Cannabis use disorder an issue alongside increased normalization

With legalization of cannabis sweeping the nation—Ohio the most recent convert, starting sales of recreational pot in August—use of the drug has been increasing too. With this uptick in use and a widespread acceptance of cannabis, however, also come reports of misuse: Data show cannabis use disorder is more prevalent than ever.

A study by Columbia University researchers found that three in 10 people who reported using cannabis developed cannabis use disorder. This fairly new condition is characterized by a craving to use cannabis, an inability to stop or decrease use and interruptions in social life or relationships.

And local physicians are seeing it in patients across the age spectrum.

Cannabis is probably the most common substance Elizabeth Cuevas sees people using in her work as an internal medicine physician with Allegheny Health Network.

“It’s so common for people to smoke casually that it’s hard to point out that, actually, marijuana can have adverse effects,” she said. “A lot of people think marijuana is helping them relieve their symptoms.”

Daniel Salahuddin, a psychiatrist and family medicine physician at Sto-Rox Family Health Center, said 50% to 80% of his patients use cannabis on a regular basis: “It’s just a part of life,” he said.

While millions of Americans use cannabis to help them sleep, increase appetite, reduce nausea, or just to relax and have fun, physicians want people to know that it’s not completely benign.

“Cannabis use has become incredibly normalized in our society,” said Salahuddin. “There’s this pretty antiquated thought that cannabis is not an addictive drug.”

Cannabis use disorder may be increasing in part due to the changing nature of cannabis products. One report from the Drug Enforcement Administration shows cannabis seized by the agency in 1995 had an average THC concentration of 4% (THC is the main intoxicating compound in cannabis that makes users feel “high.”) By 2015, it was 15%.

And dispensaries sell even more potent products, like Rick Simpson Oil, which is a highly concentrated form of THC extract.

A 2022 study published in The Lancet found a link between higher potency cannabis and increased rates of both psychosis and cannabis use disorder.

These findings are especially important for adolescents to heed, as cannabis impacts the developing brain differently.

“The earlier you start smoking marijuana, the higher the risk is that you’re going to continue to smoke it, and that you may eventually have a use disorder around smoking it,” said Cuevas. “People can develop those early associations in life regarding how cannabis makes them feel.”

Researchers are still learning about the hundreds of compounds within the cannabis plant and how they work together to create the effects felt when using it—especially regarding how the body responds to long-term use.

Cuevas and Salahuddin have both noticed negative impacts of regular cannabis use on the mood of their patients, leading to depression, anxiety and irritability. Many use cannabis to relieve their anxiety, said Cuevas, not knowing that long-term use could be exacerbating those effects.

“We’re at the tip of the iceberg in terms of understanding the impact of cannabis and how it affects the body,” said Salahuddin.

But the blame shouldn’t lie with individual users, he stressed. Salahuddin sees the consequences of chronic cannabis use as a larger symptom of a sick society.

“One of the biggest things I see in the clinic is that weed is a lot of people’s primary coping mechanism,” he said. “We live in a world ridden with trauma. When people are starting to develop habitual use, that’s a way to feel better. To relax, calm down, numb yourself out.”

The pandemic heightened social isolation and loneliness, he pointed out, and inflation has been stretching people’s ability to afford things like rent and groceries.

“None of this occurs in a vacuum,” Salahuddin said. “What can we be doing to institute community-based care and adequate mental health support?”

In her work as an addiction medicine physician at the Center for Inclusion Health, Cuevas has also noticed substance use overall has increased, and a changing drug supply has shifted people’s habits.

“The amount of substance use happening now compared to earlier (in my career) is huge,” she said. “And the health consequences are remarkable.”

Few treatments for cannabis use disorder exist, and stopping or decreasing use can be incredibly difficult, said Cuevas. Behavioral interventions like cognitive behavioral therapy may be first-line treatments for helping people get to the root of why they’re using.

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