What is the medical diagnosis associated with the use of cannabis (marijuana)?

From the Guidelines

The medical diagnosis with the use of legal weed is a complex issue that requires careful consideration of the potential risks and benefits, particularly in relation to cancer, psychiatric, and cardiovascular effects, as highlighted in the 2024 ASCO guideline 1. The use of cannabis and cannabinoids in adults with cancer has been associated with various side effects, including liver enzyme elevation and drug-induced liver injury, with a pooled proportion of elevated liver enzymes of 0.07 (95% CI, 0.05 to 0.12) and a pooled proportion of those with drug-induced liver injury of 0.03 (95% CI, 0.10 to 0.06) 1. Some of the key areas of concern include:

• GI: Cannabinoid hyperemesis syndrome, characterized by cyclical emetic episodes, which can be relieved by hot showers, and is often preceded by high-dose cannabis use 1.
• Cardiovascular: Arrhythmias and orthostatic hypotension, although there is no evidence of a higher incidence of cardiovascular disease or associated mortality with cumulative lifetime use 1.
• Psychiatric: Long-term psychiatric risks, including an increased risk of developing depressive disorders, exacerbating psychiatric disorders in vulnerable individuals, and cannabis use disorders, which can affect up to 10% of adults with chronic cannabis use 1.
• Driving Safety: Cannabis users are at a higher risk of motor vehicle accidents, with a meta-analysis showing that drivers who test positive for cannabis or self-report using cannabis are more than twice as likely to be involved in motor vehicle crashes 1. It is essential for clinicians, adults with cancer, and caregivers to understand the degree of risk for the emergence of long-term side effects with cannabis and/or cannabinoid use, as emphasized in the 2024 ASCO guideline 1 and supported by the American College of Physicians' position paper 1. Therefore, a thorough medical evaluation and monitoring are crucial when using legal weed, particularly in vulnerable populations, to minimize the risk of adverse effects and ensure the best possible outcomes in terms of morbidity, mortality, and quality of life.

From the Research

Medical Diagnosis with Legal Weed

The medical diagnosis related to the use of legal weed, also known as medicinal cannabis, is a complex issue that has been studied in various research papers. Some of the key points related to medical diagnosis with legal weed are:

• Chronic pain management: Medicinal cannabis has been shown to be effective in managing chronic pain, especially neuropathic and nociplastic pain or pain with an inflammatory component 2, 3.
• Mental health conditions: Medicinal cannabis has been used to treat various mental health conditions, including anxiety, depression, and insomnia, with varying degrees of success 2, 4, 5.
• Combination therapies: Combination tetrahydrocannabinol (THC)/cannabidiol (CBD) medicines or CBD-only medicines have been shown to be effective in treating chronic pain and mental health conditions, with CBD-only medicines having a better safety profile 2.
• Adverse effects: Medicinal cannabis can have adverse effects, including dose-dependent adverse events, and can exacerbate certain conditions, such as depression, psychosis, and suicide 2, 5.
• Patient-centered approach: A patient-centered approach to evaluating the role of medical cannabis in the treatment of chronic pain is necessary to ensure that patients, providers, and policy makers can make informed decisions on medicinal cannabis use 6.

Key Findings

Some of the key findings related to medical diagnosis with legal weed are:

• Medicinal cannabis can provide short-term relief for certain symptoms, but it is not a cure and can have mental health risks 5.
• High doses of CBD can provide acute relief in anxiety, while CBD + THC combinations can alleviate withdrawal in cannabis use disorder and improve sleep 5.
• THC can be associated with dose-dependent adverse events and deterioration of primary study outcomes, such as in psychosis 5.
• Patient engagement in informing additional research is necessary to ensure that patients, providers, and policy makers can make informed decisions on medicinal cannabis use 6.

Conditions Treated with Medicinal Cannabis

Some of the conditions that have been treated with medicinal cannabis include:

• Chronic pain 2, 3, 6
• Anxiety disorders 4, 5
• Depression 2, 4, 5
• Insomnia 2, 5
• Psychosis 4, 5
• Substance use disorders 4, 5
• Autism spectrum disorder 5
• Attention-deficit hyperactivity disorder 5
• Obsessive-compulsive disorders 5
• Anorexia nervosa 5
• Bipolar disorders 5