Navigating the Complexities of Cannabis Use Disorder: Insights from a Prescribing Doctor
Article Written By Dr. Nic Giummarra
Key Insights
Cannabis Use Disorder (CUD) affects up to 200,000 Australians, with a societal cost of $4.5B (AIWH, 2021).
Approximately 20-25% of medicinal cannabis users meet the criteria for CUD, leading to tolerance, escalating use, and adverse effects on mental, physical, and professional well-being.
CBD-dominant flowers may be more effective for treating anxiety compared to THC-dominant or balanced THC:CBD flowers (Bidwell et al., 2024).
Heavy use of high-THC flowers can lead to structural brain changes in younger individuals, affecting emotional regulation and working memory (Coyle Patel, 2024).
Integrating psychotherapy and responsible prescribing is crucial for addressing the root causes of CUD and improving patient outcomes.
The Case Study
I review the patient's file as I prepare for my next telehealth consultation. Michael, a 22-year-old male, has booked an appointment for anxiety. The sparse information in his online forms and the absence of a comprehensive health summary from his GP raise concerns.
The video call connects, and Michael appears on my screen, shirtless and sporting a shoulder-length mullet. "G'day mate, I'm Mick," he greets me with a smile that seems incongruous with his reported anxiety.
Delving into Michael's history, I listen as he recounts a childhood marred by trauma, neglect, and a failing school system. His story, punctuated by grimaces and agitation, paints a picture of a young man grappling with the lingering effects of PTSD and depression.
Michael admits to using cannabis for the past five years, consuming around 3 grams per day. As I assess him for Cannabis Use Disorder (CUD), he acknowledges the escalation of his use and the possibility of addiction.
CUD is a growing concern, affecting up to 200,000 Australians and costing society approximately $4.5 billion (AIWH, 2021). Recent studies suggest that 20-25% of medicinal cannabis users meet the criteria for CUD, leading to tolerance, increased use, and negative impacts on mental, physical, and professional well-being.
In Michael's case, the absence of psychotherapy—the first-line treatment for addressing the root causes of his suffering—is conspicuous. I contemplate how to approach his treatment best, drawing upon recent research.
A study by Lynskey (2024) found that 77% of patients using medicinal cannabis for PTSD experienced significant improvements in well-being and quality of life, maintained for up to 12 months. Additionally, Bidwell et al. (2024) showed that CBD-dominant flowers were more effective in reducing anxiety compared to THC-dominant or balanced CBD:THC flowers.
However, the heavy use of high-THC flowers, particularly in younger individuals, can lead to structural brain changes affecting emotional regulation and working memory (Coyle Patel, 2024).
Armed with this knowledge, I present Michael with a comprehensive treatment plan. I prescribe a CBD-dominant oil, Humacology 225mg CBD; 25mg CBN : 2mg THC, to be taken at 0.5ml twice daily. For nighttime use, I recommend a THC-dominant oil, Heyday 26mg/ml from the popular Night Queen cultivar, with a likely dose of 0.25 – 0.75ml.
To address daytime symptoms, I suggest a CBD flower, Kind Sol 16% CBD, at 1g/day. For nighttime use, I propose an indica-dominant flower with 20% THC and myrcene and linalool as dominant terpenes at 1g/night. I emphasize the importance of using a vaporizer for lung health and discuss the potential for incorporating psychotherapy.
To my relief, Michael is receptive to the plan. "Sounds great, mate, I'm keen to give the CBD and vape a try!" he enthuses.
As we conclude the consultation, I am hopeful that this personalized approach, coupled with ongoing monitoring and support, will help Michael manage his symptoms, reduce his reliance on high-THC cannabis, and ultimately improve his quality of life.
The complexities of treating patients with CUD and co-occurring mental health conditions are undeniable. As medicinal cannabis gains acceptance, it is imperative that we, as healthcare providers, navigate these challenges with a commitment to evidence-based practices, responsible prescribing, and a holistic approach to patient care. Only then can we truly make a difference in the lives of those we serve.
Dr. Nic Giummarra is a vocationally-registered GP who now specialises in Medicinal Cannabis prescribing, education, and advocacy and is an industry leader with Cannabis Clinicians Australia. In 2021, he 'accidentally' began to prescribe Medicinal Cannabis for his patients who had run out of options and consistently began to see incredible results. A handful of patients soon became hundreds, and now he is energised by the daily feedback from patients who say this has changed their lives. Nic has a special interest in mental health.
Disclaimer: This information is shared with a global readership for educational purposes only and does not constitute medical or business advice. All patient-related information has been de-identified OR fictional to protect privacy. Nothing in this article is intended to promote the use or supply of medical cannabis to members of the public.
