An update on cannabis use disorder with comment on the impact of policy related to therapeutic and recreational cannabis use

Abstract

Confusion and controversy related to the potential for cannabis use to cause harm, or alternatively to provide benefit, continues globally. This issue has grown in intensity and importance with the increased recognition of the public health implications related to the escalation of the legalization of cannabis and cannabinoid products. This selective overview and commentary attempt to succinctly convey what is known about one potential consequence of cannabis use, the development of cannabis use disorder (CUD). Such knowledge may help guide a reasonable and objective public health perspective on the potential impact of cannabis use and CUD. Current scientific data and clinical observation strongly support the contention that cannabis use, like the use of other substances such as alcohol, opioids, stimulants, and tobacco, can develop into a use disorder (addiction) with important clinical consequences. Epidemiological data indicate that the majority of those who use cannabis do not have problems related to their use, but a substantial subset (10-30%) do report experiencing symptoms and consequences consistent with a CUD. Treatment seeking for CUD comprises a substantial proportion of all substance use treatment admissions, yet treatment response rates show much room for improvement. Changing cannabis policies related to its therapeutic and recreational use are likely to impact the development of CUD and its course; however, definitive data on such effects are not yet available. Clearly, the development of more effective prevention and treatment strategies is needed for those vulnerable to developing a CUD and for those with a CUD.

The Lower-Risk Cannabis Use Guidelines’ (LRCUG) recommendations: How are Canadian cannabis users complying?

“…The behavioral uptake potential of interventions such as the LRCUG is uncertain, for example among intensive, chronic users. However, it should be emphasized that the LRCUG represent a targeted prevention measure, rather than a (self-) treatment tool for individuals possibly characterized by CUD ( Budney et al, 2019 , Caulkins and Kilborn, 2020 , Jutras-Aswad et al, 2019 ). Nevertheless, other complementary, targeted intervention measures combined with appropriate regulatory provisions focusing on specific risk behaviors (e.g., lower-risk product availability, content labeling) are required in order for a prevention tool like the LRCUG to be effective ( Caulkins and Kilborn, 2019 , Hall, 2018 , Parmar and Sarkar, 2017 ).…”

Assessing the public health impacts of legalizing recreational cannabis use: the US experience

“…More frequent use of potent cannabis may increase the prevalence of cannabis dependence, i.e. more cannabis users will experience impaired control over their cannabis use despite such use harming them 43 . The 9% risk of dependence among lifetime users in the US in the early 1990s may increase in those who use more potent cannabis products 44 .…”

Perspective: Quality Versus Quantity; Is It Important to Assess the Role of Enhancers in Complex Disease from an In Vivo Perspective?

“…In an attempt to identify drug stratification loci within the genome, we used comparative genomics to explore the regulation of the gene ( CNR1 ) encoding the cannabinoid-1 receptor (CB 1 ). The pharmacogenomics of CB 1 has gained considerable interest following the legalization of therapeutic cannabinoids in many countries around the world, including the legalization of recreational cannabis use in a number of states in the US [ 67 ]. We used comparative genomics to identify a polymorphic enhancer region within intron1 of the CNR1 locus that lay in strong linkage disequilibrium (LD; a phenomenon where groups of alleles travel together in a population) with a group of SNPs that had been previously associated with addictive behaviors [ 68 ].…”