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Medical Cannabis Patients at Lower Risk of Developing Cannabis Use Disorder, Study Finds

By Leo Bear-McGuinness

Published: Aug 30, 2023   
Person about to light a cannabis cigarette.

Image credit: iStock

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A significant minority of medical cannabis patients go on to develop cannabis use disorder (CUD), according to a new study. This proportion, however, is still lower than the proportion of recreational consumers with CUD.

After conducting a survey of patients in Washington – which has had a legal recreational cannabis market since 2014 – the researchers observed that 13.4% of medical cannabis patients displayed CUD symptoms; among the patients who claimed to only use cannabis recreationally, 22.4% showed similar CUD signs.

Disordered smoking

Some 22 million people around the world reportedly live with CUD, a condition typified by cravings and withdrawal symptoms when marijuana isn’t taken.

This condition is usually associated with recreational cannabis,but the new study – published in JAMA Network Open – shows that CUD is present among medical cannabis patients, too.

To get their data, the researchers from the University of Washington conducted a survey within the Kaiser Permanente health care company in Seattle. Respondents were asked if they consumed cannabis in the past 30 days and, if so, what kind? Recreational or medical? CUD severity was determined via a checklist of symptoms, including cravings, withdrawal, and “failed attempts to cut down”.

After sifting through the results of 1,463 participants, the researchers found that 13.4% of medical cannabis-only participants met the criteria for a CUD diagnosis; 22.4% of nonmedical participants met the criteria; 25.6% of participants who used cannabis for both purposes met the criteria.

Among these participants, 1.3% of medical cannabis-only participants met the criteria for moderate-to-severe CUD; 7.2% of nonmedical participants met these criteria along with 7.5% of participants who used cannabis for both purposes.

The researchers behind the paper say that, as legal recreational cannabis use continues to increase across the US, their results underscore the importance of assessing patient cannabis use and CUD symptoms in medical settings.

Medical cannabis and CUD

The University of Washington study isn’t the first to demonstrate that medical cannabis patients can develop CUD.

In 2022, another study surveyed 905 people in Australia who used illicit cannabis to treat a medical condition. About a third (32%) of these participants met the criteria for CUD. Yet these medical cannabis users weren’t patients in the traditional sense. While medical cannabis is legal in Australia, the vast majority of survey respondents (98%) sourced their drugs from the illicit market.

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

One study published inLancet 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.”


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