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Abstract
Confusion and controversy related to the potential for cannabis use to cause harm,
or alternatively to provide benefit, continues globally. This issue has grown in intensity
and importance with the increased recognition of the public health implications related
to the escalation of the legalization of cannabis and cannabinoid products. This selective
overview and commentary attempt to succinctly convey what is known about one potential
consequence of cannabis use, the development of cannabis use disorder (CUD). Such
knowledge may help guide a reasonable and objective public health perspective on the
potential impact of cannabis use and CUD. Current scientific data and clinical observation
strongly support the contention that cannabis use, like the use of other substances
such as alcohol, opioids, stimulants, and tobacco, can develop into a use disorder
(addiction) with important clinical consequences. Epidemiological data indicate that
the majority of those who use cannabis do not have problems related to their use,
but a substantial subset (10–30%) do report experiencing symptoms and consequences
consistent with a CUD. Treatment seeking for CUD comprises a substantial proportion
of all substance use treatment admissions, yet treatment response rates show much
room for improvement. Changing cannabis policies related to its therapeutic and recreational
use are likely to impact the development of CUD and its course; however, definitive
data on such effects are not yet available. Clearly, the development of more effective
prevention and treatment strategies is needed for those vulnerable to developing a
CUD and for those with a CUD.
Lack of current and comprehensive trend data derived from a uniform, reliable, and valid source on alcohol use, high-risk drinking, and DSM-IV alcohol use disorder (AUD) represents a major gap in public health information.
The cannabis plant (Cannabis sativa L.) and products thereof (such as marijuana, hashish and hash oil) have a long history of use both as a medicinal agent and intoxicant. Over the last few years there have been an active debate regarding the medicinal aspects of cannabis. Currently cannabis products are classified as Schedule I drugs under the Drug Enforcement Administration (DEA) Controlled Substances act, which means that the drug is only available for human use as an investigational drug. In addition to the social aspects of the use of the drug and its abuse potential, the issue of approving it as a medicine is further complicated by the complexity of the chemical make up of the plant. This manuscript discusses the chemical constituents of the plant with particular emphasis on the cannabinoids as the class of compounds responsible for the drug's psychological properties.
Laws and attitudes toward marijuana in the United States are becoming more permissive but little is known about whether the prevalence rates of marijuana use and marijuana use disorders have changed in the 21st century.