attention, and decreased coordination and balance		*Negative effects include paranoia, dry mouth, tachycardia (especially with alcohol coingestion), anxiety, drowsiness, impaired short-term memory, poor attention, and decreased coordination and balance
	* Essentially impossible to overdose		*Essentially impossible to overdose

	=== Withdrawal ===		===Withdrawal===

	* Typically occurs after heavy, prolonged use		*Typically occurs after heavy, prolonged use
	* Requires three or more of the following, within 1 week of cessation		*Requires three or more of the following, within 1 week of cessation
	** Irritability, anger, or aggression		**Irritability, anger, or aggression
	** Nervousness or anxiety		**Nervousness or anxiety
	** Sleep difficulty (insomnia, disturbing dreams		**Sleep difficulty (insomnia, disturbing dreams
	** Decreased appetite or weight loss		**Decreased appetite or weight loss
	** Restlessness		**Restlessness
	** Depressed mood		**Depressed mood
	** At least one of: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache		**At least one of: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache

	== Diagnosis ==		==Diagnosis==

	* Uses the diagnostic criteria for any [[substance use disorder]]		*Uses the diagnostic criteria for any [[substance use disorder]]
	* Heavy use is detectable for up to 30 days in urine		*Heavy use is detectable for up to 30 days in urine
	** Indirect exposure (e.g. second-hand) will generally not generate a positive urine test		**Indirect exposure (e.g. second-hand) will generally not generate a positive urine test

	== Management ==		==Management==

	=== Screening ===		===Screening===

	* The [[CUDIT-R]] tool is a self-screening questionnaire		*The [[CUDIT-R]] tool is a self-screening questionnaire

	=== Treatment ===		===Treatment===

	* Cognitive behavioural therapy (CBT) and motivational enhancement therapy (MET) increases abstinence, decreases frequency of use, decreases severity of dependence, and decreases severity of cannabis-related problems		*Cognitive behavioural therapy (CBT) and motivational enhancement therapy (MET) increases abstinence, decreases frequency of use, decreases severity of dependence, and decreases severity of cannabis-related problems
	* There are no proven and approved pharmacologic interventions		*There are no proven and approved pharmacologic interventions
			*The following have been investigations
	* [[Gabapentin]] 1200 mg daily may decrease use		**[[Gabapentin]] 1200 mg daily may decrease use
	* Cannabis replacement therapy with dronabinol or nabiximols may decrease withdrawal and increase retention in treatment programs		**Cannabis replacement therapy with dronabinol or nabiximols ''may'' decrease withdrawal and increase retention in treatment programs, but not statistically significant
	* ~~So far, the~~ following have been studied and found to ''not'' be useful: SSRIs, antidepressants, mixed-action antidepressants, atypical antidepressants, anxiolytics, and norepinephrine reuptake inhibitors		**The following have been studied and found to ''not'' be useful: SSRIs, antidepressants, mixed-action antidepressants, atypical antidepressants, anxiolytics, and norepinephrine reuptake inhibitors
	** Mixed results for N-acetyl cysteine and naltrexone		**Mixed results for N-acetyl cysteine and naltrexone

	=== Pain management ===		===Pain management===

	* One observational study suggests that cannabis use is not opioid sparing, does not reduce pain scores, and decreases activity scores [[CiteRef::campbell2018ef]]		*One observational study suggests that cannabis use is not opioid sparing, does not reduce pain scores, and decreases activity scores [[CiteRef::campbell2018ef]]
	** However, it is still under active research for chronic non-cancer pain		**However, it is still under active research for chronic non-cancer pain
	* Avoid prescribing cannabis products to patients with [[Substance use disorder\|substance use disorders]] without the involvement of an addiction medicine specialist		*Avoid prescribing cannabis products to patients with [[Substance use disorder\|substance use disorders]] without the involvement of an addiction medicine specialist

	== Prevention ==		==Prevention==

	* Prevention strategies include delaying onset of cannabis use, not driving while intoxicated, and avoiding smoked cannabis		*Prevention strategies include delaying onset of cannabis use, not driving while intoxicated, and avoiding smoked cannabis

	[[Category:Addiction medicine]]		[[Category:Addiction medicine]]

Aidan: /* Treatment */

2020-07-09T13:55:45Z

Treatment

← Older revision		Revision as of 13:55, 9 July 2020
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	* Cognitive behavioural therapy (CBT) and motivational enhancement therapy (MET) increases abstinence, decreases frequency of use, decreases severity of dependence, and decreases severity of cannabis-related problems		* Cognitive behavioural therapy (CBT) and motivational enhancement therapy (MET) increases abstinence, decreases frequency of use, decreases severity of dependence, and decreases severity of cannabis-related problems
			* There are no proven and approved pharmacologic interventions
	* [[Gabapentin]] 1200 mg daily may decrease use		* [[Gabapentin]] 1200 mg daily may decrease use
	* Cannabis replacement therapy with dronabinol or nabiximols may decrease withdrawal and increase retention in treatment programs		* Cannabis replacement therapy with dronabinol or nabiximols may decrease withdrawal and increase retention in treatment programs

Aidan: Created page with "== Background == * Cannabis refers to the plants within the Cannabaceae family (marijuana), which includes ''Cannabis indica'' and ''C. sativa'' * Cannabis products are being..."

2020-07-09T13:54:41Z

Created page with "== Background == * Cannabis refers to the plants within the Cannabaceae family (marijuana), which includes ''Cannabis indica'' and ''C. sativa'' * Cannabis products are being..."

New page

== Background ==

* Cannabis refers to the plants within the Cannabaceae family (marijuana), which includes ''Cannabis indica'' and ''C. sativa''
* Cannabis products are being prescribed for adjunctive management of chronic pain
* Some people who use cannabis can develop a [[substance use disorder]]

=== Pathophysiology ===

* The primary psychoactive chemical is tetrahydrocannabinol (THC)
** THC content of cannabis has increased from 3% in the 1970s to 12% mroe recently
* Half-life with occasional use is 1.3 days, but with frequent use increases to 5 to 13 days due to sequestration in fat

=== Risk Factors ===

* Younger age
* Male sex
* Lower socioeconomic status
* Early onset of cannabis use
* Other substance use concerns, including nicotine, alcohol, cocaine, and opioids
* Family history of substance use disorders
* Concurrent mental health disorders

== Clinical Presentation ==

=== Acute intoxication ===

* Positive effects include relaxation, euphoria, heightened perception, sociability, sensation of time slowing, increased appetite, and decreased pain
* Negative effects include paranoia, dry mouth, tachycardia (especially with alcohol coingestion), anxiety, drowsiness, impaired short-term memory, poor attention, and decreased coordination and balance
* Essentially impossible to overdose

=== Withdrawal ===

* Typically occurs after heavy, prolonged use
* Requires three or more of the following, within 1 week of cessation
** Irritability, anger, or aggression
** Nervousness or anxiety
** Sleep difficulty (insomnia, disturbing dreams
** Decreased appetite or weight loss
** Restlessness
** Depressed mood
** At least one of: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache

== Diagnosis ==

* Uses the diagnostic criteria for any [[substance use disorder]]
* Heavy use is detectable for up to 30 days in urine
** Indirect exposure (e.g. second-hand) will generally not generate a positive urine test

== Management ==

=== Screening ===

* The [[CUDIT-R]] tool is a self-screening questionnaire

=== Treatment ===

* Cognitive behavioural therapy (CBT) and motivational enhancement therapy (MET) increases abstinence, decreases frequency of use, decreases severity of dependence, and decreases severity of cannabis-related problems
* [[Gabapentin]] 1200 mg daily may decrease use
* Cannabis replacement therapy with dronabinol or nabiximols may decrease withdrawal and increase retention in treatment programs
* So far, the following have been studied and found to ''not'' be useful: SSRIs, antidepressants, mixed-action antidepressants, atypical antidepressants, anxiolytics, and norepinephrine reuptake inhibitors
** Mixed results for N-acetyl cysteine and naltrexone

=== Pain management ===

* One observational study suggests that cannabis use is not opioid sparing, does not reduce pain scores, and decreases activity scores [[CiteRef::campbell2018ef]]
** However, it is still under active research for chronic non-cancer pain
* Avoid prescribing cannabis products to patients with [[Substance use disorder|substance use disorders]] without the involvement of an addiction medicine specialist

== Prevention ==

* Prevention strategies include delaying onset of cannabis use, not driving while intoxicated, and avoiding smoked cannabis

[[Category:Addiction medicine]]