Marijuana

 Marijuana in America embodies a complex love/hate relationship as it remains a Schedule I drug despite its recognized medicinal benefits for conditions like migraines and nausea. I also support complementary/alternative practices. However, while its recreational legalization has gained traction, the lack of consistent medical guidelines leaves providers and patients navigating a gray area. Many self-medicate with marijuana or other substances, further complicating discussions around its potential for addiction, which the DSM defines vaguely. With no approved treatments for cannabis use disorder, perspectives on its usage vary widely—from complete abstinence to daily consumption—highlighting the tension between its medicinal promise and the serious risks of addiction. DSM 5 Criteria for Cannabis Disorder: 

Treating Marijuana Use and Associated Conditions

1. Encourage Abstinence
   • Children: Educate on avoiding marijuana use entirely by addressing risks like worsening anxiety, paranoia, and potential laced products.
   • Adults: Focus on harm reduction, continuing education about marijuana’s negative effects, and addressing the underlying mood issues.
2. Target Mood Symptoms
   • For users who are unwilling or unable to abstain, focus on improving mood and sleep through SSRI/SNRIs, anxiolytics, or mood stabilizers.
   • Avoid benzodiazepines (BZDs) initially due to addiction risk, but consider them for patients who have quit marijuana and follow a strict treatment plan.
3. Reevaluate the Treatment Plan
   • Tailor plans to individual needs, addressing both substance use and broader mental health or life challenges.
   • Example: A patient who stopped marijuana but still experienced severe anxiety benefited from diazepam as a last resort after trying non-addictive treatments, enabling improved functionality and quality of life.
4. Additional Treatment Recommendations
   • Detox: Typically 5–7 days with symptoms like nausea, vomiting, headaches, anxiety, insomnia, and irritability. Supportive measures include rest, fluids, and symptom-targeted medications (e.g., promethazine, acetaminophen).
   • Long-term Care: Use SSRIs/SNRIs for mood stabilization and psychosocial therapy to address withdrawal and dependency. Avoid BZDs for addiction treatment unless severe anxiety requires it.

Key Takeaways

• Avoid one-size-fits-all approaches; consider individual circumstances and goals.
• Combine substance use management with broader quality-of-life improvements to prevent relapse.

What If Marijuana is Used Responsibly?

Responsible marijuana use involves moderate consumption and obtaining a marijuana card to ensure legality and quality (using sources not tampered). Patients should be educated about marijuana’s legal status, regulations, and potential risks such as legal issues or job loss. Nurse practitioners cannot issue marijuana cards or prescribed it, but can refer patients to appropriate facilities. Remember medicinal uses of THC, requires medical providers –read more about the NP’s Guide to Medical Marijuana. Harm reduction should always be encouraged, even with responsible use.

Points to Remember

• Marijuana refers to the dried leaves, flowers, stems, and seeds from the Cannabis sativa or Cannabis indica plant.
• The plant contains the mind-altering chemical THC and other related compounds.
  People use marijuana by smoking, eating, drinking, or inhaling it.
• Smoking and vaping THC-rich extracts from the marijuana plant (a practice called dabbing) is on the rise. THC over activates certain brain cell receptors, resulting in effects such as altered senses, changes in mood, impaired body movement, difficulty with thinking and problem-solving, impaired memory and learning
• Marijuana use can have a wide range of health effects, including hallucinations and paranoia, breathing problems, and possible harm to a fetus’s brain in pregnant women
• The amount of THC in marijuana has been increasing steadily in recent decades, creating more harmful effects in some people.
• It’s unlikely that a person will fail a drug test or get high from passive exposure by inhaling secondhand marijuana smoke.
• There aren’t any reports of teens and adults dying from using marijuana alone, but marijuana use can cause some very uncomfortable side effects, such as anxiety and paranoia and, in rare cases, extreme psychotic reactions.
• Marijuana use can lead to a substance use disorder, which can develop into an addiction in severe cases.
• No medications are currently available to treat marijuana use disorder, but behavioral support can be effective.

-Drug Abuse