Cannabis Use Disorders in Primary Care: Screening and Treatment Suggestions

Abstract

Objective: To review, through case-based learning, the screening for and treatment of cannabis use disorders in primary care. Harm reduction modalities as it pertains to cannabis use are also reviewed. Methods: PubMed was searched for studies on cannabis use disorders with a specific focus on screening and treatment modalities. The literature cited was reviewed for those relevant studies identified through PubMed. Results: Problematic cannabis use can be screened for with a single question. A positive screening question can lead to more intensive screening with a validated questionnaire. A high score on a validated questionnaire may lead to examination of the DSMV criteria. Withdrawal symptoms can be treated with synthetic cannabinoids. Maintenance may involve cannabinoids or other medications but the evidence is more mixed for this setting. Harm reduction techniques may be useful in those that are not interested in cutting down or in those that are willing to reduce but not stop cannabis consumption. Brief intervention may be effective in the primary care setting. There are patients who should not use cannabis. Conclusion: Primary care providers should screen for cannabis use disorders with a single question in those patients presenting with problems that could be related to substance use. More in-depth screening is triggered by a positive response. Withdrawal management, maintenance therapy and harm reduction are all within the scope of primary care providers and should be explored with the patients. If these interventions are unsuccessful, the patient can be referred to an addiction medicine specialist.