Is Cannabis Addictive?

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As medical cannabis gains acceptance in our society, I am seeing more people in my practice who are new or quite inexperienced with its properties.  Many of these patients are concerned that they might become addicted to cannabis.   

is cannabis addictive According to a 2011 study of recreational users of drugs, the probability of becoming dependent on cannabis is 8.9%.  Other substances are reported to have much higher risks of dependency: 67.5% for nicotine users, 22.7% for alcohol users, 20.9% for cocaine users. (1)  Recent media reports have stated that the numbers of those seeking drug treatment for cannabis dependence are rising.  But according to a recent study, 70% of Americans in drug treatment for cannabis were court-ordered to do so as part of a plea agreement, not because they are dependent on the drug. (2)  Due to continued prosecution of cannabis users, the numbers of those considered “cannabis dependent” are falsely elevated — most will choose rehab over jail time.  However, it’s clear that the majority of cannabis users, both medical and recreational, do not develop addiction issues.

Tolerance — defined as the need to use more of the drug to get the desired effect or less of an effect is achieved with a previously effective amount — has been demonstrated with THC use following repeated exposure.  Studies in animals have suggested that tolerance appears to develop due to a reduction of the available cannabinoid receptors in the brain when they are exposed to THC on a chronic basis. (3,4)  A subsequent 2012 study showed that humans have the same mechanism of tolerance.  Chronic heavy users of THC-rich cannabis had a decreased number of cannabinoid receptors when compared to non-users.  The same researchers also showed that this decrease in receptors was reversible; a 4-week abstinence from THC resulted in an increase of receptors to a normal level. (5)  Cannabidiol, the non-psychoactive cannabinoid in the cannabis plant, does not cause tolerance as it does not work directly at the cannabinoid receptors. (6)

Withdrawal — defined as the physiological and mental effects due to the cessation of use or reduction in intake of a psychoactive substance that has been regularly used to induce a state of intoxication — was previously thought not to occur with cannabis but recent research has demonstrated a withdrawal syndrome that can occur when chronic heavy use of THC-rich cannabis is stopped abruptly.  The most common symptoms associated with THC withdrawal are anxiety, depressed mood, irritability, sleep difficulty, strange or very vivid dreams, anger, and decreased appetite. Less commonly, headaches, sweating, chills, stomach pain and general physical discomfort have also been observed.  These symptoms last approximately one to two weeks. (7)  Cannabidiol can reduce withdrawal symptoms from THC. (8)

smoking weed familyIn my clinical practice, I find that most adults who have not used cannabis regularly in their lives, who begin to use it due to a medical condition and who find good results with improvement in their quality of life, are extremely unlikely to have dependence issues.  I advise all medical patients to use the smallest dose of THC that gives the desired result, and if they are doing well, they can skip doses to keep tolerance to a minimum.  Including CBD to a medical cannabis regimen will likely improve effectiveness and help keep tolerance at bay.  Using the cannabinoids found in the raw, unheated flower (THCA, CBDA) will also help reduce the chance of developing tolerance and add medical benefits.  If tolerance develops, abstinence from the medication for a few days or even a few weeks (as long as the patient is not suffering during that time) allows for tolerance to drop.  

Although cannabis is extremely safe, dependence on any substance is possible.  Chronic heavy users of cannabis often express the desire to cut back on or eliminate their use but find the withdrawal symptoms uncomfortable.  I recommend using CBD-rich cannabis to help reduce withdrawal symptoms and allow the cannabinoid receptors to return to normal numbers.  Once homeostasis has been achieved, THC-rich cannabis may be reintroduced with more effective results at lower doses.   

Learn more about cannabis medicine in “Cannabis Revealed: How the world’s most misunderstood plant is treating everything from chronic pain to epilepsy” by Bonni Goldstein, M.D.

References

  1. Lopez-Quintero C, de los Cobos JP, Hasin DS, et al. Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug and alcohol dependence. 2011;115(1-2):120-130. doi:10.1016/j.drugalcdep.2010.11.004.
  2. Copeland, J., et al. Cannabis Treatment Outcomes among Legally Coerced and Non-coerced Adults. BMC Public Health (2007) 7
  3. Oviedo, A., et al. Chronic Cannabinoid Administration Alters Cannabinoid Receptor Binding in Rat Brain:  A Quantitative Autoradiographic Study.  Brain Research (1993) 616: 293-302
  4. Fan, F., et al. Cannabinoid regulation without Alteration of the Inhibitory Effect of CP 55,940 on Adenyl Cyclase IN the Cerebellum of CP 55,940-tolerant Mice.  Brain Research (1996) 706: 13-20 1996
  5. Hirvonen, Jussi, et al. “Reversible and regionally selective downregulation of brain cannabinoid CB1 receptors in chronic daily cannabis smokers.” Molecular psychiatry 17.6 (2012): 642-649.
  6. Vermersch, Patrick. “Sativex®(tetrahydrocannabinol+ cannabidiol), an endocannabinoid system modulator: basic features and main clinical data.” Expert review of neurotherapeutics 11.sup4 (2011): 15-19.
  7. Copersino, M., et al.  Cannabis Withdrawal among Non-treatment-seeking Adult Cannabis Users.  American Journal of Addictions (2006) 15: 8-14
  8. Crippa, J. A. S., et al. “Cannabidiol for the treatment of cannabis withdrawal syndrome: a case report.” Journal of clinical pharmacy and therapeutics 38.2 (2013): 162-164.

About Author

Bonni Goldstein, M.D. is a physician who specializes in cannabis medicine in Los Angeles, California. She specialized in Pediatric Emergency medicine for years before witnessing the amazing benefits of this treatment in an ill loved one. Since then, she has successfully treated thousands of adult and pediatric patients with cannabis. She regularly speaks about cannabis medicine at conferences and patient groups around the world. She is the owner and medical director of CannaCenters and medical advisor to Weedmaps.com. She is the author of the recently published book, Cannabis Revealed.

13 Comments

  1. With cannabis being illegal world wide how do they get to any percentage of addiction, that study will be inaccurate, and inconsistent

  2. Very good article. And I learned a few things. I have nothing but personal experience in this matter, but my experience shows me that cannabis is likely not addictive unless used for the purpose of numbing reality that’s too stressful or causes great anxiety. I don’t see what hitting a tolerance would have to do with actual addiction. Maybe some just like a mild ‘high’ all the time, which to me is not a physical addiction either, but more psychological. I can’t see where cannabis could be compared at all with something like alcohol, where the withdrawal symptoms are seriously physical, from physical withdrawal, not physical from psychological withdrawal as it is with cannabis. If that makes any sense….

  3. It’s ridiculous to think it is addictive. Although I am loathe to do so, I agree (sort of) with Jane. It would be more phycological than physical. Users do just enjoy the “mild” high all the time. It’s effects during use can be equated to alcohol as in it helps them loosen up, without the sick, full feeling that comes with consuming alcohol. It can also be compared to tobacco use as in it is a form of stress release when being consumed. Like a cigarette. Not that these three are the same, but everyone uses them for different reasons. But to think that marijuana is addictive like tobacco is silly. I haven’t partaken in over three months. I, however, cannot seem to kick the cigarette addiction without hating everyone in sight when I don’t have one.

  4. I used for 19 years and stopped in an instant and was sober for 22 years. I experienced a little trouble sleeping and some other discomforts for a week or so. After that nothing. I started again after I retired and nobody was making me pee in a bottle. I started again because some of my meds for sleep had started causing RLS. I found an article saying cannabis could help so after finding “God Damn the Dealer Man” i scored and am sleeping well.

  5. Michael Anuenue Primacio on

    It’s to bad that the cannabis plant and the medical users of the plant are discriminated against. No other dr prescribed drugs is treated this way. Maybe because it’s a plant not a drug like they thought us. That mut magruff should stop lying to our children, like they lied to me.
    Thank you for providing the plant medicine. I hope that prices will be fare. If you need an helper I am free from 8am to 2 pm.
    My opinion is alcohol and cannabis cannot be compared to each other. One is a chemical substance that is fermented and brewed, and one is a dried herb,bud or flower of a plant that also can give seed if allowed. The only thing alcohol and the cannabis plant have in common is prohibition history 1936 – 1937 the lies of the people that call them selves americans, they say they free but prisons and court’s of extortion are big business,and that’s reality. ALOHA

  6. Another reality is…evil things should be discriminated against and that’s certainly understandable. Although many cannabis users don’t consider it to be evil, a lot of people do. So that’s what we’re up against. But reality also says cannabis is a mind-altering substance, which is why so many use it recreationally and that’s another truth we face in this discussion. Many don’t want cannabis used as common as aspirin. If cannabis were not a mind-altering substance, big pharma would prolly have already bought it all up and had it sold by now. (No…I do not like big pharma….)

    • Michael Anuenue Primacio on

      Aloha Jane, cannabis is not evil, people choose to do evil. I agree that evil things should be discriminated against. Let’s start with adultery and lieing these are laws of God which I’ve witnessed and use to participate in while I was ignorant to truth. These people who make up laws will be punished for leading people ashtray and teaching lies.The cannabis plant was, before 1937 , and still, is a plant medicine and food for centuries before americans broke off from their mainland. It is not for everyone, just like some tea s are not for everyone. Food is mind altering and I love the feeling of a full belly.
      Please don’t ever compare the cannabis plant to aspirin again. People have died from direct use of aspirin. None have died from cannabis, only from the violance created by man’s law.
      Yes pharmaceutical companies do make sythetic form of cannabis, it is called mirrinol or dronibinol. It is very expensive, the reality is the laws of man restrict people from healing their selves.

    • Isn’t a lot of pharmaceutical drugs mind altering as well. I know for a fact Xanax is. They prescribed it for my anxiety. I don’t take it anymore.

  7. And Aloha to you too. 🙂 I used Aspirin as an example of something common, not as something safe. But I appreciate your reasonable answer to what I wrote. No, the actual cannabis ‘plant’ is no more evil than poisonous herb plants, but some do consider its ‘effects’ on people to be an evil. I believe that’s why it’s opposed at all.
    The best thing about your post is your discovery of the truth. Refreshing, isn’t it. And one thing about truth (reality) is that it remains the same (real) even when some folks don’t believe it.
    As for me, I’m experimenting with cannabis on a very mild level (one hit/vape) to see if I can find a strain that will lessen mucous production during colds, etc. I’m looking at other herbs in tea or tincture form as well for the same reason. (Sorry this has nothing to do with addiction so I’m getting a little off topic.)

    • Jane cannabis is not poisonous, but it is a herb. I’ve witnessed the healing of sick and injured humans from the correct use of the cannabis plant. Cannabis will not work for your mucous issue, recola, and ginger and lots of sleep may help. Peace

  8. I used the word ‘poisonous’ just to demonstrate how poison plants are just fine, not ‘evil’ by themselves (as cannabis is also not), but some would call them evil because of their effects on humans. Thanks for the tip on recola and ginger but hey…not giving up on a possible cannabis strain out there that may help with mucous. Actually, mucous is not such an issue with me as it is with a far-away friend that finds breathing difficult because of it. I don’t have a clue why she produces so much but that’s got to be not fun. It would just be nice if cannabis were legal enough to have all kinds of uber-research allowed and going on right now.

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