eMedicine Specialties > Psychiatry > Addiction

Cannabis Compound Abuse: Treatment & Medication

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

Treatment

Medical Care

  • Acute intoxication usually resolves unremarkably within 4-6 hours and is best managed by the following measures:
    • Frequent reassurance and maintenance of a nonthreatening environment
    • Minimal stimuli
    • Use of a specifically assigned nurse to calm the patient
    • Judicious use of BZs when significant anxiety is present

Consultations

  • People who use marijuana and are suffering from biological, psychological, or social impairment from marijuana use should be evaluated and, if necessary, treated by a psychiatrist.
    • The treatment of marijuana abuse follows the general principals of substance abuse, with particular attention paid to psychological and social aspects.
    • Marijuana may be one of many drugs abused, and total abstinence from all psychoactive substances (with the exception of caffeine) is the treatment goal.
    • Interventions may include psychiatric evaluation, occupational and family assessment, and implementation of a comprehensive treatment plan.
      • Psychological issues (eg, denial, minimization, rationalization) must be confronted.
      • Often, cessation of drug use and consequent cognitive improvement result in self-motivation and changes in the occupational and social well-being of the patient.
      • Lifestyle changes, such as avoiding drug-related situations, may be encouraged.
    • Identify and address low self-esteem, mood disorders, family problems, and other stresses.
    • One-to-one therapy, group therapy, and even hospitalization may be necessary components of the treatment plan. (Patients with uncomplicated marijuana use in the absence of other psychiatric or medical problems are rarely hospitalized.)

Medication

Short-term, low-dose BZ treatment for acute intoxication has been used. Chronic psychosis associated with marijuana use (coded in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV] as either cannabis-induced disorder with delusions or cannabis-induced disorder with hallucinations) may require antipsychotic treatment. Drug therapies that diminish cravings for marijuana or intoxicating effects from marijuana use currently are not available.

Anxiolytics

Depress all levels of CNS, which in turn reduce anxiety symptoms.


Lorazepam (Ativan)

Treatment of 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 h after administration. Sedative hypnotic with 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 CNS, including limbic and reticular formation. When patient must be sedated for more than a 24-h period, this medication is excellent.

Adult

0.5-1 mg PO/IV q3-4h prn to resolve symptoms; not to exceed 4 mg in 24 h

Pediatric

0.05 mg/kg/dose IV q4-8h

Toxicity of BZs in the CNS increases when used concurrently with alcohol, phenothiazines, barbiturates, and MAOIs

Documented hypersensitivity, preexisting CNS depression, hypotension

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Caution in renal or hepatic impairment, myasthenia gravis, organic brain syndrome, or Parkinson disease

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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