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Cannabis Use Disorder Is Just As Common Among Medical Cannabis Patients, Study Finds

By Leo Bear-McGuinness

Published: Feb 16, 2022   
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Some 22 million people around the world reportedly live with cannabis use disorder (CUD), a condition typified by cravings and withdrawal symptoms when marijuana isn’t taken.

This condition is usually associated with recreational cannabis, but a new study has found that CUD is just as prevalent among medical cannabis users – at least, those who are self-medicating with illicit cannabis.

Published in Drug and Alcohol Review, the study surveyed 905 people in Australia who used illicit cannabis to treat a medical condition. About a third (32 percent) of these participants met the criteria for CUD.

A CUD survey

To get their data, the researchers from the University of Sydney used an existing survey of medical cannabis patients in Australia from 2018-2019.

While medical cannabis is legal in Australia, the vast majority of survey respondents (98 percent) sourced their drugs from the illicit market.

To determine if the respondents had CUD or not, the researchers looked at the yes/no responses to several key statements such as: “I often take cannabis in larger amounts or over a longer period of time than I intended to” and “My cannabis use results in failure to fulfil my major role obligations at work, school or home”.

While most participants displayed a seemingly healthy relationship with their cannabis, 32 percent met the criteria for CUD and 12.9 percent met the criteria for moderate-to-severe CUD.

Among these CUD participants, the most common CUD-associated attributes were withdrawal (35 percent), tolerance (21 percent), cravings (18 percent), and using cannabis longer than intended (16 percent).

Participants were more likely to display CUD if they were younger, consuming their cannabis via inhalation (as opposed to edibles or oils), and were treating a mental health condition.

Different estimates of CUD among recreational consumers have put the proportion between 22 and 32 percent. As such, the researchers at the University of Sydney say medical cannabis consumers seem just as likely to exhibit CUD as their recreational counterparts.

“Our study highlights that CUD is not an uncommon condition amongst people using cannabis to treat medical conditions, with rates comparable to populations of people who use cannabis for recreational purposes,” the researchers wrote in their conclusion.

However, the research team acknowledge that their conclusion may not apply to patients of legal, pharmaceutically-produced medical cannabis. The majority of the participants in their study sourced their cannabis from the illicit market and 64 percent claimed to use their medication recreationally, too.

“It may be that the probability of developing CUD differs between users who only use it for solely for medical reasons, those who use it both recreationally and medically and those who use it solely recreationally,” the researchers opine in their study. “Future studies should also examine CUD profiles in these three different sub-groups.”

A cure to CUD?

Several studies have investigated whether certain compounds can help treat CUD. And many of those investigated compounds have been cannabinoids.

One study published in Lancet Psychiatry in 2020 involved a randomized controlled clinical trial of CBD. The researchers found that CUD participants who took CBD had more cannabis- abstinent days compared to those given a placebo.

“We know that CBD has contrasting effects to THC on the endocannabinoid system,” Dr Tom Freeman, an addiction researcher at the University of Bath and lead author of the study, told Analytical Cannabis at the time.

“We know that THC is a partial agonist at cannabinoid receptors. But CBD has minimal direct activity at cannabinoid receptors.”

“At the same time, it does have properties that could be helpful in treating cannabis use disorder, such as inhibiting the effects of other ligands acting on the CB1 receptor and increasing endocannabinoids. And this is a potential mechanism through which it could be acting to alleviate the cannabis use disorder and help people cut down their use.”

Published in 2019 in JAMA Internal Medicine, another study from the University of Sydney found that participants treated with both counselling and the CBD:THC-mouth spray Sativex experienced fewer cannabis withdrawal symptoms and saw improvements in their physical and psychological well-being.

“This is the first study with sufficient power to allow us to draw conclusions regarding the efficacy of cannabinoid medicines for outpatient treatment of cannabis dependence,” Nick Lintzeris, the study’s lead author and professor of addiction at the University of Sydney, told Analytical Cannabis at the time.

“The counselling and regular reviews had some benefits – but that these are enhanced when combined with active medication” he added. “This is a finding generally consistent with the evidence from other areas of health care – that combined medication and counselling is often more effective than either approach alone.”


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