14 - The Policy Implications of Cannabis Dependence

Summary

Introduction

In this chapter, we discuss the potential policy implications of the observation that some cannabis users become dependent on the drug in the sense that they lose control of their use, and find themselves unable to cut down or stop using cannabis despite health and personal problems caused by its use. We begin by summarizing the key features of cannabis dependence, and briefly discussing why dependence requires a policy response. The various ways in which the public health system may respond to cannabis dependence are then explored. These options are not limited to specialist interventions for people who request assistance to stop using cannabis. We place specialist interventions in a spectrum of interventions ranging from education about the risks of developing dependence, to screening, early intervention, and specialist treatment. The appropriateness of these interventions will vary with the severity of cannabis dependence. Within specialist treatment programs, we discuss the need for management of withdrawal, comorbid substance disorders (e.g., alcohol and opioid use disorders), comorbid mental disorders (e.g., depression and schizophrenia), and the special problems of cannabis-dependent adolescents. In the absence of evidence on many of these issues, these sections pose questions rather than provide definitive answers.

The final section of the chapter discusses the role that cannabis dependence may play in policy debates about medical cannabis use and the legal status of recreational cannabis use. This section is necessarily speculative given the dearth of evidence.