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Cannabis use disorder

Key sources
The following summarized guidelines for the evaluation and management of cannabis use disorder are prepared by our editorial team based on guidelines from the World Health Organization (WHO 2023), the American Society of Regional Anesthesia and Pain Medicine (ASRA 2023), the Society of Obstetricians and Gynaecologists of Canada (SOGC 2022), the United States Department of Defense (DoD/VA 2021), the U.S. Preventive Services Task Force (USPSTF 2020), the Canadian Coalition for Seniors' Mental Health (CCSMH 2020), and the American College of Obstetricians and Gynecologists (ACOG 2017).
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Guidelines

1.Screening and diagnosis

Indications for screening: as per VA 2021 guidelines, insufficient evidence to recommend for or against screening for drug use disorders in primary care to facilitate enrollment in treatment.
I
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2.Medical management

Pharmacotherapy: insufficient evidence to recommend for or against the use of pharmacotherapy in the treatment of CUD.
I

3.Nonpharmacologic interventions

Brief intervention
As per WHO 2023 guidelines:
Offer screening and brief intervention in adults using cannabis. Include at least a single session, incorporating individualized feedback and advice on reducing or stopping cannabis consumption and the offer of follow-up care in the brief intervention.
B
Consider referring adult patients with hazardous cannabis use or CUD not responding to brief interventions for specialist intervention.
C

More topics in this section

  • Psychotherapy

  • Mindfulness-based therapies

  • Technology-based interventions

  • Recovery-oriented interventions

4.Perioperative care

Perioperative considerations, screening for cannabis use
Obtain universal screening for cannabinoids (including the type of cannabis or cannabinoid product, time of last consumption, route of administration, and amount and frequency of use) before surgery.
A
Do not obtain universal toxicology screening for cannabinoids preoperatively.
D

More topics in this section

  • Perioperative considerations (counseling)

  • Perioperative considerations (timing of surgery)

  • Perioperative considerations (cannabis dose tapering)

  • Perioperative considerations (anesthesia and analgesia)

  • Perioperative considerations (ventilation)

  • Perioperative considerations (monitoring)

  • Perioperative considerations (management of cannabis withdrawal)

5.Specific circumstances

Female patients, screening for cannabis use
Screen females for cannabis use
B
using appropriate screening tools
B
as for other substance use and obtain further exploration of its impact.
B
Use a trauma-informed care approach and harm reduction when inquiring about cannabis use.
B

More topics in this section

  • Female patients (counseling in cannabis users)

  • Elderly patients (screening for cannabis use)

  • Elderly patients (education and counseling)

  • Elderly patients (advice for avoidance)

  • Elderly patients (clinical assessment)

  • Elderly patients (management)

  • Pregnant patients (screening)

  • Pregnant patients (counseling)

  • Pregnant patients (advice for avoidance)

  • Pregnant patients (monitoring)

  • Breastfeeding patients