Treatment

Marijuana withdrawal has been demonstrated in laboratory animals, as well as in humans, and is now well documented. Chronic heavy users of cannabis may experience some withdrawal in the form of irritability, general discomfort, disrupted sleep, and decreased appetite (Budney, Moore, Vandrey, & Hughes, 2003). This syndrome is not as painful as that with heroin, as dangerous as that with alcohol, or as long-lasting as that with cocaine. It may contribute to relapse in some individuals.

The clinician is confronted with a wider range of marijuana users. At one end is the individual who uses the drug only rarely, but whose use is detected on a routine drug screen and brought to the clinician's attention, perhaps for an evaluation. Brief assessment, to make sure the problem is not more serious than it appears, is always necessary in this case. Subsequent follow-up, to ensure that the initial impression was correct, is part of a thorough assessment. In this instance, the user is usually embarrassed and repentant, and has no objection to future monitoring. Users who do not have a problem with marijuana do not have a problem giving it up. They may be able to use it in the future, once they have demonstrated the capacity for voluntary nonuse.

On the other end of spectrum is the person, most predictably the adolescent, who uses the drug both daily and heavily. In this case, the individual may need much more intensive rehabilitation and may need to be admitted to a residential drug treatment facility. In any case, the clinician must be alert to any underlying comorbid condition and treat it appropriately. Many researchers believe that marijuana is administered as a form of self-medication (Marmor, 1998).

The comorbid conditions that have been suggested to be associated with marijuana use range from the personality disorders to psychotic spectrum illness. In certain personality disorders, the drug's sedating and anxiolytic properties may be used to reduce painful affects. In some mode disorders, marijuana may be a form of self-medication for agitation, even manic or hypomanic states. This hypothesis is still quite intriguing and controversial; at the present time, there is only anecdotal and circumstantial evidence for its existence.

In recent years, there has been increased interest in "medicinal marijuana" (Iversen & Snyder, 1999) as an advocacy issue for such conditions as glaucoma (American Academy of Opthalmology, 1992; Hepler & Petrus, 1976; National Eye Institute, 1997), epilepsy (Feeney, 1976), nausea and other symptoms associated with cancer and chemotherapy (Kris et al., 1996; Maurer, Henn, Dittrich, & Hofmann, 1990; Nelson et al., 1994; Sallan, Zinberg, & Frei, 1975; Tramer et al., 2001; Vinciguerra, Moore, & Brennan, 1988). In general, there are better and safer agents for such medical conditions. Marijuana may, however, have some use, and the issue has been subject to much debate within the public arena, such as California voters' passing of the Compassionate Use Act (Proposition 215) (Marmor, 1998). Although the possible medicinal benefits of marijuana have been a matter of perennial debate within the medical community as well (Grinspoon & Bakalar, 1995; Kassirer, 1999), with articles and commentary frequently appearing in the Journal of the American Medical Association and the New England Journal of Medicine, the issue has yet to have been satisfactorily resolved through sound, scientifically methodical research (National Institutes of Health, 1997).

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