Development and Consequences of Cannabis Dependence

Department of Psychiatry, University of Vermont, South Burlington 05403, USA.
The Journal of Clinical Pharmacology (Impact Factor: 2.47). 11/2002; 42(11 Suppl):28S-33S. DOI: 10.1002/j.1552-4604.2002.tb06000.x
Source: PubMed

ABSTRACT The past 10 to 15 years of clinical and basic research have produced strong evidence demonstrating that cannabis can and does produce dependence. Clinical and epidemiological studies indicate that cannabis dependence is a relatively common phenomenon associated with significant psychosocial impairment. Basic research has identified a neurobiological system specific to the actions of cannabinoids. Human and nonhuman studies have demonstrated a valid withdrawal syndrome that is relatively common among heavy marijuana users. Last, clinical trials evaluating treatments for cannabis dependence suggest that this disorder, like other substance dependence disorders, is responsive to intervention, yet the majority of patients have difficulty achieving and maintaining abstinence. Of concern, treatment seeking for marijuana dependence has increased almost twofold over the past 10 years. This report briefly reviews selected research literature relevant to our current understanding of cannabis dependence, its associated consequences, and treatment efficacy.

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    ABSTRACT: Background Emergent studies show that similar to other substances of abuse, cue-reactivity to cannabis is also associated with neural response in the brain's reward pathway (Filbey et al., 2009). However, the inter-relatedness of brain regions during cue-reactivity in cannabis users remains unknown Methods In this study, we conducted a series of investigations to determine functional connectivity during cue-reactivity in 71 cannabis users. First, we used psychophysiological interaction (PPI) analysis to examine coherent neural response to cannabis cues. Second, we evaluated whether these patterns of network functional connectivity differentiated dependent and non-dependent users. Finally, as an exploratory analysis, we determined the directionality of these connections via Granger connectivity analyses Results PPI analyses showed reward network functional connectivity with the nucleus accumbens (NAc) seed region during cue exposure. Between-group contrasts found differential effects of dependence status. Dependent users (N = 31) had greater functional connectivity with amygdala and anterior cingulate gyrus (ACG) seeds while the non-dependent users (N = 24) had greater functional connectivity with the NAc, orbitofrontal cortex (OFC) and hippocampus seeds. Granger analyses showed that hippocampal and ACG activation preceded neural response in reward areas Conclusions Both PPI and Granger analyses demonstrated strong functional coherence in reward regions during exposure to cannabis cues in current cannabis users. Functional connectivity (but not regional activation) in the reward network differentiated dependent from non-dependent cannabis users. Our findings suggest that repeated cannabis exposure causes observable changes in functional connectivity in the reward network and should be considered in intervention strategies.
    Drug and Alcohol Dependence 07/2014; DOI:10.1016/j.drugalcdep.2014.04.002 · 3.28 Impact Factor
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    ABSTRACT: Background: No studies have investigated cannabis withdrawal in indigenous or incarcerated populations, and there is currently no standard treatment for cannabis withdrawal in Australian prisons. Aims: This cross sectional survey examines cannabis use, dependence and involuntary (abrupt cessation) withdrawal in incarcerated indigenous males for the purpose of improving clinical management. Methods: 101 consenting inmates (18–40 years) from an Australian correction centre were interviewed. Demographic characteristics, lifetime cannabis use (LCU), severity of dependence, cannabis withdrawal symptoms, psychological well-being and alcohol use were measured and compared using univariate and multivariate analyses. Results: Cannabis withdrawal symptoms were reported in 57% of current cannabis users compared with 16% of non-users (p < 0.01), indicating detectable cannabis dependence and withdrawal in a unique indigenous inmate population. Multivariate analysis revealed statistically significant associations between LCU and cannabis dependence (OR = 8.1; 95% CI: 2.2–29.1) when controlling for psychological well-being and alcohol consumption. Conclusions: Upon admission to a correction centre, cannabis users should be assessed and monitored for physical and psychological symptoms of withdrawal. Implications: Routine cannabis withdrawal monitoring will maximise staff and inmate safety. This improvement to policy will ensure appropriate risk management of staff and inmates.
    Journal of Substance Use 08/2014; DOI:10.3109/14659891.2014.950702 · 0.48 Impact Factor
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    ABSTRACT: S everal jurisdictions in the U.S. have taken steps toward decriminalizing marijuana possession for personal use or when recommended by a physician for medicinal purposes. Other jurisdictions have pending ballot initiatives or legislative bills proposing such changes in the law. The Board of Directors of the National Association of Drug Court Professionals (NADCP) has determined that it is essential for Drug Court practitioners to be fully and objectively informed about the effects of marijuana on their participants and the public at-large. This document briefly reviews the scientific evidence concerning the effects of marijuana. Source: Office of National Drug Control Policy, Who' s Really in Prison for Marijuana? [NCJ #204299] (citing BJS, 1999, Substance abuse and treatment, state and federal prisoners, 1997 [NCJ #172871]; U.S. Sentencing Commission, 2001 Sourcebook of Federal Sentencing Statistics). N.R. = not reported. (CASA, 2010), less than 1 percent (0.9%) of jail and prison inmates in the U.S. were incar-cerated for marijuana possession as their sole offense. Excluding jail detainees who may be held pending booking or release on bond, the rates are even lower. Prison inmates sentenced for marijuana possession account for 0.7 percent of state prisoners and 0.8 percent of federal prisoners (see Table). And, con-sidering that many of those prisoners pled down from more serious charges, the true incarceration rate for marijuana possession can only be described as negligible. Prison inmates sentenced for marijuana possession account for 0.7 percent of state prisoners and 0.8 percent of federal prisoners.

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May 26, 2014