Is cannabis addictive? A guide to cannabis use disorder

Is medicinal cannabis addictive?

While most patients won’t become addicted to cannabis, cannabis can be addictive, even when it is prescribed for a medical reason. The likelihood of an addiction occurring or the extent of an addiction, depends on many factors, including genetic predisposition, cannabis potency, and individual susceptibility.

Research suggests that around 9% of cannabis users may develop an addiction¹. So, even if patients are consuming medicinal cannabis, there is still the potential for addiction. However, under your guidance as an experienced healthcare professional, you can help your patients to better understand their predisposition for addiction and take steps to avoid it. 

Addiction is a complex condition that involves a compulsive pattern of drug use despite negative consequences². Cannabis addiction can be mild or severe, with varying effects on a person’s psychological and physical wellbeing.

Can you become addicted to cannabis?

While cannabis addiction is not likely, it is possible, even with medicinal cannabis treatments. Cannabis can become addictive because its active compound, delta-9-tetrahydrocannabinol (THC), activates the brain’s reward system releasing dopamine³.

When a person consumes cannabis regularly, the brain may reinforce and strengthen the connection between the rewarding stimulus (cannabis) and the positive feelings experienced, leading the brain's reward system to become dysregulated.

In these cases, the over-activation of the reward system can cause changes where the brain needs more THC to achieve the same pleasure response. This phenomenon, known as increased tolerance, can contribute to addictive patterns as people may continue to take more THC to chase the same sensation of pleasure.

Once addicted, people may develop signs of cannabis addiction⁴, including cravings, cannabis withdrawal symptoms, and difficulty managing the amount of frequency of their cannabis use.

Physical dependence 

Physical dependence occurs when the body adapts to a medication or substance and experiences withdrawal symptoms when the patient stops treatment or reduces the amount they take.

Not everyone who takes medicinal cannabis will become physically dependent, however, it can sometimes occur with regular or prolonged use, especially at higher doses⁵. Like addiction, many factors may lead to physical dependence including your unique metabolism and physiology.

When external cannabinoids, like medical cannabis, interact with the body’s cannabinoid receptors, they affect the body’s physiological functions. With extensive or extended use, cannabis can affect various neurotransmitters (chemical messengers) in the brain which can affect mood, appetite, and sleep patterns.
Because the body can adapt to high levels of external cannabinoids in the body, a withdrawal or sudden reduction in cannabis use can lead to a range of physical symptoms⁶ including:

• Abdominal pain.
• Shakiness/tremors.
• Sweating.
• Fever.
• Chills.
• Headache.

If a patient stops taking medical cannabis suddenly, they may notice physical symptoms after a few days which may last for several weeks. It’s important to remember that not everyone will experience the same symptoms with the same severity.

In general, cannabis does not typically produce strong physical dependence⁷, unlike some other common medicines, including antidepressants, Corticosteroids, or opioids. If a patient has concerns about developing physical dependence, we recommend working closely with them to provide them with guidance around suitable cannabis use. 

Psychological dependence 

As the mind adapts to the presence of cannabinoids, if a patient suddently stops or reduces their cannabis intake, it could result in psychological symptoms⁸. These symptoms can include:

• Disturbed sleep patterns.
• Irritability.
• Anxiety.
• Restlessness.
• Poor cognitive function.

Not everyone who uses medicinal cannabis will experience these psychological symptoms while reducing or stopping their cannabis use. For those that do experience psychological symptoms, they typically begin a few days after decreasing or stopping cannabis and last several weeks.

Some people may develop a psychological dependence on medical cannabis to feel pleasure or alleviate psychological distress and discomfort. Patients who experience difficulty controlling or stopping their medicinal cannabis use could be at risk of their psychological dependence turning into addiction. We recommend working closely with your patient and their primary care team to mitigate any risk of addiction. 

What is cannabis use disorder?

Cannabis Use Disorder (CUD) is a diagnosable mental health condition recognised by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)⁹ due to its potential to cause significant impairment or distress.

The DSM-5 defines CUD as a pattern of cannabis use that leads to clinically significant problems. To confirm a diagnosis of CUD in a patient, their doctor or mental health specialist must first evaluate their symptoms against CUD-specific criteria. 

How common is cannabis use disorder?

Cannabis use disorder is relatively common, particularly among people who use large amounts of cannabis regularly.

Around 9% of people who use cannabis may develop a cannabis use disorder. However, the percentage of people who develop CUD varies depending on various factors such as frequency and intensity of cannabis use, individual susceptibility, and other environmental and genetic factors.

A 2022 study published in the Drug Alcohol Review of Australians showed that CUD in medical cannabis users was comparable to recreational users¹⁰.

Taking a break from medicinal cannabis can potentially reduce the risk of developing cannabis use disorder, particularly if the break helps patients maintain control over their cannabis use. By discontinuing or reducing cannabis use, patients may also avoid potential negative effects associated with regular and heavy consumption.

Helping prevent cannabis use disorder in your patients 

While it’s difficult to completely avoid cannabis use disorder, there are steps you can take with your patient to reduce their risk and promote a healthy relationship with medicinal cannabis.


When starting a course of medicinal cannabis, you should provide your patient with:

• A comprehensive assessment: You should conduct a thorough medical assessment to evaluate your patient’s specific medical condition, symptoms, and overall health. This assessment will help determine if medicinal cannabis is a suitable treatment option for them, taking into account factors such as the severity of their symptoms, potential benefits, and any existing medical conditions or medications that may interact with medical cannabis treatments.
• A personalised treatment plan: Based on the assessment, you can create a personalised treatment plan tailored to your specific needs. This includes determining the appropriate dosage and frequency of use.
• Ongoing support: Regular follow-up appointments with your patient allow for the monitoring of their progress and adjustment of the treatment plan as needed. You can assess any potential side effects and make necessary modifications to ensure the patient’s well-being.
• Education and guidance: You can explain the potential risks associated with cannabis use, discuss potential interactions with other medications or substances, and advise on strategies to reduce the risk of cannabis addiction.

Signs of cannabis use disorder

To meet the diagnostic criteria for CUD, a person must show a problematic pattern of cannabis use that leads to significant impairment or distress, with at least two of the following symptoms within a 12-month period¹¹:

• Taking more cannabis or using it for longer than intended.
• Persistent desire or unsuccessful efforts to cut down or control cannabis use.
• Spending significant time obtaining, using, or recovering from cannabis.
• Strong craving or desire to use cannabis.
• Cannabis use leading to failures in work, school, or home obligations.
• Continued cannabis use despite social or interpersonal problems caused by it.
• Giving up or reducing important activities due to cannabis use.
• Using cannabis in physically hazardous situations.
• Continuing cannabis use despite knowing it causes physical or psychological problems.
• Developing tolerance (needing more cannabis for desired effects) or experiencing diminished effects with the same amount of cannabis.
• Experiencing cannabis withdrawal symptoms or using it to relieve or avoid withdrawal.

The severity of CUD is determined by the number of symptoms present:

• Mild: 2-3 symptoms.
• Moderate: 4-5 symptoms.
• Severe: 6 or more symptoms.

If a patient reaches out to you with the suspicion that they may have a cannabis addiction, there are many helpful treatment options you can recommend, alongside screening for an official diagnosis. These include counselling and behavioural therapies. 

Cannabis withdrawal symptoms

Not everyone who uses cannabis will experience withdrawal symptoms. As with physical and psychological dependence, the risk of developing withdrawal symptoms after taking medicinal cannabis depends on the dosage, frequency, and length of time taking this medication.

While withdrawal symptoms for cannabis are typically mild for most people, a recent study into cannabis withdrawal showed that the most frequently reported symptoms include irritability, anxiety, restlessness, and difficulty sleeping.

Overall, people reported a range of symptoms during cannabis withdrawal including:

• Irritability.
• Anxiety.
• Restlessness.
• Difficulty sleeping.
• Decreased appetite.
• Mood swings.
• Fatigue.
• Headaches.
• Muscle aches.
• Sweating.
• Dizziness.
• Nausea and/or vomiting.

It is important to remember that the severity of withdrawal symptoms is not the same for everyone. Some patients may experience very mild withdrawal symptoms (like you might experience when quitting caffeine) while others may experience more severe symptoms.

Factors that influence the likelihood of cud

It's important to understand that addiction is not solely determined by the substance itself. Factors such as a patient’s environmental surroundings, genetic predisposition, individual susceptibility, psychological background, and social influences can also significantly contribute to the risk of addiction.

Some factors that influence the likelihood of developing cannabis use disorder include:

Cannabis use disorder and age

CUD is more common in people who start using cannabis at a young age. A study published in the journal Drug and Alcohol Dependence found that the risk of developing CUD was 4-7 times higher in people who started using cannabis before the age of 18 than in people who started using cannabis after the age of 25¹².

Cannabis use disorder and genetics

Genetics can play a role in the development of cannabis use disorder. Research suggests that some people may be more genetically predisposed to developing problematic cannabis use compared to others¹³.

These genetic factors can influence how people respond to the effects of cannabis, regulate their brain's reward system, and process substances. For example, variations in genes involved in the endocannabinoid system, such as the cannabinoid receptor 1 (CB1) gene, have been associated with an increased risk of cannabis dependence.

Cannabis use disorder and mental health 

Cannabis Use Disorder can be associated with mental health conditions, suggesting a complex relationship between cannabis use and mental wellbeing. While a direct link is difficult to prove, research shows that people with pre-existing mental health disorders may be more susceptible to developing problematic cannabis use.

People with conditions such as depression, anxiety, and schizophrenia may have a heightened vulnerability to CUD¹⁴. This two-way relationship suggests that cannabis use can worsen the symptoms of mental health disorders, while people with these disorders may self-medicate with cannabis to lessen their symptoms.

Cannabis use disorder and substance abuse

Having an addiction to another substance can significantly increase the chance of developing cannabis use disorder¹⁵. The co-occurrence of substance addiction and CUD can lead to more severe and persistent cannabis use problems, worsening physical and mental health problems, and impaired cognitive function.

Cannabis use disorder and cannabis potency 

High-potency cannabis, with elevated levels of THC (delta-9-tetrahydrocannabinol), has been linked to an increased likelihood of developing CUD¹⁶. Stronger psychoactive effects of potent cannabis may contribute to higher tolerance, physical and psychological dependence, and addiction.

The intensity of psychoactive effects can be influenced by cannabis potency. Higher potency cannabis can lead to increased intoxication, cognitive impairment, and increased risk-taking behaviour, which can all contribute to problematic cannabis use.

Cannabis use disorder treatment

There are a number of treatment options available for CUD. The most effective treatment approach is typically a combination of medication and therapy. A common therapy for CUD, Cognitive Behavioural Therapy (CBT), has been known to help people identify and change their thoughts and behaviours that contribute to their cannabis use. Strategies for helping patients through addiction 

If a patient approaches you with suspected signs of cannabis addiction or dependence, or reports that cannabis is having a negative impact on their life in any way, there are some strategies you can implement to help them feel supported and move forward. These strategies may include:

• Making an appropriate treatment plan
• Taking regular tolerance breaks from cannabis
• Gradual reduction of dose to a lower, more beneficial level, or with the goal of cessation (if appropriate)
• Changing the administration method (for example, from inhaled to more long-acting oral options)
• Consider other therapy options, such as CBT
• Identifying triggers for excessive cannabis use and strategise how to deal with them
• Building a strong support network
• Developing a healthy lifestyle
• Looking at life from a holistic point of view and improving your diet and exercise habits can have enormous benefits for health and wellbeing

The bottom line

While most patients will not become addicted to medicinal cannabis, it’s important to take the time to understand each patient’s risks for addiction, including their mental health and genetic factors, to make an informed decision.

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