N Engl J Med
Cannabis use disorder: How to determine if patients meet diagnostic criteria
Use of cannabis has been linked to increased motor vehicle crashes, suicidality, cardiovascular conditions, and pulmonary disease. Cannabis use disorder involves cannabis use despite adverse consequences. An estimated 16 M people in the U.S. have the disorder. While it can occur in any age group, it is typically seen in young adults (median age at onset, 22 years). It is estimated that 14%of 18-to-25-year-olds in the U.S. have cannabis use disorder, and longer duration of use is linked with higher prevalence. The condition often coexists with other psychiatric conditions, such as other substance use disorders (e.g., alcohol, tobacco), depression, generalized anxiety disorder, or PTSD.
The U.S. Preventive Services Task Force recommends that adolescents and adults receive screening for substance use disorders (including cannabis) when services for accurate diagnosis and effective treatment can be made available.
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Diagnostic Criteria* for Cannabis Use Disorder
Diagnosis requires 2 or more of the following criteria in a 12-month period. Severity: Mild = 2 - 3 criteria, Moderate = 4 - 5 criteria, Severe = 6+ criteria. Partial remission is defined as no longer meeting any criteria for cannabis use disorder x 3 months. Full remission is defined as zero criteria x 12 months.
Impaired control over cannabis use
1. Using cannabis for longer periods of time than intended or using larger amounts than intended
2. Unsuccessful in reducing or controlling cannabis use, despite wanting to do so
3. Spending a great deal of time getting or using cannabis or recovering from its use
4. Strong desire or craving to use cannabis
Social impairment due to cannabis use
1. Failure to fulfill major role obligations at work, school, or with family due to cannabis use
2. Continued cannabis use despite having persistent cannabis-related interpersonal or social problems
3. Giving up or reducing time spent on important activities because of cannabis use
Risky use of cannabis
1. Repeated use of cannabis in physically dangerous situations
2. Continued use of cannabis even though the person is aware that use is likely to be causing or worsening a cannabis-related physical or psychological problem
Pharmacologic indicators
1. Tolerance. With chronic cannabis use, the effects of cannabis decrease when it is repeatedly used in the same amount, or the amount of cannabis needed to achieve the same effects must be increased
2. Withdrawal. Either a typical cannabis withdrawal syndrome or use of cannabis to avoid experiencing a withdrawal syndrome
* From theDiagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision
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Source:
Gorelick, D. (2023, Dec. 14). N Engl J Med (2023;389:2267-75). https://www.nejm.org/doi/full/10.1056/NEJMra2212152