Cannabis Use Disorder (CUD) is defined as a relapsing disorder characterized by persistent use of marijuana despite negative consequences such as being arrested and incarcerated.
According to epidemiologists, roughly 219-million people throughout the world use cannabis. If marijuana consumers were to create their own quasi-nation-state, they would outnumber the populations of Russia (143-million) and the United Kingdom (68-million) combined.
Based on 2021 U.S. data approximately 16.3-million people met the criteria for CUD wherein prevalence is said to be highest among young adults (14.4% in ages 18–25). The studies also indicated men are more likely to develop CUD than women.
Diagnosing CUD is difficult because its interpretation is filtered through moral networks that vary across cultures, religions, and political landscapes. Religious traditions often frame non-medical drug use as being contrary to human dignity and temperance. Some religious groups are so radical about drug use they reject all medicinal interventions for themselves and their children. Moral narratives can shape whether individuals view their drug use as problematic. Added to the narratives are political issues where CUD becomes the focus of debates about legalization, public health, and regulatory laws.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), has lumped marijuana “abuse” and “dependence” into a single disorder with eleven criteria, adding craving and withdrawal while removing all harmful legal issues. Mere use is considered abuse. This shift increased detections of mild to moderate cases of CUD and changed prevalence estimates.
The current criteria include loss of control over the use of cannabis, continued use despite physical or psychological harm, tolerance and withdrawal, and impaired functioning at work, school, or in relationships. DSM-5’s broader standards affect the prevalence statistics used in policy debates over full legalization.
When none of the DSM-5 criteria fit an individual cannabis consumer then the individual clearly should not be diagnosed as having CUD even though they might use cannabis. A majority—about 95-percent—of total marijuana consumers in the U.S. exhibit no CUD symptoms. They are healthy, functioning, well-informed and well-adjusted adults who in some cases are still vulnerable to the dragnet of marijuana prohibition and its punitive approaches. Governments are expected to balance harm reduction with autonomy and economic interests, but many fall short when it comes to substances that have been listed in Schedule I of the Controlled Substances and CSA Schedules.
No FDA approved medications exist for CUD. Treatment systems often lag rising drug exposures. Past drug trials have explored agents targeting cannabinoid receptors, glutamate signaling, and stress pathways to no avail. A 2023 systematic review found no completed psilocybin trials for CUD, although the review did expose some self-reported survey data suggesting at least some individuals experienced reduced cannabis use after psychedelics use. Psychedelics may work by modulating reward pathways, enhancing psychological flexibility, and reducing compulsive drug use patterns. Comprehensive research using psilocybin to treat CUD has yet to be completed.
Amazing progress is being made in addiction research. Recent breakthroughs in understanding brain chemistry and physiology point to solutions to a problem that has plagued societies for millennia. Modern scientific instrumentation can detect addiction pathways in the brain to reveal the brain structures linked to opioid and cocaine addictions. These pathways may someday be targeted by newly developed drugs and methodologies that alter specific neural pathways and block addictions.
A few chemical tools for addiction control may already exist. Presently it’s understood that SSRIs prescribed for depression reduce social anxiety, MDMA-assisted therapy can increase trust and emotional openness, and psychedelics can reduce rigid thinking patterns.
A problem affecting public acceptance of brain enhancement treatments is that reductions in rigid thinking are seen by some as posing a moral threat to their personal world view.
Moralistic arguments against marijuana and psychedelic drugs can still overshadow their use as drug substitutes or addiction blockers. Punishments and partial treatments tend to be preferred by prohibitionists compared to finding actual cures or more effective treatments lasting more than 24 hours.
A total cure would presumedly leave prohibitionists with little or no further justification to wage drug wars. However, the tribal instincts and superstitions which targeted cannabis consumers beginning in Europe in the 16th century would persist. Prohibition is mostly useless as a mode of social control if it cannot neutralize or erase tribal fears and inclinations.
By reversing the roles of drug user and prohibitionist, it’s easy to deduce that forced attempts to pharmacologically alter the tribal instincts of prohibitionists by forcing them to drink wine, use cannabis, or take psychedelics, would violate the individual’s autonomy, consent, political freedom, and human rights. It would resemble a coercive and perverse political psychiatry often associated with authoritarian regimes. It would give prohibitionists a taste of their own medicine.
Anti-drug crusaders can also fear recreational or mind-altering drugs that could trigger people to think for themselves and thereby reject someone else’s authority. These types of drug panics were harbored by Nazis who limited public education to only those topics which supported the Reich. To emphasize their totalitarian outlook, they burned books in the public squares. Nazi Germany preferred that their common citizens be ignorant, barely literate, dependent, and thereby subservient to the fascist goals of the Third Reich. No mind expansion was allowed.
By consuming marijuana citizens have issued a declaration of independence that says they don’t need someone else’s tyranny to survive. No need exists for an overwhelming drug authoritarian presence like that found in Russia and China which impose draconian drug use penalties upon their citizens. Drug war fraud will need to disappear if civil society is to prosper. With proper use of drugs people can feel better about themselves and others. They are in superior positions to chemically fortify themselves against those sadistic enough to want them to suffer or remain incapacitated based on little more than ill-defined, ill-equipped and ill-fated concepts like cannabis use disorder.
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