Proposed Changes to Cannabis Use Disorder Diagnosis Could Improve Accuracy for Marijuana User

Cannabis use disorder is a mental health condition defined by the Diagnostic and Statistical Manual of Mental Disorders, which can cause significant impairment or distress to individuals who use cannabis regularly. However, as the use of cannabis for therapeutic purposes becomes increasingly prevalent, experts are calling for a new approach to accurately diagnose cannabis use disorder, which could help avoid misdiagnosis and stigmatization for medical marijuana users.

Tammy Chung, the director of the Center for Population Behavioral Health at Rutgers Institute for Health, Health Care Policy, and Aging Research, along with her colleagues Marc Steinberg of Rutgers Robert Wood Johnson Medical School and Mary Barna Bridgeman of the Rutgers Ernest Mario School of Pharmacy, has published a commentary in JAMA Psychiatry, outlining the challenges and changes needed to accurately diagnose cannabis use disorder for medical marijuana users.

Challenges in Diagnosing Cannabis Use Disorder

One of the major challenges in diagnosing cannabis use disorder is the rapid increase in state-level legalization of cannabis for therapeutic purposes. The diagnostic manual used to define substance use disorders was developed before this sharp rise, meaning it considers cannabis to be an illicit substance, even if a person reports using cannabis only for therapeutic purposes under appropriate medical supervision.

Another challenge is the absence of a standard dose for medical marijuana, different ways of consuming cannabis, the lack of dosing guidelines for specific health conditions, and limited evidence of the therapeutic effects of cannabis for many health conditions.

Proposed Changes to Diagnosis Protocol

Chung and her colleagues suggest that the diagnostic manual should take into account the use of cannabis for therapeutic purposes as a separate category from recreational use. This would avoid misdiagnosis, especially for individuals who use cannabis only for therapeutic purposes under appropriate medical supervision.

Their proposed model would require the presence of at least two of the eleven criteria used to diagnose cannabis use disorder, excluding increased tolerance and withdrawal symptoms. If two or more other symptoms are reported, such as difficulties cutting down on cannabis use or use in hazardous situations, the standard model of diagnosing an individual with cannabis use disorder can still be used.

The Importance of Accurate Diagnosis

Accurate diagnosis is crucial to ensure proper treatment for individuals with cannabis use disorder. Overdiagnosis can lead to stigmatization and flawed understanding of the effects of therapeutic use of cannabis on health. Specific training in assessing the criteria in the context of an individual who uses cannabis for therapeutic purposes could improve the validity of cannabis use disorder diagnoses.

Journal Information: Tammy Chung et al, Recommendation for Cannabis Use Disorder Diagnosis in a Context of Cannabis for Therapeutic Purposes, JAMA Psychiatry (2023). DOI: 10.1001/jamapsychiatry.2023.0053