Is Cannabis Addictive? A Guide to Cannabis Addiction

Is cannabis addictive? When starting a new medication, such as medicinal cannabis, it's natural to be curious about its potential effects. Even with plant-based medicines, it’s important to learn about the safety aspects of your treatment plan, including your new medicine’s addictive potential.

Read on to understand cannabis addiction (sometimes called ‘weed addiction’ or ‘marijuana addiction’ - learn more about the language of cannabis here), how cannabis addiction happens, and how to safely introduce or maintain medicinal cannabis into your treatment regime.

Is medicinal cannabis addictive?

While most patients won’t become addicted to cannabis, cannabis can be addictive, even when it is prescribed for a medical reason. The likelihood of an addiction occurring or the extent of an addiction, depends on many factors, including genetic predisposition, cannabis potency, and individual susceptibility.

Research suggests that around 9% of cannabis users may develop an addiction¹. So, even if you’re taking medicinal cannabis, there is still the potential for addiction. However, when taken under the guidance of a healthcare professional, patients can better understand their predisposition for addiction and take steps to avoid it. 

Addiction is a complex condition that involves a compulsive pattern of drug use despite negative consequences². Cannabis addiction can be mild or severe, with varying effects on a person’s psychological and physical wellbeing. If you think you might be struggling with cannabis addiction, or are starting to notice unhealthy changes in your cannabis use, start an honest conversation with your doctor about how to manage it.

Can You Become Addicted to Cannabis?

While cannabis addiction is not likely, it is possible. Cannabis can become addictive because its active compound, delta-9-tetrahydrocannabinol (THC), activates the brain’s reward system releasing dopamine³.

When you take cannabis regularly, your brain may reinforce and strengthen the connection between the rewarding stimulus (cannabis) and the positive feelings experienced, leading the brain's reward system to become dysregulated.

In these cases, the over-activation of the reward system can cause changes where the brain needs more THC to achieve the same pleasure response. This phenomenon, known as increased tolerance, can contribute to addictive patterns as people may continue to take more THC to chase the same sensation of pleasure.

Once addicted, people may develop signs of cannabis addiction⁴, including cravings, cannabis withdrawal symptoms, and difficulty managing the amount of frequency of their cannabis use.

Physical Dependence 

Physical dependence occurs when your body adapts to a medication or substance and experiences withdrawal symptoms when you stop or reduce the amount you take.

Not everyone who takes medicinal cannabis will become physically dependent, however, it can sometimes occur with regular or prolonged use, especially at higher doses⁵. Like addiction, many factors may lead to physical dependence including your unique metabolism and physiology.

When external cannabinoids, like medical cannabis, interact with the body’s cannabinoid receptors, they affect the body’s physiological functions. With extensive or extended use, cannabis can affect various neurotransmitters (chemical messengers) in the brain which can affect our mood, appetite, and sleep patterns. Learn more about cannabinoids here.

Because the body can adapt to high levels of external cannabinoids in the body, a withdrawal or sudden reduction in cannabis use can lead to a range of physical symptoms⁶ including:

• Abdominal pain.
• Shakiness/tremors.
• Sweating.
• Fever.
• Chills.
• Headache.

If you stop taking medical cannabis suddenly, you may notice physical symptoms after a few days which may last for several weeks. It’s important to remember that not everyone will experience the same symptoms with the same severity. 

In general, cannabis does not typically produce strong physical dependence⁷, unlike some other common medicines, including antidepressants, Corticosteroids, or opioids. If you are worried about developing a physical dependence, we recommend working closely with healthcare professionals, like our Polln specialists, for guidance around your cannabis use.

Psychological Dependence 

As the mind adapts to the presence of cannabinoids, suddenly stopping or reducing your cannabis intake may result in psychological symptoms⁸. These symptoms can include:

• Disturbed sleep patterns.
• Irritability.
• Anxiety.
• Restlessness.
• Poor cognitive function.

Not everyone who uses cannabis will experience these psychological symptoms while reducing or stopping their cannabis use. For those that do experience psychological symptoms, they typically begin a few days after decreasing or stopping cannabis and last several weeks.

Some people may develop a psychological dependence on cannabis to feel pleasure or alleviate psychological distress and discomfort. If you experience difficulty controlling or stopping your cannabis use, then your psychological dependence on cannabis may turn into an addiction.

Our Polln doctors can help patients navigate their concerns around psychological dependence on cannabis and put preventive measures in place to help patients protect their mental wellbeing. 

What is Cannabis Use Disorder?

Cannabis Use Disorder (CUD) is a diagnosable mental health condition recognised by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)⁹ due to its potential to cause significant impairment or distress.

The DSM-5 defines CUD as a pattern of cannabis use that leads to clinically significant problems. To be diagnosed as having a CUD, your doctor or mental health specialist will evaluate your symptoms against CUD-specific criteria. 

How Common is Cannabis Use Disorder?

Cannabis use disorder is relatively common, particularly among people who use large amounts of cannabis regularly.

Around 9% of people who use cannabis may develop a cannabis use disorder. However, the percentage of people who develop CUD varies depending on various factors such as frequency and intensity of cannabis use, individual susceptibility, and other environmental and genetic factors.

A 2022 study published in the Drug Alcohol Review of Australians showed that CUD in medical cannabis users was comparable to recreational users¹⁰.

Taking a break from medicinal cannabis can potentially reduce the risk of developing cannabis use disorder, particularly if the break helps you maintain control over your cannabis use. By discontinuing or reducing cannabis use, you may also avoid potential negative effects associated with regular and heavy consumption.

Helping Prevent Cannabis Use Disorder

While it’s not possible to completely avoid cannabis use disorder, there are steps you can take to reduce your risk and promote a healthy relationship with medicinal cannabis.

Consulting with a knowledgeable doctor about medicinal cannabis use can be highly beneficial in reducing the risk of developing a cannabis use problem.

When starting a course of medicinal cannabis, your doctor should provide you with:

• Taking more cannabis or using it for longer than intended.‍
• A comprehensive assessment: Your doctor should conduct a thorough medical assessment to evaluate your specific medical condition, symptoms, and overall health. This assessment will help determine if medicinal cannabis is a suitable treatment option for you, taking into account factors such as the severity of your symptoms, potential benefits, and any existing medical conditions or medications that may interact with cannabis.
• A personalised treatment plan: Based on the assessment, a doctor can create a personalised treatment plan tailored to your specific needs. This includes determining the appropriate dosage and frequency of use.
• Ongoing support: Regular follow-up appointments with your doctor allow for the monitoring of your progress and adjustment of the treatment plan as needed. They can assess any potential side effects and make necessary modifications to ensure your well-being.
• Education and guidance: Doctors can explain the potential risks associated with cannabis use, discuss potential interactions with other medications or substances, and advise on strategies to reduce the risk of cannabis addiction.

If you’re looking to get started with medicinal cannabis, or want to help a loved one explore medicinal cannabis options, Polln has a team of expert specialists available to discuss your treatment needs and ways to safely start a program of plant-based treatment. 

By involving a doctor in your medicinal cannabis journey, you can benefit from their expertise, personalised care, and ongoing support, all of which can reduce the risk of developing a CUD.

Signs of Cannabis Use Disorder

To meet the diagnostic criteria for CUD, a person must show a problematic pattern of cannabis use that leads to significant impairment or distress, with at least two of the following symptoms within a 12-month period¹¹:

• Taking more cannabis or using it for longer than intended.
• Persistent desire or unsuccessful efforts to cut down or control cannabis use.
• Spending significant time obtaining, using, or recovering from cannabis.
• Strong craving or desire to use cannabis.
• Cannabis use leading to failures in work, school, or home obligations.
• Continued cannabis use despite social or interpersonal problems caused by it.
• Giving up or reducing important activities due to cannabis use.
• Using cannabis in physically hazardous situations.
• Continuing cannabis use despite knowing it causes physical or psychological problems.
• Developing tolerance (needing more cannabis for desired effects) or experiencing diminished effects with the same amount of cannabis.
• Experiencing cannabis withdrawal symptoms or using it to relieve or avoid withdrawal.
  

The severity of CUD is determined by the number of symptoms present:

• Mild: 2-3 symptoms.
• Moderate: 4-5 symptoms.
• Severe: 6 or more symptoms.
  

If you think that you might have a cannabis addiction, reach out to a health professional for an official diagnosis and support. There are many helpful treatment options available, including counselling and behavioural therapies.

Cannabis Withdrawal Symptoms

Not everyone who uses cannabis will experience withdrawal symptoms. As with physical and psychological dependence, the risk of developing withdrawal symptoms after taking medicinal cannabis depends on the dosage, frequency, and length of time taking this medication.

While withdrawal symptoms for cannabis are typically mild for most people, a recent study into cannabis withdrawal showed that the most frequently reported symptoms include irritability, anxiety, restlessness, and difficulty sleeping.

Overall, people reported a range of symptoms during cannabis withdrawal including:

• Irritability.
• Anxiety.
• Restlessness.
• Difficulty sleeping.
• Decreased appetite.
• Mood swings.
• Fatigue.
• Headaches.
• Muscle aches.
• Sweating.
• Dizziness.
• Nausea and/or vomiting.

It is important to remember that the severity of withdrawal symptoms is not the same for everyone. Some people may experience very mild withdrawal symptoms (like you might experience when quitting caffeine) while others may experience more severe symptoms.

Factors that Influence Likelihood of CUD

It's important to understand that addiction is not solely determined by the substance itself. Factors such as your environmental surroundings, genetic predisposition, individual susceptibility, psychological background, and social influences can also significantly contribute to the risk of addiction.

Some factors that influence the likelihood of developing cannabis use disorder include:

Cannabis Use Disorder and Age

CUD is more common in people who start using cannabis at a young age. A study published in the journal Drug and Alcohol Dependence found that the risk of developing CUD was 4-7 times higher in people who started using cannabis before the age of 18 than in people who started using cannabis after the age of 25¹².

Cannabis Use Disorder and Genetics

Genetics can play a role in the development of cannabis use disorder. Research suggests that some people may be more genetically predisposed to developing problematic cannabis use compared to others¹³.

These genetic factors can influence how people respond to the effects of cannabis, regulate their brain's reward system, and process substances. For example, variations in genes involved in the endocannabinoid system, such as the cannabinoid receptor 1 (CB1) gene, have been associated with an increased risk of cannabis dependence.

Cannabis Use Disorder and Mental Health 

Cannabis Use Disorder can be associated with mental health conditions, suggesting a complex relationship between cannabis use and mental wellbeing. While a direct link is difficult to prove, research shows that people with pre-existing mental health disorders may be more susceptible to developing problematic cannabis use.

People with conditions such as depression, anxiety, and schizophrenia may have a heightened vulnerability to CUD¹⁴. This two-way relationship suggests that cannabis use can worsen the symptoms of mental health disorders, while people with these disorders may self-medicate with cannabis to lessen their symptoms.

Cannabis Use Disorder and Substance Abuse

Having an addiction to another substance can significantly increase the chance of developing cannabis use disorder¹⁵. The co-occurrence of substance addiction and CUD can lead to more severe and persistent cannabis use problems, worsening physical and mental health problems, and impaired cognitive function.

Cannabis Use Disorder and Cannabis Potency 

High-potency cannabis, with elevated levels of THC (delta-9-tetrahydrocannabinol), has been linked to an increased likelihood of developing CUD¹⁶. Stronger psychoactive effects of potent cannabis may contribute to higher tolerance, physical and psychological dependence, and addiction.

The intensity of psychoactive effects can be influenced by cannabis potency. Higher potency cannabis can lead to increased intoxication, cognitive impairment, and increased risk-taking behaviour, which can all contribute to problematic cannabis use.

Cannabis Use Disorder Treatment

There are a number of treatment options available for CUD. The most effective treatment approach is typically a combination of medication and therapy. A common therapy for CUD, Cognitive Behavioural Therapy (CBT), has been known to help people identify and change their thoughts and behaviours that contribute to their cannabis use.

In addition to medication and therapy, it’s important to talk to your prescribing doctor. If you’re taking more than prescribed or find that you’re struggling with physical or psychological dependence, then they can help you manage your cannabis use and adjust your treatment plan.

The Bottom Line

Like any new medication, it’s important to understand its addictive potential before starting a course of treatment. While most patients will not become addicted to medicinal cannabis, it’s important to take the time to understand your personal risks for addiction, including your mental health and genetic factors, to make an informed decision. By starting your medicinal cannabis journey with the support of a specialised healthcare team, like our Polln doctors, you can lessen your cannabis addiction risk while improving your overall wellbeing.

FAQs

‍Is CBD addictive?‍

THC (tetrahydrocannabinol) and CBD (cannabidiol) are two of the most common cannabinoids found in cannabis. THC is psychoactive and produces the "high" associated with cannabis use, while CBD is non-psychoactive and does not cause intoxication. THC has pain-relieving, anti-inflammatory, and appetite-stimulating effects. CBD has anti-inflammatory, anti-anxiety, and neuroprotective properties.

CBD (cannabidiol) is not considered addictive. CBD does not produce the psychoactive effects typically associated with THC (tetrahydrocannabinol), the primary psychoactive component of cannabis. It interacts with different receptors in the body and does not have the same potential for abuse or dependence as THC.

What is considered heavy cannabis use?

The specific threshold for heavy use may depend on factors such as individual tolerance, frequency of use, duration of use, and the potency of the cannabis products being used. That being said, the definition of heavy cannabis use generally refers to the frequent and substantial use of cannabis, enough that a person would feel intoxicated daily.

‍How long does it take to become dependent on cannabis?

Some people may develop dependence relatively quickly, while others may not become dependent on cannabis after extended use. The time it takes to develop dependence, or whether you develop cannabis dependence, is dependent on many factors, including frequency of use, quantity consumed, the potency of the cannabis, individual physiology, and genetic factors.

From the Doctor: Dr Matt Carson, MBBS, FRACGP

If you think you are experiencing any signs of cannabis addiction or dependence, or if cannabis is having a negative impact on your life in any way, please consider reaching out to your prescribing doctor to discuss strategies to move forward. These strategies may include:

• Making an appropriate treatment plan.
• Taking regular tolerance breaks from cannabis.
• Gradual reduction of dose to a lower, more beneficial level, or with the goal of cessation (if appropriate).
• Changing the administration method (for example, from inhaled to more long-acting oral options).
• Consider other therapy options such as CBT.
• Identifying triggers for excessive cannabis use and strategise how to deal with them.
• Building a strong support network.
• Developing a healthy lifestyle.
• Looking at life from a holistic point of view and improving your diet and exercise habits can have enormous benefits for health and wellbeing.