I’ve written about marijuana before and this love/hate relationship in America. It continues to be a schedule I substance but has medicinal value in various medical symptoms. Yet, everyone shouldn’t get “high” like your brain surgeon, the pilot, a goldfish, young kids, etc.
I understand how marijuana’s medicinal use can improve symptoms such as migraines, nausea, and so on. I also support complementary/alternative practices. However, marijuana is mainly only legalized for recreational use and continues to be a schedule I drug, thus everyone is sort of winging it medically.
In general, you’ll see many people self-medicating with marijuana or other various substances. Providers and patients also have a difficult time when calling marijuana an “addiction”. I believe one or 2 times is too much and know people that say twice a day is the best. The DSM definition is somewhat vague and there are no approved medications to treat a cannabis disorder. These challenges make marijuana abstinence a joke but addictions are very serious.
How to Treat
- Encourage Abstinence: I treat kids and the best way to avoid the marijuana path is by educating them about avoiding it in the first place. With adults, keep educating, and although they can be more difficult or set in their ways, I at least try harm reduction. I explain to kids and adults how marijuana will make your anxiety and paranoia worsen (warn about it being laced) and target the mood.
- Targeting the Mood: for those who do smoke and are determined to not abstain, continue to encourage harm reduction and target mood. Maybe the marijuana is actually alleviating mood symptoms or having this placebo effect. We don’t want to cold turkey a person but use SSRI/SNRIs, anxiolytics, or mood stabilizers to improve the anxiety or depression and target sleep. AVOID BZD (at least initially). I wouldn’t mind a BZD if the patient has successfully stopped smoking marijuana but work and agree on a treatment plan that won’t put the patient at risk for another addiction.
- Reevaluate the Treatment Plan: I had a patient that stop smoking for about 6 months (rx tests confirmed) but continued to battle severe anxiety that she couldn’t get a job or leave the house for over 10 years. I didn’t want to restart a BZD just because the patient stop smoking marijuana but I didn’t want the patient to be in limbo. It was a gamble but restarting the person on diazepam was life-changing for the good. This was after months of being on non-schedule anxiolytics so it was truly the last resort. She agreed to monthly Rx screens and was able to get a job, drive, and live happier. The patient had multiple addictions and was relatively new to me so I just assumed drugs (not anxiety) were the main reason that the person couldn’t live a functional life. It could’ve been a combination of things, therefore a treatment plan can’t just focus on drugs despite it being the main issue. Once we got some stability, we could focus on improving her quality of life that addictions usually rob a person of… Goals and maintaining responsibilities are key to preventing relapse.
- Additional Treatment: CARLAT suggested marijuana detox is initially about 5-7 days with difficult symptoms; n/v, headache, anxiety, insomnia, and irritability. Also recommended rest, fluids, and if needed promethazine or prochlorperazine for n/v and acetaminophen or ibuprofen for headaches, and any SSRI or SNRI for long-term treatment for mood symptoms. CARLAT discourages BZDs, which is true to treat a marijuana addiction but it can still be used to treat severe anxiety, which is the key difference. Stahl reported little or no evidence for pharmacological treatment for marijuana dependence or withdrawal. Withdrawal symptoms usually resolve <1-2 weeks and psychosocial therapy is recommended.
What If Marijuana is Used Responsibly
I have patients that use moderate amounts of marijuana, THC oils, edibles, etc. I still try to advocate for getting a marijuana card so a person knows the source and it’s not tampered with. Plus, it’s the legal thing to do. The FDA hasn’t approved marijuana to treat anything and the DEA still has it listed as a scheduled 1 so educate the patient how you can’t just start a weed farm, driving around with bags, selling or growing it just because… It’s heavily regulated with many different rules depending on state and reasonings. Keep educating so people hopefully won’t get arrested, lose their job, have child protective services involved, or have a series of bad events. NPs don’t issue marijuana cards, I usually refer them to their PCP. It’s mainly provided by a holistic provider or a medicinal facility. Lastly, even if a person is smoking responsibly, continue to encourage harm reduction.
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.
