Risks associated with the non-medicinal use of cannabis.
Cannabis is the most commonly consumed illicit drug around the world; in Germany, about 4.5% of all adults use it each year. Intense cannabis use is associated with health risks. Evidence-based treatments are available for health problems caused by cannabis use.



Selective literature review based on a search of the PubMed database, with special emphasis on systematic reviews, meta-analyses, cohort studies, randomized controlled trials (RCTs), case-control studies, and treatment guidelines.



The delta-9-tetrahydrocannabinol content of cannabis products is rising around the world as a result of plant breeding, while cannabidiol, in contrast, is often no longer detectable. Various medical conditions can arise acutely after cannabis use, depending on the user's age, dose, frequency, mode and situation of use, and individual disposition; these include panic attacks, psychotic symptoms, deficient attention, impaired concentration, motor incoordination, and nausea. In particular, intense use of high doses of cannabis over many years, and the initiation of cannabis use in adolescence, can be associated with substance dependence (DSM-5; ICD-10), specific withdrawal symptoms, cognitive impairment, affective disorders, psychosis, anxiety disorders, and physical disease outside the brain (mainly respiratory and cardiovascular conditions). At present, the most effective way to treat cannabis dependence involves a combination of motivational encouragement, cognitive behavioral therapy, and contingency management (level 1a evidence). For adolescents, family therapy is also recommended (level 1a evidence). No pharmacological treatments can be recommended to date, as evidence for their efficacy is lacking.



Further research is needed to elucidate the causal relationships between intense cannabis use and potential damage to physical and mental health. Health problems due to cannabis use can be effectively treated.
Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Teaching Hospital of the University of Duisburg/Essen, German Center for Addiction Research in Childhood and Adolescence (DZSKJ), University Hospital Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Göttingen and DFG Research Center and Cluster of Excellence Nanoscale Microscopy and Molecular Physiology of the Brain (CNMPB) of the University Medical Center Göttingen, Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Kreiskrankenhaus Prignitz, Perleberg; Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Martin-Luther- University Halle-Wittenberg, Halle (Saale).
Eva
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Hoch
Udo
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Bonnet
Rainer
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Thomasius
Florian
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Ganzer
Ursula
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Havemann-Reinecke
Ulrich W
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Preuss
D001007:Anxiety / Q000453:epidemiology* / Q000628:therapy*; D015984:Causality; D003072:Cognition Disorders / Q000453:epidemiology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods / Q000706:statistics & numerical data; D015897:Comorbidity; D005196:Family Therapy / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D013287:Illicit Drugs / Q000506:poisoning; D015994:Incidence; D002189:Marijuana Abuse / Q000453:epidemiology* / Q000628:therapy*; D018570:Risk Assessment; D016896:Treatment Outcome
D013287:Illicit Drugs