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CUD and THC Tolerance

March 9, 2021 – By Sandy Yanez

High tolerance is costing you more than just your money.

Cannabis use has become increasingly accepted socially and legally, for both recreational and medicinal purposes. Without reliable information about the effects of cannabis, people cannot make informed decisions regarding its use

Cannabis tolerance develops when the medication no longer works as well as it once did. Cannabis dependence or addiction can develop from tolerance by the continued use and adding higher and higher doses in an attempt to produce results.

Statistics

Current statistics show in 2020 there were 41.9 million cannabis users, and it is predicted in 2021 this will increase to 42.9 million, and by 2025 it is estimated there will be over 46 million cannabis users. Of these numbers 9% of the cannabis users will develop cannabis use disorder. Now 9% doesn’t sound like a large number but that’s roughly 3,690,000 million people who will become dependent on cannabis.

Cannabis use disorder can happen from a few different factors. 1) Cannabis use disorder can be caused from a lack of education provided form dispensaries and physicians to the patients, allowing the patient to self-medicate at the wrong dose, 2) the patient has an underlying state which they might be trying to run from and use cannabis as the escape, 3) or a genetic variant.

CUD Defined

Cannabis use disorder (CUD) is defined as the continuous use of cannabis despite harmful or adverse effects. CUD by the Diagnostic and Statistical Manual of Mental Disorders DSM-5, is defined as having a minimum of two of the following symptoms:

  • Development of high tolerance as defined by either the (1) need to increase cannabis to achieve desired effects or (2) markedly diminished effect with continued use of the same amount of the substance
  • Consuming larger amounts than intended
  • There is a desire or unsuccessful efforts to cut down or control use
  • Craving cannabis or a strong desire, urge to use cannabis
  • Missing or giving up social, recreational activities
  • Psychological issues exacerbated by cannabis
  • Failure to meet daily obligations
  • Problems at work, school, and home as a result of use
  • Taking cannabis in high-risk situations
  • A great deal of time is spent in activities necessary to obtain cannabis, use cannabis, or recover from its effects
  • Withdrawal, as manifested by either (1) the characteristic withdrawal syndrome for cannabis or (2) cannabis is taken to relieve or avoid withdrawal symptoms

Long Term Effects

Long term effects of cannabis use disorder include:

  • Central Nervous System – problems with memory, learning, problem-solving, coordination, and pleasure
  • Psychiatric – depression, increased risk of psychosis, and anxiety
  • Respiratory – chronic bronchitis and bronchial irritation, bronchospasm
  • Cardiovascular – heart palpitations, irregular beat, racing heartbeat, positional hypotension
  • Gastrointestinal – changes in bowel habits, appetite changes, nausea and vomiting

Treatment

Currently there are no FDA approved medications to treat CUD. Treatment for CUD includes the medications Lofexidine, which is used for opiate withdrawal and has serious side effects that may affect the heart, blood vessels, and may cause very low blood pressure. Gabapentin is an anti-convulsant and is also used to treat neuropathic pain. Side effects to gabapentin include difficulty with coordination and concentration with possible depression and suicidal tendencies. N-acetylcysteine, originally designed for treating Tylenol overdose, inhibits FAAH which may contribute to reduced withdrawal symptoms.

Therapies used in conjunction with medications include cognitive behavioral therapy (CBT) which teaches patients strategies to identify and correct behaviors that lead to substance abuse, contingency management (CM) which monitors target behaviors and rewards possible behavior changes and can lead to longer periods of abstinence during treatment, and motivational enhancement treatment (EMT) which is designed to engage individuals who are ambivalent about treatment. Holistic treatment known as complementary and alternative medicine (CAM) incorporates meditation, biofeedback, hypnosis, or progressive muscle relaxation, as part of the recovery practice.

CBD

Research has found that cannabidiol (CBD) is successful in treating CUD and the patient does not have to stop cannabis use to see results. CBD can either dampen an out-of-control high, balance it, or boost it. This paradoxical effect of CBD is dependent upon an often-overlooked factor: dosage. Low doses of CBD will enhance the effects of THC, which in turn reduces the increased use of THC to receive the desired effects. A high dose of CBD will reduce and almost totally inhibit the euphoric effects of THC, while retaining THCs benefits. Scientists found that THC and CBD are the power couple of cannabis compounds—they work best together.

“Start low, go slow”

“Start low” refers to cannabis’ concentration of the intoxicating cannabinoid THC. Commercial cannabis flower typically ranges from 17% to 30% THC, and new users should aim for the low end of that spectrum. Selecting a cultivar that contains a combination of THC and the non-intoxicating cannabinoid CBD can also help minimize THC’s potential to cause anxiety and paranoia.

“Go slow” refers to the rate of cannabis inhalation/ingestion. When smoking or vaping cannabis flower, take a small puff or two, then wait 10-20 minutes to gauge the effects.

Cannabis that is not inhaled but ingested (cannabis-infused food items), known as “edibles”, comes with its own dosing rules. Whereas smoking or vaping cannabis delivers effects within minutes, ingesting cannabis requires a wait with effects not felt for 1-2 hours after ingestion. And while the effects of smoked cannabis dissipate within an hour or two, the effects of edible cannabis can stick around for upwards of six hours. It is best for beginners’ to start with smoking/vaping or tinctures rather than ingesting edible cannabis.

Tips for Recovery Before it Escalates to Addiction:

  • Think about your patterns of cannabis consumption. Being aware of how much you consume and how often will help you set out a plan to reduce while monitoring the progress.
  • Analyze the reasons behind your cannabis use. Whatever your reason, outlining them clearly will help you differentiate between when you should rather hold back on the cannabis.
  • It is difficult to change patterns of behavior, which is why it is important that you plan and record your cannabis consumption. Telling someone you trust is a good idea as they can help keep you accountable and on track.
  • Make a step-by-step plan for change. I know that it is not desirable to plan your consumption, but if your cannabis use is problematic, a step-by-step plan, when followed, will keep you on track.
  • Reflect on the effects of your cannabis weekly. Check whether there are any improvements in the adverse outcomes whether its’ concerned with finances, relationships, or health. Reflections also serve as motivation as you see the victory you’ve gained from your own intervention.
  • Staying positive and staying active are also important aspects when trying to recover from problematic use. Give yourself credit where it is due and make time for yourself through activities that keep you active and further boost your health. Daily affirmations, yoga, jogging, meditation and simply working out at the gym are a few examples of things that you would benefit from.
  • Take tolerance breaks.
  • Use a variety of different strains to avoid building up a tolerance to that strain.
  • Avoid adding tobacco to cannabis.

Patterns of cannabis use develop without much thought, however, changing them requires thought and intentional action. Luckily, the staff here at Plant Family Therapeutics cares about you and your health. If you feel you need help with Cannabis Use Disorder, please contact us for a free professional medical cannabis consult.

References

Dean, O., Giorlando, F., & Berk, M. (2011). N-acetylcysteine in psychiatry: Current therapeutic evidence and potential mechanisms of action. Journal of psychiatry &neuroscience: JPN, 36(2), 78-86. https://doi.org/10.1503/jpn.100057

Drugs.com (na) Lofexidine and Gabapentin https://www.drugs.com/

Freeman, T., Hindocha, C., Baio, G., Shaban, N., et al. (2020). Cannabidiol for the treatment of cannabis use disorder: A phase 2a, double-blind, placebo-controlled, randomized, adaptive Bayesian trail. The Lancet Psychiatry, 7(10)838-874. https://doi.org/10.1016/S2215-0366(20)30290-X

Hindocha, C., Freeman, T., Schafer, G., et al., (2019). Acute effects of cannabinoids on addiction endophenotypes are moderated by genes encoding the CB1 receptor and FAAH enzyme. Wiley. v25 (3) https://doi.org/10.1111/adb.12762

Marijuana statistics (2019) Talbottcampus.com. https://talbottcampus.com/marijuana-statistics/

NIDA (2020). Available Treatments for Marijuana Use Disorders. https://www.drugabuse.gov/publications/research-reports/marijuana/available-treatments-marijuana-use-disorders.    

Patel, J & Marwaha, R. (2020) Cannabis use disorder. StatPearls, Treasure Island (FL). P1-28 https://www.ncbi.nlm.nih.gov/books/NBK538131/#_NBK538131_pubdet_

Sherman, B. J., & McRae-Clark, A. L. (2016). Treatment of cannabis use disorder: Current science and future outlook. Pharmacotherapy, 36(5), 511–535. https://doi.org/10.1002/phar.1747

Solowij, N., Broyd, S., Greenwood, L., van Hell, H., Martelozzo, D., Rueb, K., et al., (2019). A randomised controlled trial of vaporised Δ9-tetrahydrocannabinol and cannabidiol alone and in combination in frequent and infrequent cannabis users: Acute intoxication effects. European Archives of Psychiatry and Clinical Neuroscience. doi:10.1007/s00406-019-00978-2