Cannabis, Marijuana and Addiction
If you know someone who may have a cannabis use disorder or any other substance use disorder, it’s best to speak with a medical professional to understand how you can help that person. If you think that cannabis might be right for you for medicinal purposes, please speak with your GP or contact a clinic.
There’s been a long-standing debate about whether cannabis is addictive. Proponents of the plant often say that marijuana is not addictive, while those whose minds go to reefer madness liken cannabis consumption to that of an illicit injectable.
It’s important to understand that the correct terminology for any drug addiction is called a ‘use disorder’ for example, alcohol use disorder or cannabis use disorder. This article has been written to help people understand that neither the cannabis zealots nor the prohibition proponents are correct – there is in fact a middle ground on the discussion of cannabis use disorder.
In this article Dr Mark Hardy helps us set the record straight by explaining everything you need to know about cannabis use disorder. Here’s what the article covers:
- 00:14 | What’s the difference between addiction and dependence?
- 02:33 | What are the signs of addiction, dependence or substance use disorder? (video only)
- 04:36 | Is cannabis or marijuana addictive?
- 06:04 | Which chemical in cannabis is responsible for cannabis use disorder?
- 07:55 | A comparison of the burden of disease between cannabis and other drugs.
- 12:02 | What causes cannabis addiction (cannabis use disorder)?
- 12:38 | How is cannabis use disorder diagnosed?
- 16:42 | What percentage of medical cannabis patients develop a use disorder?
- 17:42 | What percentage of adult-use cannabis consumers develop a cannabis use disorder?
- 18:38 | What is the treatment for cannabis use disorder?
You can also check out the cannabis use disorder informational infographic below.
What is the difference between addiction and dependence?
To be noted as an addict rather than to have a mental health condition or to have a physical problem, is at times, a really negative stigma to place on someone.
The terminology around ‘use disorders’ or addiction as many think of it, is determined by the Diagnostic and Statistical Manual (DSM). This manual characterises and classifies various mental health conditions.
A use disorder (addiction) or dependence have similar precursors and similar defining characteristics. The main characteristics of a use disorder or dependence, whether it be alcohol, cannabis or another drug, are:
- Tolerance to a substance.
- Withdrawal, if that substance was withheld.
- Salience, a set of behaviors that promote the use of that substance above all other considerations.
The DSM-5 has added the notion of cravings into the definition of a ‘use disorder’ which falls under the category of salience.
In conclusion, dependence occurs in situations where you may not necessarily see all three of those conditions of tolerance, withdrawal, and salience in play. Someone experiencing addiction encompasses the traits of dependence along with drug seeking behaviours.
Is cannabis or marijuana addictive?
Yes. Frequent use of cannabis may lead to cannabis use disorder (cannabis addiction). However, it’s important to remember that cannabis is made up of multiple chemicals. A use disorder does not simply occur because an individual consumes cannabis. Addiction to cannabis is related to the volume of THC consumed and the frequency with which an individual consumes it.
There are about 200-400mg of THC in a gram of illicit cannabis in Australia. Dr Hardy said that most of the people he’d seen with a cannabis use disorder were smoking at least a gram of cannabis per day.
Which chemical in cannabis is responsible for cannabis use disorder?
Delta-9-tetrahydrocannabinol (THC) is the psychoactive component of cannabis that is responsible for addiction or cannabis use disorder.
In Australia, THC found in illicitly grown plants can make up somewhere between 20% and 40% of the entire chemical constituent of the plant and can cause considerable intoxication and cause some of the mental health symptoms that we commonly associate with smoking cannabis.
CBD is a non-psychoactive part of cannabis and people don’t have impairment on this chemical.
What’s important to know, however, is that both CBD and THC have medical benefits and these benefits can increase by having the two chemicals together. This phenomenon is commonly called the entourage effect.
Dr Hardy talked about instances where both are used together, saying:
There are many instances where we use a 50:50 mix of CBD and THC or 10% of one and 90% of another in order to achieve a goal of managing someone’s pain, anxiety, or sleep the best way we possibly can while minimising the mental health fallout from the experience of cannabis intoxication at too high doses.
A comparison of the burden of disease between cannabis and other drugs.
When talking about the prevalence of cannabis use disorder in Australia, it’s important to note that we’re focussed on illicit cannabis and THC, not CBD. THC is the chemical in cannabis that drives dependence. Green-market Australian cannabis can to have quite high potencies of THC – between 15%-40%.
Research shows that as of 2020, about 11% of the population had tried cannabis in the last 12 months. It might surprise you how small the burden of disease relating to cannabis use disorder actually is.
- 16.5% of the burden of disease in this country is due to drug and alcohol problems
- Of the 16.5% about 14% is due to alcohol and nicotine.
- Between 2-3% of the 16% is due to illicit drugs.
- Opioids are responsible for about 30% of the burden of disease in the illict drug subset (2-3%)
- 20-25% is from injections and problems related to injecting drugs (of the subset 2-3%)
Cannabis use disorders contribution to the total burden of disease is about 8% of the 2-3% in Australia => Cannabis use disorder is under 1% of the total burden of disease.
So when talking about whether cannabis is causing wide-spread health problems or impacting people’s health and wellbeing negatively, cannabis is only a small factor compared to both accepted and illicit drugs.
What causes cannabis addiction (cannabis use disorder)?
The substance behind a substance use disorder is not solely about the drug itself. There are many factors that contribute to the condition. The drug focussed drivers of a cannabis use disorder include:
- Concentration or amount of cannabis smoked per day.
- Age of first use.
- Frequency of use.
There are also many other family and social determinants such as: genetics, traumas and other situations that have occurred in people’s lives that contribute to the likelihood of a cannabis use disorder.
How is cannabis use disorder diagnosed?
Diagnosing cannabis use disorder is done by establishing a dependence criteria or a use disorder criteria. This means establishing that a patient has:
- Salience (addictive or drug seeking behaviours)
In order to do this a doctor will ask the patient a number of questions including questions such as:
- How old were you when you first used cannabis?
- How much did you use then/now?
- Does it have the same effect?
- Does it still have any effect on you at all?
- What was it like when you stopped?
- Tell us about times when you haven’t been able to get this substance (cannabis)?
- What symptoms did you have?
Normally doctors ask questions about drug seeking, however getting cannabis in Australia and in most parts of the world is very easy. But, doctors assess other behaviours such as not being able to go to work, job performance dropping or family interactions becoming difficult.
So, diagnosing someone with a cannabis use disorder comes down to fulfilling these criteria and seeing if there’s a narrative of dysfunction in their life as they’ve used cannabis over time.
What percentage of medical cannabis patients develop a use disorder?
People often ask whether medical cannabis is addictive. Dr Hardy estimated that, of the number of medical cannabis patients who are treated for other conditions with medical cannabis, approximately less than 1% will develop a cannabis use disorder.
He attributed the low number to not only the fact that cannabis is a low risk substance, but also that with medical cannabis in particular, THC consumption happens at very low doses.
If we look at dosing with oils that contain THC, we’re using somewhere between one 20th and one 40th of the dose of THC that might be inhaled when someone is smoking a joint.
Cannabis, when used as medicine, is microdosed which allows people to gain the benefits of cannabis without many side effects and decreases the potential for developing a cannabis use disorder.
What percentage of adult-use cannabis consumers develop a cannabis use disorder?
Based on the research from the Australian Institute of Health and Welfare, Dr Hardy estimated that somewhere between 60 and 90%, depending on the age demographic will have tried cannabis. He said that it’s probably only about 1% or 2% who will end up with a cannabis use disorder.
Most people will try a substance once, or maybe even smoke once a week or once a month or less. And, it’s only a small percentage of people who will experience the phenomenon of daily cannabis use in sufficient doses to induce tolerance, withdrawal, and salience.
As of October 2020, a survey found that 1 in 8 Australians drink alcohol every day and 1 in 10 are drinking the recommended upper limit of alcohol consumption (10 drinks per week).
What is the treatment for cannabis addiction?
We asked Dr Hardy how those When asked about treatment for cannabis use disorder, Dr Hardy said:
One thing that needs to be remembered when it comes to any use disorder of any substance is it’s one thing to detoxify a patient. It’s another to keep them from relapsing.
The condition isn’t solely defined by the product of consideration and the patient. It actually involves a set of social, biological, physical, and psychological determinants that need to case managed in patients in order to maintain abstinence in the longer term.
He also talked about four arms of recovery:
- Therapy (via a therapist)
- A cohort of compatriots who can work together
- Internal resources
There are some pharmacological treatments to help with cannabis use disorder. Some studies show that drugs that help people desist from nicotine can be used alone or in combination with depressant medications. This may help with sleep and promote appetite for people early in the phase of withdrawal from cannabis. However, there isn’t any significant scientific evidence to show this works consistently.
Those with a use disorder need to look beyond their physician and look towards some sort of therapeutic environment, for example a therapist, where they discuss the aspects of their lives that have led them to the point where they’re using this drug as a coping mechanism.
Next, Dr Hardy recommended seeking out people who feel comfortable with discussing their condition. For some people a 12 step program can meet this need. For others it may be one of many recovery based groups which might include smart recovery or a group that a local hospital might offer.
Finally, he talked about people’s internal resources.
Some people have very poor distress tolerance. They become anxious very, very quickly. Their emotions become quite plyable. One of the things that they can do by working on those other three aspects is to develop a repertoire within themselves of internal resources that will allow them to deal with stressful situations as they arise in the future.
Cannabis is similar to other drugs in the fact that too much is not good. Cannabis can be addictive when consumed in an inappropriate manner. That said, every person is different and therefore, what may be too much for one individual might be the right amount for someone else.
What we can tell you is that smoking high potency, THC based cannabis on a daily basis increases the likelihood of an individual having a cannabis use disorder at some stage in their lives. Whether you consume cannabis via legal channels for medicinal purposes or have chosen to self-medicate, being mindful of what your body needs is the key.