Lecture on Cannabis Use and Treatment

Introduction

• Speaker: Addiction psychiatrist at UC Davis
• Location: Substance Use Disorders Treatment Clinic
• Focus of Lecture: Cannabis use and its implications

General Overview

• Cannabis use is widespread across various age groups.
• Frequent use is clustered at lower ages, but lifetime use is common even in older populations.
• Cannabis is often marketed like alcohol, normalizing its use.

Legal Status and Spending

• Most U.S. states have legalized cannabis in some form.
• Cannabis spending has been increasing, particularly for adult or recreational use.
• Comparison: Alcohol spending remains significantly higher than cannabis.

Public Perception

• Views on cannabis are polarized.
• Some view it as dangerous, others as a harmless panacea.

Cannabis and the Endocannabinoid System

Discovery and Receptors

• Discovered in the late 1980s:
  • CB1 and CB2 receptors found in human and rat brains.
  • Found across various body systems.
• Endogenous ligands include 2-AG and anandamide.

Characteristics of Endocannabinoids

• Act differently from classic neurotransmitters.
• Widely distributed receptors contribute to diverse effects.

FDA-Approved Cannabis Medications

• Current approved uses:
  • AIDS anorexia
  • Chemotherapy-induced nausea and vomiting
  • Pediatric epilepsy
• Future potential for multiple sclerosis treatment with THC and CBD.

Research and Challenges

• Significant ongoing research with over 400 trials in the U.S.
• Complexity of cannabis composition hinders clinical research.

Components of Cannabis

• Delta-9 THC and CBD are the main compounds.
• Terpenes have undefined roles and effects.
• Marketing often uses misleading distinctions between strains like "sativa" and "indica."

User Perspectives

• Cannabis is advertised with "Entourage effects," though evidence is lacking.
• Products marketed as distinct often are not.

Regulation and Medicinal Cannabis

• California Department of Cannabis Control oversees regulation.
• Medicinal cannabis requires a physician's recommendation.
• California legislature defines indications, allowing broad access.

Understanding Usage

• Cannabis use is diverse: flower, wax, oil, edibles, etc.
• Key factors: source of cannabis (dispensary vs. street), route of use, and frequency.
• Smoking/vaping vs. ingestion impacts onset and risk.

Safe Use and Guidelines

• Expert consensus offers guidelines for safer use:
  • Avoid synthetic cannabinoids.
  • Prefer non-smoking methods.
  • Avoid daily use to reduce the risk of addiction.

Risks and Withdrawal

• Cannabis withdrawal symptoms include anxiety, irritability, and sleep issues.
• Withdrawal often delayed due to THC's lipophilic nature.

Current Resources

• Use reliable sources for information:
  • National Academy of Sciences report.
  • Center for Medicinal Cannabis Research.

Treatment of Cannabis Use Disorders

• No established pharmacotherapy; focus on psychosocial treatments.
• Peer support groups like Marijuana Anonymous.
• Gabapentin may help alleviate withdrawal symptoms.

Conclusion

• Cannabis has diverse and complex effects on the body.
• Ongoing research and regulation continue to shape understanding and management of cannabis use.