History
Physicians rarely diagnose cannabis dependence because it is deemed an insignificant drug in comparison to others. Nevertheless, physicians should screen for cannabis use because it may be used in conjunction with other drugs. A motivational effect of heavy use is characterized by poor attention and goal-directed thinking or behavior.
The CAGE questions used for alcohol dependence can also be used to screen for marijuana use. The acronym CAGE stands for the main words of the four questions: cut, annoyed, guilty, and eye opener. Two or more positive responses to the following CAGE questions suggests dependence:
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Have you ever felt you ought to cut down on your use?
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Have people annoyed you by criticizing your use?
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Have you ever felt guilty about your use?
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Have you ever needed to use in the morning as an “eye opener”?
A syndrome of cyclic vomiting, termed cannabinoid hyperemesis syndrome, has been described in association with heavy, long-term use of marijuana. Patients describe severe abdominal pain and vomiting that is relieved by taking hot showers or baths. The syndrome usually resolves within days of stopping marijuana use. A study from Colorado reported that the frequency of cannabinoid hyperemesis syndrome nearly doubled after the legalization of recreational marijuana in that state. [22]
Physical
Marijuana can produce a wide range of effects, including the following:
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Conjunctival injection
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Drowsiness
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Euphoria
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Nausea
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Increased appetite
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Dryness or irritation of the nasal or oropharynx
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Hypertension
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Tachycardia
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Tachypnea
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Hypotonia
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Tremors
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Impaired motor function
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Slurred speech
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Impaired short-term memory
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Inability to perform complex tasks
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Acute psychosis
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Agitation or bizarre behavior
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Urinary retention
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Impaired reaction time
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Decreased intraocular pressure
Less objective findings include the following:
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Dose-dependent miosis may be present
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Balance or motor incoordination, as elicited by a positive Romberg sign, may be observed
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Impaired performance with cognitive functioning tasks, including serial addition/subtraction, and object recall may be observed
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Sensory function and pain perception appear to remain intact
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Flowering top of cannabis plant.
