Medicinal Cannabis and Addiction: Separating Fact from Fiction

The cannabis debate often polarises between claims of complete harmlessness and warnings of inevitable dependency. But what does the science actually tell us? At Cannabis Clinic, we believe informed patients make better decisions. Let’s examine the evidence about medicinal cannabis and addiction risk, how it compares to other medications, and what this means for your health journey.

Understanding Addiction vs. Regular Use

Addiction isn’t simply regular use – it’s when a substance hijacks your brain’s reward pathways, creating compulsive behaviour despite harm. According to DSM-5 criteria, addiction involves¹:

• Loss of control over consumption patterns
• Continued use despite negative consequences to health, relationships, or responsibilities
• Cravings and withdrawal when stopping
• Failed attempts to reduce or quit
• Tolerance buildup requiring higher doses for the same effect
• Life disruption as use becomes the primary focus

This framework helps us understand that not all substances carry equal addiction risk. While opioids, alcohol, and nicotine create powerful dependencies, other medications pose minimal risk. Understanding where cannabis fits in this spectrum is crucial for making informed treatment decisions.

How Medicinal Cannabis Works

Unlike many addictive substances that flood the brain with artificial chemicals, cannabis works through your body’s existing endocannabinoid system (ECS) – a natural network regulating mood, pain perception, sleep, and immune function².

The ECS includes:

• Cannabinoid receptors (CB1 in the brain, CB2 throughout the body)
• Natural cannabinoids your body produces (endocannabinoids)
• Enzymes that break down cannabinoids when no longer needed

Cannabis contains plant-based cannabinoids:

• THC (Tetrahydrocannabinol): The psychoactive compound that binds to CB1 receptors, producing pain relief, relaxation, and euphoria
• CBD (Cannabidiol): Non-intoxicating compound that modulates the ECS without causing a “high”

The Research: Cannabis Use Disorder (CUD)

A Critical Distinction

CUD is a broad diagnostic category that can include problematic use patterns. The DSM-5 diagnostic criteria for CUD were originally developed for recreational cannabis users, and their application to medicinal cannabis patients remains controversial among researchers19. Recent studies have identified the need for population-specific approaches to CUD assessment, particularly for those using cannabis medically18. Research examining CUD in medical cannabis patients found that standard assessment tools like the CUDIT-R may result in false positives, as these tools fail to account for legitimate medical use patterns where the benefits and side effects are overseen by medical professionals19.

Recent meta-analyses show approximately 25-29% of medicinal cannabis users meet CUD criteria within 6-12 months³. This is due to regular use, dependence and withdrawal when stopping, being part of the diagnostic criteria. However, this diagnostic framework may not adequately distinguish between therapeutic dependence (similar to patients on long-term antidepressants) and problematic addiction patterns19. 

THC vs. CBD: Different Risk Profiles

THC can lead to physical dependence in some users. Common withdrawal symptoms include7:

• Irritability and mood swings
• Sleep disruptions and vivid dreams
• Appetite changes
• Anxiety and restlessness
• Physical discomfort

However, cannabis withdrawal is generally milder and shorter-lived than withdrawal from alcohol, opioids, or benzodiazepines.

CBD presents a stark contrast:

• Produces no euphoric effects
• Has no known addictive properties
• May actually reduce cravings in people with substance use disorders5
• Shows promise in treating opioid addiction

This is why many medicinal cannabis products emphasize CBD content, offering therapeutic benefits with minimal dependency risk.

Risk Factors: Who’s Most Vulnerable?

Cannabis Dependence doesn’t affect everyone equally. Understanding risk factors helps patients and doctors make informed treatment decisions³,⁴:

Usage patterns:

• Daily or near-daily consumption
• High-THC products (>15% THC)
• Smoking rather than other consumption methods

Personal factors:

• Starting use before age 18
• Co-existing mental health conditions (anxiety, depression, PTSD)
• Personal or family history of substance abuse
• Using cannabis as primary coping mechanism for stress
• Male gender (slightly higher risk)

Environmental factors:

• Easy access to high-potency products
• Social circles that normalize heavy use
• Lack of alternative pain management options

Comparing Cannabis to Other Medications

Context matters when evaluating addiction risk. Here’s how medicinal cannabis compares to common alternatives:

Medication Type	Addiction Risk	Withdrawal Severity	Fatal Overdose Risk	Annual US Deaths
Opioids	High 6	Severe	High	~105,0009
Benzodiazepines	High	Severe	High	Included in overdose deaths9
Alcohol	High	Severe	High	~178,00010,11
Tobacco/Nicotine	Very High	Moderate	Low	~490,00012, 13
Antidepressants	Very Low16	Mild-Moderate15, 16	Low	~5,80017
Cannabis (THC)	Moderate³	Mild-Moderate7	None	Zero recorded8
CBD Cannabis	None	None	None	Zero

Sources: CDC data 2023-2024; NIDA statistics; Multiple epidemiological studies

This comparison reveals cannabis’s unique position: moderate dependency risk with no fatal overdose potential. Notably, while antidepressants have very low addiction potential, 55-61% of users experience withdrawal effects when attempting to stop14, 16, with 27% of users reporting feeling addicted16. However, antidepressant deaths typically involve intentional overdose or combination with other substances17, contrasting sharply with cannabis which has no recorded fatal overdoses.

Dependence vs. Addiction: Understanding the Difference

Medical professionals distinguish between these related but different concepts:

Physical dependence occurs when your body adapts to regular substance use, leading to withdrawal symptoms when stopping. This is a normal physiological response that can occur without problematic use patterns¹. This is exemplified by antidepressants, where 55% of users experience withdrawal effects when stopping, yet these medications have very low addiction potential14.

Addiction involves behavioural changes: compulsive seeking, loss of control, and continued use despite negative consequences¹.

Many patients develop dependence on medications like antidepressants, blood pressure drugs, or diabetes medications without becoming addicted. The same principle applies to medicinal cannabis – dependence may occur, but it doesn’t automatically indicate addiction.

Minimising Risk: Practical Strategies

If you’re considering or currently using medicinal cannabis, these evidence-based strategies can help minimise dependency risk:

Medical Supervision

• Work with qualified healthcare providers experienced in cannabis medicine
• Follow prescribed dosing schedules carefully
• Schedule regular check-ins to assess effectiveness and side effects
• Discuss any concerns about dependency openly

Smart Product Selection

• Choose CBD-dominant formulations when possible
• Avoid high-THC products unless specifically needed for your condition
• Consider products with balanced THC:CBD ratios (1:1 or 2:1)
• Opt for an oil over the flower where able 

Mindful Usage Patterns

• Avoid daily use when possible – consider alternating days
• Take periodic “tolerance breaks” (48-72 hours every few weeks)
• Keep a usage journal to monitor patterns and effects
• Set clear boundaries around when and why you use cannabis

Building Healthy Habits

• Develop non-cannabis coping strategies for stress and pain
• Maintain social connections outside of cannabis use
• Engage in regular exercise and mindfulness practices
• Address underlying mental health issues with appropriate therapy

Breaking Through Cannabis Stigma

The addiction debate around cannabis often reflects broader cultural attitudes rather than scientific evidence. While legitimate risks exist, they must be viewed in proper context:

• Cannabis addiction rates are lower than many prescription medications
• No fatal overdoses have been recorded8
• Many patients successfully use cannabis long-term without developing problematic patterns
• CBD products offer therapeutic benefits with essentially no addiction risk

Both fear-based messaging and dismissive attitudes toward risk disserve patients seeking evidence-based information. The goal is balanced, factual understanding that empowers informed decision-making.

If you are worried that you may have a problem

Our doctors understand cannabis better than most, and if you are not happy with your relationship with cannabis it’s best to say so. Speaking with your doctor is a great opportunity to take back control with their assistance and ensure your usage is as effective as possible, while avoiding the negatives.

The Bottom Line

For most patients using medicinal cannabis under medical supervision, dependence risk is manageable and often outweighed by therapeutic benefits. The key is understanding your individual risk factors and implementing appropriate safeguards.

Essential takeaways:

• THC can cause dependence and potentially addiction, particularly with daily use
• CBD appears to have no addictive potential
• CUD diagnostic criteria may not accurately reflect problematic use in medicinal patients18, 19
• Cannabis dependence risk is moderate—higher than once thought, but significantly lower than many alternatives
• Individual risk factors significantly influence outcomes
• Medical supervision and mindful usage patterns substantially reduce risk

Making Informed Decisions

Every medication carries risks and benefits. The goal isn’t to eliminate all risk – it’s to make informed decisions that optimise your health outcomes. If considering medicinal cannabis:

1. Discuss your complete medical history with a qualified provider, including any substance use concerns
2. Consider your personal risk factors honestly and thoroughly
3. Start with CBD-dominant products if therapeutically appropriate
4. Establish clear treatment goals and measurable success metrics
5. Plan for regular reassessment of your treatment plan every 3-6 months
6. Stay informed about emerging research and best practices

Cannabis medicine continues evolving rapidly as research expands our understanding. Working with experienced healthcare providers ensures you receive current, evidence-based guidance tailored to your specific situation.

References

1. Gorelick DA. Cannabis-Related Disorders and Toxic Effects. N Engl J Med. 2023 Dec 14;389(24):2267-2275.
2. Lu HC, Mackie K. An Introduction to the Endogenous Cannabinoid System. Biol Psychiatry. 2016 Apr 1;79(7):516-25.
3. Dawson D, Stjepanović D, Lorenzetti V, Cheung C, Hall W, Leung J. The prevalence of cannabis use disorders in people who use medicinal cannabis: A systematic review and meta-analysis. Drug Alcohol Depend. 2024 Apr 1;257:111263.
4. Page RL, Allen LA, et al,. Medical Marijuana, Recreational Cannabis, and Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation [Internet]. 142(10).
5. Hurd YL, Spriggs S, et al,. Cannabidiol for the Reduction of Cue-Induced Craving and Anxiety in Drug-Abstinent Individuals With Heroin Use Disorder: A Double-Blind Randomized Placebo-Controlled Trial. Am J Psychiatry. 2019 Nov 1;176(11):911-922.
6. Vowles KE, McEntee ML, et al,. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 2015 Apr;156(4):569-576.
7. Kesner AJ, Lovinger DM. Cannabis Use, Abuse, and Withdrawal: Cannabinergic Mechanisms, Clinical, and Preclinical Findings. Journal of Neurochemistry. 2021;157(5):1674-1696.
8. Richards JR. Cannabinoid Hyperemesis Syndrome: Pathophysiology and Treatment in the Emergency Department. J Emerg Med. 2018 Mar;54(3):354-363.
9. National Institute on Drug Abuse. Drug Overdose Deaths: Facts and Figures. August 21, 2024. Available at: https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates
10. Centers for Disease Control and Prevention. Deaths from Excessive Alcohol Use — United States, 2016–2021. MMWR Morbidity and Mortality Weekly Report. 2024;73:154–161.
11. National Institute on Alcohol Abuse and Alcoholism. Alcohol-Related Emergencies and Deaths in the United States. Available at: https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics-z/alcohol-facts-and-statistics/alcohol-related-emergencies-and-deaths-united-states
12. Centers for Disease Control and Prevention. Burden of Cigarette Use in the U.S. Updated October 8, 2024. Available at: https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html
13. Centers for Disease Control and Prevention. Tobacco-Related Mortality. Updated August 22, 2022. Available at: https://archive.cdc.gov/www_cdc_gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/index.htm
14. Horowitz MA, Framer A, Hengartner MP, Sørensen A, Taylor D. Estimating Risk of Antidepressant Withdrawal from a Review of Published Data. CNS Drugs. 2023 Feb;37(2):143-157
15. Read J, Cartwright C, Gibson K. How many of 1829 antidepressant users report withdrawal effects or addiction? Int J Ment Health Nurs. 2018 Dec;27(6):1805-1815.
16. Read J. How common and severe are six withdrawal effects from, and addiction to, antidepressants? The experiences of a large international sample of patients. Addict Behav. 2020 Mar;102:106157.
17. National Institute on Drug Abuse. Number of overdose deaths from antidepressants in the U.S. from 1999 to 2022. Statista. May 14, 2024.
18. Myers MG, Ganoczy D, Walters HM, Pfeiffer PN, Ilgen MA, Bohnert KM. Assessing the diagnostic utility of the Cannabis Use Disorder Identification Test – Revised (CUDIT-R) among veterans with medical and non-medical cannabis use. Drug Alcohol Depend. 2023 Jun 1;247:109876.
19. Gruber SA, Smith RT, Dahlgren MK, et al. Assessing Cannabis Use Disorder in Medical Cannabis Patients: Interim Analyses from an Observational, Longitudinal Study. Cannabis and Cannabinoid Research. 2023;8(3):567-581.

This article is for educational purposes only and should not replace professional medical advice. Always consult with qualified healthcare providers before starting or stopping any medication.