The legal status of cannabis is rapidly changing in the United States with a total of 33 U.S. states permitting adult use of medical cannabis and 11 states additionally permitting recreational use in 2020 (Hassin & Walsh, 2021).
What is Cannabis Use Disorder (CUD)?
The purpose of this article is to bring awareness and education to the medical and psychiatric community on providing an appropriate diagnosis for Cannabis Use Disorder (CUD). The fifth edition of the Diagnostic Statistical Manual was published in 2013. Cannabis abuse and dependence were combined in the DSM-5 into a single entity capturing the behavioral disorder that can occur with chronic cannabis use and named Cannabis Use Disorder (Patel & Marwaha, 2022).
What is Considered Appropriate Use or Inappropriate Use of Cannabis?
If you look at the criteria for CUD and you are a medical cannabis patient, you might be quite surprised that you too fit into the constructs of what constitutes cannabis use disorder. For those of you who are not familiar with the constructs they are listed here (DSM-V, 2013):
- A problematic pattern of cannabis use leading to clinically significant impairment or distress, as manifested by occurring within a 12-month period and taken in larger amounts over a longer period than was intended.
- There is a persistent desire or unsuccessful efforts to cut down or control cannabis use.
- A great deal of time is spent in activities necessary to obtain cannabis, cannabis use, or recover from its effects.
- Craving, or a strong desire or urge to use cannabis.
- Recurrent cannabis use results in failure to fulfill role obligations at work, school or home.
- Continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis.
- Important social, occupational, or recreational activities are given up or reduced because of cannabis use.
- Recurrent cannabis use in situations in which it is physically hazardous (e.g., operating heavy machinery or driving a vehicle).
- Cannabis use continues despite knowledge of having persistent physical or a psychological problem that is likely to have been exacerbated by cannabis.
- Tolerance, as defined by either: (1) a need for markedly increased cannabis to achieve intoxication or desired effect or (2) a markedly diminished effect with continued use of the same amount of the substance.
- Withdrawal, as manifested by either (1) the characteristic withdrawal syndrome for cannabis or (2) cannabis is taken to relieve or avoid withdrawal symptoms.
Ask yourself or re-assess one or more of your current cannabis patients and reflect on how many of these 11 bullet points could identify you or your patient. If you said yes to two or more, you have now captured an ICD-10 code for Cannabis Use Disorder making this a billable diagnosis for the insurance companies.
May the illumination in the darkness of the perceptions of cannabis use disorder be the wisdom gifted to you to continue to seek the wisdom and understanding of this very valuable plant. Your endocannabinoid system will thank you and so will your patients.
References
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-5 American Psychiatric Association, 2013.
Hasin, D., & Walsh, C. (2020). Cannabis Use, Cannabis Use Disorder, and Comorbid Psychiatric Illness: A Narrative Review. Journal of clinical medicine, 10(1), 15. https://doi.org/10.3390/jcm10010015
Patel J. & Marwaha R. Cannabis Use Disorder. https://www.ncbi.nlm.nih.gov/books/NBK538131/
