The New England Journal of MedicineCannabis-Related Disorders and Toxic Effects

Unraveling the Complexities of Cannabis Use Disorder: A Comprehensive Review

This comprehensive review examines the multifaceted aspects of cannabis use disorder, its implications on physical and psychological health, and the current state of treatment. It provides an in-depth understanding of the disorder, from its pharmacological underpinnings to its societal impact, offering valuable insights for healthcare professionals navigating this complex issue.

Key Points:

• Cannabis contains more than 500 identified chemicals, including more than 125 phytocannabinoids, with THC and CBD being the most studied.
• Cannabis has a dichotomous legal status in the United States, with varying degrees of legality at the state level.
• Cannabis is one of the most commonly used psychoactive substances globally, with an estimated 52.4 million users in the United States in 2021.
• Cannabis use disorder often co-occurs with other psychiatric conditions, including other substance use disorders and major depression.
• The major effects of cannabis are generated by the interaction of THC with the endocannabinoid system.
• Acute psychological effects of cannabis use include euphoria, relaxation, sedation, increased appetite, and impaired short-term memory.
• Cannabis use poses a global disease burden, associated with an increased risk of motor vehicle crashes, suicidality, and cardiovascular and pulmonary disease.
• Cannabis use disorder is a chronic, relapsing condition, with loss of control over cannabis use being the core feature.
• Psychosocial treatments, such as cognitive behavioral therapy (CBT) and motivational enhancement therapy (MET), have significant short-term efficacy in helping patients reduce or stop their cannabis use.
• Cannabis withdrawal typically requires formal treatment only if sleep or mood disturbances interfere with daily life.
• Long-term cannabis use has adverse effects on physical and psychological health, including cannabinoid hyperemesis syndrome, a form of cyclic vomiting syndrome.

Worldwide, an estimated 209 million persons 15 to 64 years of age used cannabis in 2020, representing about 4% of the global population in that age group.

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