eMedicine Specialties > Psychiatry > Addiction

Cannabis Compound Abuse: Follow-up

Author: Lina Cassandra Vawter, MD, Resident, Department of Psychiatry, University of Massachusetts Memorial Medical Center
Coauthor(s): Caroline Fisher, MD, PhD, Associate Director of Psychiatric Education & Training, Assistant Professor of Psychiatry, Consulting Staff in Pediatric Neurology, Department of Psychiatry, University of Massachusetts Medical School; Medical Director and Co-owner, Pediatric Behavioral Health, LLC
Contributor Information and Disclosures

Updated: Feb 20, 2007

Follow-up

Further Outpatient Care

  • Follow-up care should be comprehensive and involve specialist services such as those provided by drug treatment units.
    • Treatment includes behavior therapy (aimed at reducing the chances of reexposure and establishing coping mechanisms to resist further use); family, group, and individual therapy; and periodic testing of urine to monitor abstinence.
    • Narcotics Anonymous (NA) is a self-help group organized on principles similar to Alcoholics Anonymous and is useful in helping addicts maintain abstinence.
    • Adolescent drug programs usually focus on promoting communication skills and age-appropriate behaviors.

Deterrence/Prevention

  • School-based programs and peer-led groups may be useful in primary prevention of marijuana abuse.
  • Voucher-based reinforcement of marijuana abstinence among individuals with serious mental illness has proven effective.

Complications

  • Marijuana use may be complicated by comorbid substance use and medical problems as outlined.
  • Marijuana abuse may result in infants with low birth weights.
  • THC is soluble in breast milk and can be passed to infants.

Prognosis

  • As with other substance abuse conditions, relapse is common, and treatment may be necessary for multiple episodes.

Patient Education

  • Inform patients about the possible carcinogenic properties of marijuana.
  • The role of marijuana as a gateway drug must be emphasized to users. Complete abstinence is the goal.
  • For excellent patient education resources, visit eMedicine's Substance Abuse Center. Also, see eMedicine's patient education articles Drug Dependence and Abuse and Substance Abuse.

Miscellaneous

Medicolegal Pitfalls

  • Failure of physicians to recognize cannabis abuse is common. People who use marijuana generally have no stigmata of marijuana abuse, and a high index of suspicion and careful urine testing may be needed to diagnose such abuse.
  • Marijuana abuse may be a factor in vehicle or machinery accidents because intoxication affects coordination and motor performance. Perform the appropriate tests for use of marijuana after these accidents.
  • Cannabis intoxication may be associated with dysphoric, irritable, or aggressive mood changes. Carefully examine patients for evidence of suicidality and homicidality, document presence or absence thereof, and manage as indicated.

Special Concerns

  • Marijuana is the most commonly used illicit drug among pregnant women and women of childbearing age in most Western societies. Studies on electively aborted fetuses demonstrated impairment of growth during midgestation. Additionally, fetuses exposed to marijuana via maternal use had lower birthweight, head circumference, foot length, and body length.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Robert C Daly, MB, ChB, MPH, BCh and Can M Savasman, MD to the development and writing of this article.



More on Cannabis Compound Abuse

Overview: Cannabis Compound Abuse
Differential Diagnoses & Workup: Cannabis Compound Abuse
Treatment & Medication: Cannabis Compound Abuse
Follow-up: Cannabis Compound Abuse
Multimedia: Cannabis Compound Abuse
References
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References

  1. Substance Abuse and Mental Health Services Administration. Results from the 2005 National Survey on Drug Use and Health: National Findings. Rockville, MD: Office of Applied Studies, NSDUH Series H-30;. 2006;DHHS Publication No. SMA 06-4194.

  2. Johnston LD, O'Malley PM, Bachman JG, Schulenberg JE. Monitoring the Future national results on adolescent drug use: Overview of key findings, 2005. Bethesday, MD: National Institute on Drug Abuse;. 2006;NIH Publication No. 06-5882.

  3. Agrawal A, Lynskey MT. The genetic epidemiology of cannabis use, abuse and dependence. Addiction. Jun 2006;101(6):801-12.

  4. Degenhardt L, Hall W. Is cannabis use a contributory cause of psychosis?. Can J Psychiatry. Aug 2006;51(9):556-65.

  5. Gruber SA, Yurgelun-Todd DA. Neuroimaging of marijuana smokers during inhibitory processing: a pilot investigation. Brain Res Cogn Brain Res. Apr 2005;23(1):107-18.

  6. Haney M, Rabkin J, Gincerson E, Foltin RW. Dronabinol and marijuana in HIV+ marijuana smokers: acute effects on caloric intake and mood. Psychopharmacology. 2005;181(1):170-178.

  7. Hurd YL, Wang X, Anderson V, et al. Marijuana impairs growth in mid-gestation fetuses. Neurotoxicol Teratol. Mar-Apr 2005;27(2):221-9.

  8. Iversen L. Cannabis and the brain. Brain. Jun 2003;126(Pt 6):1252-70.

  9. Musshoff F, Madea B. Review of biologic matrices (urine, blood, hair) as indicators of recent or ongoing cannabis use. Ther. Drug Monit. 2006;28:155-63.

  10. Ramaekers JG, Moeller MR, van Ruitenbeek P, et al. Cognition and motor control as a function of Delta9-THC concentration in serum and oral fluid: limits of impairment. Drug Alcohol Depend. Nov 8 2006;85(2):114-22.

  11. Stinson FS, Ruan WJ, Pickering R, Grant BF. Cannabis use disorders in the USA: prevalence, correlates and co-morbidity. Psychol Med. Jul 20 2006;1-14.

  12. Strasser F, Luftner D, Possinger K, et al. Comparison of orally administered cannabis extract and delta-9-tetrahydrocannabinol in treating patients with cancer-related anorexia-cachexia syndrome: a multicenter, phase III, randomized, double-blind, placebo-controlled clinical trial from the Cann. J Clin Oncol. Jul 20 2006;24(21):3394-400.

  13. Zuardi AW, Crippa JA, Hallak JE, et al. Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug. Braz J Med Biol Res. Apr 2006;39(4):421-9.

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Further Reading

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Keywords

Cannabis sativa, C sativa, marijuana, tetrahydrocannabinol, THC, hashish, ganja, pot, weed, reefer, grass, joint, roach, dope, spliff, herb

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Contributor Information and Disclosures

Author

Lina Cassandra Vawter, MD, Resident, Department of Psychiatry, University of Massachusetts Memorial Medical Center
Lina Cassandra Vawter, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Caroline Fisher, MD, PhD, Associate Director of Psychiatric Education & Training, Assistant Professor of Psychiatry, Consulting Staff in Pediatric Neurology, Department of Psychiatry, University of Massachusetts Medical School; Medical Director and Co-owner, Pediatric Behavioral Health, LLC
Caroline Fisher, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Child and Adolescent Psychiatry, and American Psychiatric Association
Disclosure: Nothing to disclose.

Medical Editor

Barry I Liskow, MD, Vice Chairman, Director Psychiatry Residency Program, Professor, Department of Psychiatry, University of Kansas Medical School
Barry I Liskow, MD is a member of the following medical societies: American Academy of Addiction Psychiatry
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

David Bienenfeld, MD, Vice-Chair, Program Director, Professor, Department of Psychiatry, Wright State University School of Medicine
David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; BMS Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Other; Northstar Grant/research funds Other; Novartis  Other; Pfizer Honoraria Speaking and teaching

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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