Clinical Review

Assessment and management of cannabis use disorders in primary care

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c1571 (Published 01 April 2010) Cite this as: BMJ 2010;340:c1571
  1. Adam R Winstock, clinical senior lecturer, honorary consultant psychiatrist1,
  2. Chris Ford, clinical director2, general practice principal3,
  3. John Witton, research coordinator1
  1. 1National Addiction Centre, Institute of Psychiatry, King’s College London, London SE5 8AF
  2. 2Substance Misuse Management in General Practice (SMMGP), c/o NTA, Skipton House, London SE1 6LH
  3. 324 Lonsdale Road, London NW6 6SY
  1. Correspondence to: A R Winstock Adam.winstock{at}kcl.ac.uk

    Summary points

    • Cannabis use is common, especially among young people

    • The greatest risk of harm from cannabis use is in young people and those who are pregnant or have serious mental illness

    • A tenth of cannabis users develop dependence, with three quarters of them experiencing withdrawal symptoms on cessation

    • Most dependent users have concurrent dependence on tobacco, which increases the health risks and worsens outcomes for cannabis treatment

    • Brief interventions and advice on harm reduction can improve outcomes

    • Psychoeducation (for a better understanding of dependence), sleep hygiene, nicotine replacement therapy (where indicated), and brief symptomatic relief form the mainstay of withdrawal management

    • Dependent users may present with symptoms suggestive of depression, but diagnosis and treatment should be deferred until two to four weeks after withdrawal to improve diagnostic accuracy

    About a third of adults in the UK have tried cannabis, and 2.5 million people, mostly 16-29 year olds, have used it in the past year.1 Although most people who smoke cannabis will develop neither severe mental health problems nor dependence, regular use of cannabis may be associated with a range of health, emotional, behavioural, social, and legal problems, particularly in young, pregnant, and severely mentally ill people.2 3 The past decade has seen a shift in available cannabis preparations from resinous “hash” to intensively grown high potency herbal preparations, often referred to as skunk, which now dominates the UK market.4 Compared with traditional cannabis preparations, skunk tends to have higher levels of tetrahydrocannabinol, the main psychoactive constituent of cannabis, and lower levels of the anxiolytic cannabinoid cannabidiol. In January 2009 cannabis was returned to its original class B classification (from class C) under the UK Misuse of Drugs Act.

    Despite high levels of use, only 6% of those seeking treatment for substance misuse in England cite cannabis as their …

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