Defining problematic use of medicinal cannabis: Theoretical and empirical considerations

The use of cannabis in medical contexts is increasing globally. Medicinal cannabis refers to conventional medical treatment using cannabis-based products, given on a physician's prescription for a particular illness or health issue. In nonmedical settings, cannabis is considered one of the most commonly used recreational drugs, and its high prevalence has drawn attention to various negative consequences of its use, such as psychosis, cognitive deficits, and driving impairment. One of the most common negative consequences of cannabis use is cannabis use disorder (CUD), which affects approximately one in four recreational cannabis users during their lifetime. However, defining problematic cannabis use and CUD among medicinal cannabis patients is challenging. The use of medications often leads to physical dependence, manifested by tolerance and withdrawal symptoms, all of which are also common indicators of CUD. Therefore, standard diagnostic criteria used for recreational assessment of CUD may be inapplicable in a medical context. In this chapter, we review theoretical frameworks and empirical evidence, which may allow for future definition and assessment of problematic use of medicinal cannabis.