Cannabis Use Disorder

Can You Become Addicted to Cannabis?

A common misconception is that cannabis is non-addictive; however, after regularly using cannabis for a long period, people can develop mild physical dependence. Physical dependence is where the body builds tolerance or “gets used to” having a particular drug.

If they stop using, they may experience mild withdrawal. Symptoms can include irritability, anxiety, upset stomach, loss of appetite, sweating and disturbed sleep (CAMH, 2021). These symptoms generally last for about a week, but sleep problems may continue longer (CAMH, 2021).

Note that not all people who use cannabis regularly will experience these symptoms.

Cannabis Use Disorder (CUD) is the medical term for a spectrum of patterns of cannabis use and it can range from mild, moderate, to severe, depending upon how many of the symptoms described below are present. For someone to be diagnosed with cannabis use disorder, they must have more than two of the symptoms consistently within a 12-month period (PsychDB, 2021).

Symptoms of Cannabis Use Disorder (CUD)

Taking cannabis in larger amounts and/or over a longer period than intended.
Having a strong urge to use cannabis
Unsuccessful attempts at trying to cut down or control cannabis use
Taking time away from regular activities in order to obtain cannabis, use cannabis or recover from its effects

Cannabis use is getting in the way of fulfilling obligations at work, school or home
Continuing to use cannabis despite being aware of problems it may be causing physically, emotionally or within interpersonal relationships
Cannabis use getting in the way of social or recreational activities
Continuing to use cannabis in situations where it is physically dangerous.

While all of these symptoms can be defined under the term CUD, most people who use cannabis may not experience them (PsychDB, 2021).

Using cannabis regularly or enjoying using cannabis does not necessarily mean it is “problematic”. However, if any of the above criteria apply to you and you find that cannabis use is having a negative impact on your life; it may be time to consider taking a break or reevaluating your relationship with cannabis. While the withdrawal symptoms mentioned above are described as mild and most people do not require medical supervision to quit cannabis, the symptoms may be difficult to manage if you use a heavy amount of cannabis, or if you use cannabis to cope with trauma or mental illness. If you feel you are no longer in control, it is best to seek help from a psychological and/or medical professional. If you are someone who has a prescription for medical cannabis, reach out to your cannabis clinic for advice.

What is Cannabis Tolerance?

When you are new to using cannabis or use only occasionally, you may not need very much cannabis to feel its effects. As someone uses more frequently they will notice that they start needing more cannabis to feel the same effects. This is a phenomenon known as “tolerance”. What’s happening in the body is that our cannabis “receptors” (sites in the body that interact with cannabinoids) stop reacting as strongly to THC. This is not permanent and in fact is reversible with abstinence from cannabis. Learn about the difference between THC and CBD.

When you start noticing that you are not getting the desired effects from your usual cannabis use anymore, then it’s time to take a tolerance break or switch up your habits.

Taking a tolerance break means that you abstain from using any THC for at least 2 weeks. For heavy users, it may be necessary to take at least a month break (Hirvonen et al., 2012). Even after just 2-5 days the body’s cannabis receptors will start to reverse tolerance (D’Souza et al., 2016).

CBD interacts with the body’s cannabis receptors in a different way and as a result it’s unlikely to develop tolerance like THC does (Shannon & Opila-Lehman, 2015). This is great news if you need cannabis to relax or for pain because you can still get these good effects while taking a tolerance break by avoiding THC while minimizing the withdrawal symptoms (Shannon & Opila-Lehman, 2015).

How to take a T-Break

Taking a T-break or tolerance break is simply abstaining from cannabis for a period of time, usually for 2 weeks or up to 4 weeks. If you use a heavy amount of cannabis and are nervous about taking a T-break, start a couple weeks earlier and gradually reduce the amount of cannabis you’re using. Once it’s time for the T-break, put away all your cannabis products. Out of sight out of mind! Consider re-focusing on a hobby you’ve been neglecting or plan some fun activities to distract yourself while you take your break.

This is also a perfect time to do some personal reflection on your relationship with cannabis. Take this time to focus on the benefits of cannabis and make an effort to be mindful and thankful for what this plant has to offer. Just because cannabis isn’t as addictive as hard drugs or alcohol, doesn’t mean that it’s easy for everyone to quit cold turkey. Anything you do day in and day out is going to be difficult to stop doing. Our bodies and minds crave familiar things.

If you don’t want to or are unable to take a full break away from cannabis try:

Switching up your strains

try a more balanced product with CBD or a high CBD product with little to zero THC

Try “microdosing”

or consuming a minimal amount of cannabis on a regular basis, is a popular method of use for medical purposes. In this way, you can get the benefits of THC without developing a tolerance to its effects. Microdosing provides the medication of cannabis all day, without overwhelming your body with a lot of THC.

Switch up your routine

if you use cannabis at the same times every day your body can get used to it and you may feel like you need stronger effects as you consume throughout the day. Wait until later in the day to use cannabis instead.

Using less

try using smaller rolling papers or a smaller bowl, switch to edibles to get a stronger and longer lasting effect with less cannabis, consume more slowly and try taking just a couple puffs of your joint or vape and waiting to feel the full effects before taking more

Cannabinoid Hyperemesis Syndrome

Cannabinoid hyperemesis syndrome (CHS) is caused by long-term THC-dominant cannabis use (more than 1 year) resulting in a combination of symptoms characterized by cyclic nausea and vomiting with abdominal pain without an obvious organic cause and compulsive hot water bathing behavior. Patients usually use cannabis on a daily or weekly basis. People with CHS often take hot water baths or showers multiple times a day or a single hot shower lasting for several hours. The presence of compulsive hot water bathing is an important for the diagnosis of CHS, because no other known vomiting syndrome shares this phenomenon.

The risk of developing CHS in long-term cannabis users depends on many factors and not all are well-known. Some theories on the development of CHS are:

Some people with this syndrome have a genetic variation that results in excessive levels of cannabis metabolites that promote vomiting.

THC is stored in our body’s fat cells and long-term use likely leads to THC being stored in the fat in our brain at toxic levels, which can cause vomiting.

Long-term cannabis use can cause an imbalance in internal systems leading to vomiting

Long-term cannabis use can also cause imbalances that affect a brain structure called the hypothalamus; this may explain the compulsive bathing in hot water to relieve the nausea and vomiting.

The only way to stop the symptoms of CHS is to stop using cannabis altogether. Studies show variations for the amount of time necessary to stop using cannabis can range from 1 to 3 months (Sun & Zimmermann, 2013). Full recovery from symptoms can take months but patients will find that they can slowly return to normal eating patterns, bathing frequency, and regain wellness. Restarting cannabis use will lead to a recurrence of CHS.

To lower your risk of CHS, CUD and cannabis dependency, avoid over-using cannabis. If you use cannabis medically, discuss this with your cannabis health care team to ensure that your cannabis routine suits your needs without overuse. Be mindful with how often you use cannabis and focus on other healthy ways to manage your symptoms like healthy diet, exercise and mindfulness based stress reductions techniques.

References

CAMH. (2021). Cannabis. CAMH. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/cannabis

D’Souza, D. C., Cortes-Briones, J. A., Ranganathan, M., Thurnauer, H., Creatura, G., Surti, T., Planeta, B., Neumeister, A., Pittman, B., Normandin, M., Kapinos, M., Ropchan, J., Huang, Y., Carson, R. E., & Skosnik, P. D. (2016). Rapid Changes in CB1 Receptor Availability in Cannabis Dependent Males after Abstinence from Cannabis. Biological Psychiatry : Cognitive Neuroscience and Neuroimaging, 1(1), 60–67. https://doi.org/10.1016/j.bpsc.2015.09.008

Hirvonen, J., Goodwin, R. S., Li, C.-T., Terry, G. E., Zoghbi, S. S., Morse, C., Pike, V. W., Volkow, N. D., Huestis, M. A., & Innis, R. B. (2012). Reversible and regionally selective downregulation of brain cannabinoid CB1 receptors in chronic daily cannabis smokers. Molecular Psychiatry, 17(6), 642–649. https://doi.org/10.1038/mp.2011.82

PsychDB. (2021, January 15). Cannabis Use Disorder. PsychDB. https://www.psychdb.com/addictions/cannabis/1-use-disorder

Shannon, S., & Opila-Lehman, J. (2015). Cannabidiol Oil for Decreasing Addictive Use of Marijuana: A Case Report. Integrative Medicine: A Clinician’s Journal, 14(6), 31–35.

Sun, S., & Zimmermann, A. E. (2013). Cannabinoid Hyperemesis Syndrome. Hospital Pharmacy, 48(8), 650–655. https://doi.org/10.1310/hpj4808-650