Cannabis dependence

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Cannabis dependence

Psychological disorders

Psychological disorders

Psychological disorders


Cannabis dependence


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USMLE® Step 1 questions

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High Yield Notes

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Cannabis dependence

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USMLE® Step 1 style questions USMLE

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A 17-year-old boy is brought to the emergency department for evaluation of anxiety and paranoia. The patient was at a party where he started screaming at a girl because he believed she was going to harm him. Several minutes later, he felt restless and stated he felt like “the world was closing in on him.” Temperature is 37.2C (98.96F), heart rate is 115/minute, blood pressure is 145/90 mmHg, and respirations are 18/minute. Oxygen saturation is 99%. On physical examination, the patient appears anxious. Pupils are 3 mm and reactive to light bilaterally. The conjunctiva appears injected, and his coordination is slow. Which of the following is the most likely etiology of this patient’s presentation?

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Cannabis, or marijuana, is one of the most popular psychoactive substances worldwide, especially among teenagers.

Although the specifics of cannabis’ addictive qualities are still very much under debate, cannabis dependence disorder is officially classified in the DSM-5 and prolonged, heavy use of cannabis has been shown to cause some level of dependency.

Cannabis comes from the flowers of Cannabis sativa plants, which has oils with concentrations of tiny, fat-soluble, psychoactive molecules called cannabinoids.

The three main cannabinoids, tetrahydrocannabinol (also called THC), cannabidiol (also called CBD), and cannabinol (also called CBN), are each associated with unique psychoactive effects.

For example, THC is associated with high-grade recreational marijuana, and produces effects, like euphoria, analgesia, mild hallucinations, and an increased appetite.

Cannabidiol on the other hand does not have psychoactive effects and is commonly included in medical marijuana because it has a variety of effects including being analgesic, anti-inflammatory, anti-seizure, appetite stimulating, and anxiety-reducing.

To understand how cannabis works, let’s zoom in on a synapse of the brain to see how a stimulus response is induced generally, without drugs.

Normally, electrical signals, or action potentials, travel down the axon to the axon terminal, triggering the release of chemical messengers called neurotransmitters from synaptic vesicles into the synapse.

The neurotransmitters travel across the synapse and bind to receptors on the postsynaptic neuron, where they give the cell a message.

After the neurotransmitters have done their job, they unbind from the receptors and can simply diffuse away, be degraded by enzymes, or be picked up by proteins and returned to their release site in a process called reuptake.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "State of the Art Treatments for Cannabis Dependence" Psychiatric Clinics of North America (2012)
  5. "Cannabinoid Receptors: Where They are and What They do" Journal of Neuroendocrinology (2008)
  6. "Cannabinoids, hippocampal function and memory" Life Sciences (1999)
  7. "Pharmacokinetics and Metabolism of the Plant Cannabinoids, Δ9-Tetrahydrocannibinol, Cannabidiol and Cannabinol" Handbook of Experimental Pharmacology (undefined)
  8. "Bioanalytical procedures for determination of drugs of abuse in blood" Analytical and Bioanalytical Chemistry (2007)
  9. "Diagnostic and Statistical Manual of Mental Disorders: DSM-5" American Psychiatric Association (2013)

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