Cannabis-Related Disorders Medication
- Author: Lawrence Genen, MD, MBA; Chief Editor: David Bienenfeld, MD more...
Short-term, low-dose benzodiazepines for treatment of significant anxiety associated with acute intoxication has been used. Clinicians are advised to use caution when administering benzodiazepines for the treatment of cannabis-induced anxiety, as the anxiety will invariable resolve with no medication over a short period. Drug therapies that diminish cravings for marijuana or intoxicating effects from marijuana use are currently not available.
These agents depress all levels of CNS, which, in turn, reduces anxiety symptoms.
Lorazepam is used for acute marijuana-associated panic or anxiety symptoms. Monitor vital signs carefully after administration. Watch for respiratory depression, ataxia, and somnolence/excess sedation. Amnesia may follow administration. Effects usually last 5-8 hours. Lorazepam is a sedative hypnotic with a short onset of effects and relatively long half-life. Increasing the action of GABA, which is a major inhibitory neurotransmitter in the brain, may depress all levels of the CNS, including limbic and reticular formation. When the patient must be sedated for more than 24 hours, this medication is excellent.
Cohen PJ. Medical marijuana: the conflict between scientific evidence and political ideology. Part two of two. J Pain Palliat Care Pharmacother. 2009. 23(2):120-40. [Medline].
Remnick D. Going the Distance. The New Yorker. Available at http://www.newyorker.com/reporting/2014/01/27/140127fa_fact_remnick?currentPage=all. Accessed: May 25, 2014.
O'Brien M. Poll: Majority of Americans Support Efforts to Legalize Marijuana. NBC News. Available at http://www.nbcnews.com/storyline/legal-pot/poll-majority-americans-support-efforts-legalize-marijuana-n17416. Accessed: May 25, 2014.
Frosch D. V.A. Easing Rules for Users of Medical Marijuana. The New York Times. Available at http://www.nytimes.com/2010/07/24/health/policy/24veterans.html?pagewanted=1&_r=1. Accessed: July 24, 2010.
MacCoun R, Reuter P. Evaluating alternative cannabis regimes. Br J Psychiatry. 2001 Feb. 178:123-8. [Medline].
van den Brink W. Forum: Decriminalization of cannabis. Curr Opin Psychiatry. 2008 Mar. 21(2):122-6. [Medline].
Abrams DI, Jay CA, Shade SB, et al. Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology. 2007 Feb 13. 68(7):515-21. [Medline].
Miller MC, et al. Medical marijuana and the mind. Harvard Mental Health Letter. April 2010. 26:1-4.
Pletcher MJ, Vittinghoff E, Kalhan R, et al. Association between marijuana exposure and pulmonary function over 20 years. JAMA. 2012 Jan 11. 307(2):173-81. [Medline].
Koppel BS, Brust JC, Fife T, Bronstein J, Youssof S, Gronseth G, et al. Systematic review: efficacy and safety of medical marijuana in selected neurologic disorders: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2014 Apr 29. 82(17):1556-63. [Medline]. [Full Text].
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, DSM-5. Washington D.C.: American Psychiatric Association; 2013.
Ringen PA, Vaskinn A, Sundet K, et al. Opposite relationships between cannabis use and neurocognitive functioning in bipolar disorder and schizophrenia. Psychol Med. 2009 Nov 6. 1-11. [Medline].
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:
National Institute on Drug Abuse: Marijuana. National Institute on Drug Abuse. Available at http://www.drugabuse.gov/drugs-abuse/marijuana.
Stinson FS, Ruan WJ, Pickering R, Grant BF. Cannabis use disorders in the USA: prevalence, correlates and co-morbidity. Psychol Med. 2006 Oct. 36(10):1447-60. [Medline].
Annual Report 2006: The State of the Drugs Problem in Europe. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).
Wilson N, Cadet JL. Comorbid mood, psychosis, and marijuana abuse disorders: a theoretical review. J Addict Dis. 2009 Oct. 28(4):309-19. [Medline].
Bosker WM, Kuypers KP, Theunissen EL, Surinx A, Blankespoor RJ, Skopp G, et al. Medicinal THC (dronabinol) impairs on-the-road driving performance of occasional and heavy cannabis users but is not detected in Standardized Field Sobriety Tests. Addiction. 2012 May 4. [Medline].
Barrigón ML, Gurpegui M, Ruiz-Veguilla M, et al. Temporal relationship of first-episode non-affective psychosis with cannabis use: a clinical verification of an epidemiological hypothesis. J Psychiatr Res. 2010 May. 44(7):413-20. [Medline].
Kuepper R, van Os J, Lieb R, Wittchen HU, Höfler M, Henquet C. Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study. BMJ. 2011 Mar 1. 342:d738. [Medline]. [Full Text].
Large M, Sharma S, Compton MT, Slade T, Nielssen O. Cannabis Use and Earlier Onset of Psychosis: A Systematic Meta-analysis. Arch Gen Psychiatry. 2011 Jun. 68(6):555-61. [Medline].
Peter Hecht. Report: African-Americans disproportionately targeted for pot. The Sacramento Bee. Available at http://blogs.sacbee.com/weed-wars/2010/06/report-african-americans-disproportionately-targeted-for-pot.html. Accessed: August 3, 2010.
Lopez-Quintero C, Perez de los Cobos J, Hasin DS, et al. Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug Alcohol Depend. 2011 May 1. 115(1-2):120-30. [Medline]. [Full Text].
Preuss UW, Watzke AB, Zimmermann J, Wong JW, Schmidt CO. Cannabis withdrawal severity and short-term course among cannabis-dependent adolescent and young adult inpatients. Drug Alcohol Depend. 2010 Jan 15. 106(2-3):133-41. [Medline].
Budney AJ, Hughes JR, Moore BA, Vandrey R. Review of the validity and significance of cannabis withdrawal syndrome. Am J Psychiatry. 2004 Nov. 161(11):1967-77. [Medline].
Allsop DJ, Norberg MM, Copeland J, Fu S, Budney AJ. The Cannabis Withdrawal Scale development: Patterns and predictors of cannabis withdrawal and distress. Drug Alcohol Depend. 2011 Dec 1. 119(1-2):123-9. [Medline].
Musshoff F, Madea B. Review of biologic matrices (urine, blood, hair) as indicators of recent or ongoing cannabis use. Ther Drug Monit. 2006 Apr. 28(2):155-63. [Medline].
Carpenter KM, McDowell D, Brooks DJ, Cheng WY, Levin FR. A preliminary trial: double-blind comparison of nefazodone, bupropion-SR, and placebo in the treatment of cannabis dependence. Am J Addict. 2009 Jan-Feb. 18(1):53-64. [Medline]. [Full Text].
Degenhardt L, Dierker L, Chiu WT, et al. Evaluating the drug use "gateway" theory using cross-national data: consistency and associations of the order of initiation of drug use among participants in the WHO World Mental Health Surveys. Drug Alcohol Depend. 2010 Apr 1. 108(1-2):84-97. [Medline]. [Full Text].
Agrawal A, Lynskey MT. The genetic epidemiology of cannabis use, abuse and dependence. Addiction. 2006 Jun. 101(6):801-12. [Medline].
Degenhardt L, Hall W. Is cannabis use a contributory cause of psychosis?. Can J Psychiatry. 2006 Aug. 51(9):556-65. [Medline].
Gruber SA, Yurgelun-Todd DA. Neuroimaging of marijuana smokers during inhibitory processing: a pilot investigation. Brain Res Cogn Brain Res. 2005 Apr. 23(1):107-18. [Medline].
Haney M, Rabkin J, Gunderson E, Foltin RW. Dronabinol and marijuana in HIV(+) marijuana smokers: acute effects on caloric intake and mood. Psychopharmacology (Berl). 2005 Aug. 181(1):170-8. [Medline].
Hurd YL, Wang X, Anderson V, Beck O, Minkoff H, Dow-Edwards D. Marijuana impairs growth in mid-gestation fetuses. Neurotoxicol Teratol. 2005 Mar-Apr. 27(2):221-9. [Medline].
Iversen L. Cannabis and the brain. Brain. 2003 Jun. 126(Pt 6):1252-70. [Medline].
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:
[Guideline] Kleber HD, Weiss RD, Anton RF, et al. Treatment of patients with substance use disorders, second edition. American Psychiatic Association. Am J Psychiatry. 2006 Aug. 163(8 Suppl):5-82. [Medline].
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. 2006 Nov 8. 85(2):114-22. [Medline].
Strasser F, Luftner D, Possinger K, Ernst G, Ruhstaller T. 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 Cannabis-In-Cachexia-Study-Group. J Clin Oncol. 2006 Jul 20. 24(21):3394-400. [Medline].
Whitcomb D. Marijuana legalization will be on California ballot. Reuters. Available at http://www.reuters.com/article/idUSTRE62O08U20100325. Accessed: July 24, 2010.
Zuardi AW, Crippa JA, Hallak JE, Moreira FA, Guimaraes FS. Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug. Braz J Med Biol Res. 2006 Apr. 39(4):421-9. [Medline].