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{\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;15\\\/11\\\/12\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;15\\\/11\\\/12\u0022}],\u0022ac\u0022:{\u0022spmdc;15\\\/11\\\/12\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;15\\\/11\\\/12\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EMedical marijuana is currently legal in 23 states plus the District of Columbia. However, there is ongoing controversy about the role of marijuana in treating medical conditions, the addictive potential of medical and recreational marijuana, the best approaches to treating cannabis use disorder, and which clinical end point is most appropriate.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Emarijuana\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emedical marijuana\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Erecreational marijuana\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eabstinence\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ETHC\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Edronabinol\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Enabinol\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecognitive behavioral therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Evouchers\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emotivational interviewing\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EAs of April 2015, medical marijuana (MMJ) is legal in 23 states and the District of Columbia (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Despite the growing call to expand the use of marijuana for a host of medical conditions, however, the data regarding its safety, effectiveness, and addiction potential are still inconclusive. This session provided a forum for 3 speakers to address the legal and medical issues surrounding the use of recreational marijuana (RMJ) and MMJ.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/11\/12\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022States With Enacted Medical Marijuana LawsSource: Anthony JC et al. Exp Clin Psychopharmacol. 1994.Reproduced with permission from KP Hill, MD.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-375483814\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;States With Enacted Medical Marijuana LawsSource: Anthony JC et al. \u0026amp;lt;em\u0026amp;gt;Exp Clin Psychopharmacol\u0026amp;lt;\/em\u0026amp;gt;. 1994.Reproduced with permission from KP Hill, MD.\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/11\/12\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/11\/12\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/11\/12\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16865\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-3\u0022 class=\u0022first-child\u0022\u003EStates With Enacted Medical Marijuana Laws\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ESource: Anthony JC et al. \u003Cem\u003EExp Clin Psychopharmacol\u003C\/em\u003E. 1994.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EReproduced with permission from KP Hill, MD.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-6\u0022\u003EKevin P. Hill, MD, McLean Hospital, Belmont, Massachusetts, USA, launched the session by discussing the epidemiology of marijuana use and the potential for addiction. According to Dr Hill, almost 20 million Americans used marijuana in the past year, and up to 9% of users may become dependent (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E). Among those who start using in adolescence, 17% may become dependent [Hall W, Degenhardt L. \u003Cem\u003ELancet\u003C\/em\u003E. 2009].\u003C\/p\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/11\/12\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Estimated Prevalence of Dependence Among UsersSource: Anthony JC et al. Exp Clin Psychopharmacol. 1994.Reproduced with permission from KP Hill, MD.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-375483814\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Estimated Prevalence of Dependence Among UsersSource: Anthony JC et al. \u0026amp;lt;em\u0026amp;gt;Exp Clin Psychopharmacol\u0026amp;lt;\/em\u0026amp;gt;. 1994.Reproduced with permission from KP Hill, MD.\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/11\/12\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/11\/12\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/11\/12\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16866\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EEstimated Prevalence of Dependence Among Users\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003ESource: Anthony JC et al. \u003Cem\u003EExp Clin Psychopharmacol\u003C\/em\u003E. 1994.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EReproduced with permission from KP Hill, MD.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EDr Hill emphasized that young people who use marijuana regularly can develop neurologic sequelae, including poor cognitive function [Meier MH et al. \u003Cem\u003EProc Natl Acad Sci USA\u003C\/em\u003E. 2012], increased episodes of anxiety and depression [Crippa GA et al. \u003Cem\u003EHum Psychopharmacol\u003C\/em\u003E. 2009], and an increased risk of psychotic disorders [Di Forti M et al. \u003Cem\u003ESchizophr Bull\u003C\/em\u003E. 2014]. As well, the symptoms of cannabis withdrawal are similar to those of tobacco withdrawal [Budney AJ et al. \u003Cem\u003EJ Subst Abuse Treat\u003C\/em\u003E. 2008].\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EEach state currently enacts its own MMJ laws, which typically regulate products derived from cannabis leaves, flowers, and roots that are usually sold through state-run dispensaries. These are a different entity than dronabinol (oral tetrahydrocannabinol [THC]) and nabilone, which are medications approved by the FDA for nausea and vomiting associated with chemotherapy and for appetite stimulation in certain wasting illnesses.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EVarious states have approved cannabis for indications that include cancer, glaucoma, AIDS, hepatitis C, amyotrophic lateral sclerosis, Crohn disease, Parkinson disease, and multiple sclerosis. According to Dr Hill, however, many people who carry MMJ cards do not have one of the above conditions. He also noted that the data linking cannabinoids to symptomatic relief are most robust for chronic pain, neuropathic pain, and spasticity associated with multiple sclerosis [Koppel BS et al. \u003Cem\u003ENeurolog\u003C\/em\u003Ey. 2014]. Dr Hill emphasized that, because state laws often suggest the use of MMJ for medical conditions for which there is little or no scientific evidence supporting the use of MMJ as treatment, the policy is ahead of the science in many states.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EDr Hill closed his presentation with recommendations for patients who ask for MMJ.\u003C\/p\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\u003Cp id=\u0022p-14\u0022\u003EEstablish a prescribing policy on how you will handle MMJ in your practice.\u003C\/p\u003E\u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\u003Cp id=\u0022p-15\u0022\u003EBe open to evaluating patients who ask for MMJ.\u003C\/p\u003E\u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\u003Cp id=\u0022p-16\u0022\u003EAssess substance abuse risk with a careful medical and psychiatric history.\u003C\/p\u003E\u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\u003Cp id=\u0022p-17\u0022\u003EPsychiatric patients are unlikely candidates for MMJ, so for these patients, MMJ is best recommended by physicians treating the indicated debilitating condition.\u003C\/p\u003E\u003C\/li\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\u003Cp id=\u0022p-18\u0022\u003ETreat a request for MMJ in the same manner as requests for other addictive medications with significant potential side effects, like benzodiazepines or stimulants.\u003C\/p\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-19\u0022\u003EAndrew J. Saxon, MD, University of Washington and VA Puget Sound Health Care System, Seattle, Washington, USA, presented his thoughts on practicing psychiatry in one of the only states where RMJ is legal.\u003C\/p\u003E\u003Cp id=\u0022p-20\u0022\u003EAccording to Dr Saxon, every producer of RMJ is licensed by the state of Washington and must submit samples of the product to an independent laboratory. Samples are tested for quantities of THC and cannabidiol and for the presence of mold, bacteria, and potentially toxic pesticides and herbicides. If a representative sample does not meet applicable standards, the entire lot must be destroyed.\u003C\/p\u003E\u003Cp id=\u0022p-21\u0022\u003EWashington imposes an excise tax on RMJ, which funds the development of a biennial Healthy Youth Survey, as well as a public information website, substance abuse prevention programs, research programs, care at community health centers, and a cost\u2013benefit analysis. Dr Saxon also reviewed the law regarding driving under the influence (DUI) of marijuana. A blood level \u2265\u20055 ng\/mL of THC 2 hours after a driver is stopped results in a DUI charge. A THC level \u0026gt;\u20050 with a blood alcohol level \u2265\u20050.02 ng\/mL also results in a DUI charge.\u003C\/p\u003E\u003Cp id=\u0022p-22\u0022\u003EIn his work at the Veterans Administration Hospital, Dr Saxon has not seen an increase in either the number of patients or the severity of symptoms associated with cannabis use disorders. He also cited data suggesting that, compared with alcohol, MMJ (a proxy for RMJ) is associated with fewer traffic accidents [Anderson DM et al. \u003Cem\u003EJ Law Econ\u003C\/em\u003E. 2013] and that the rate of suicides among men decreased after the legalization of MMJ [Anderson DM et al. \u003Cem\u003EAm J Public Health\u003C\/em\u003E. 2014]. This has reinforced his opinion that, so far, little harm has come from the legalization of high-quality marijuana.\u003C\/p\u003E\u003Cp id=\u0022p-23\u0022\u003EFrances R. Levin, MD, Columbia University Medical College, New York, New York, USA, discussed the growing problem of cannabis use disorders. According to the DSM-V, cannabis use disorder is defined by 11 criteria that include amounts taken, cravings, tolerance, and withdrawal.\u003C\/p\u003E\u003Cp id=\u0022p-24\u0022\u003ECannabis is currently the most widely used illicit drug in the United States, with 19.8 million people reporting use in the past month in a 2013 report (\u003Ca id=\u0022xref-fig-3-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F3\u0022\u003EFigure 3\u003C\/a\u003E) [US Department of Health and Human Services. 2013].\u003C\/p\u003E\u003Cdiv id=\u0022F3\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/11\/12\/F3.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Past-Month Illicit Drug Use Among Persons Aged \u0026#x2265;\u0026#x2005;12 yaIllicit drugs include marijuana\/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, and prescription-type psychotherapeutics used nonmedically.Reprinted from Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-375483814\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Past-Month Illicit Drug Use Among Persons Aged \u0026#x2265;\u0026#x2005;12 y\u0026amp;lt;sup\u0026amp;gt;a\u0026amp;lt;\/sup\u0026amp;gt;Illicit drugs include marijuana\/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, and prescription-type psychotherapeutics used nonmedically.Reprinted from Substance Abuse and Mental Health Services Administration, \u0026amp;lt;em\u0026amp;gt;Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings\u0026amp;lt;\/em\u0026amp;gt;, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 3.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/11\/12\/F3.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/11\/12\/F3.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 3.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/11\/12\/F3.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16867\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 3.\u003C\/span\u003E \u003Cp id=\u0022p-25\u0022 class=\u0022first-child\u0022\u003EPast-Month Illicit Drug Use Among Persons Aged \u2265\u200512 y\u003C\/p\u003E\u003Cp id=\u0022p-26\u0022\u003E\u003Csup\u003Ea\u003C\/sup\u003EIllicit drugs include marijuana\/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, and prescription-type psychotherapeutics used nonmedically.\u003C\/p\u003E\u003Cp id=\u0022p-27\u0022\u003EReprinted from Substance Abuse and Mental Health Services Administration, \u003Cem\u003EResults from the 2013 National Survey on Drug Use and Health: Summary of National Findings\u003C\/em\u003E, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-28\u0022\u003EPsychotherapeutic approaches to cannabis use disorders include motivational interviewing, cognitive-behavioral therapy (CBT), family structural therapy, contingency management strategies, and mindfulness therapy. According to Dr Levin, motivational interviewing is an essential skill for working with substance-dependent patients, as it allows clinicians to talk to patients\u2014especially resistant patients\u2014about substance abuse and supports patients\u2019 self-efficacy [Barnett E et al. \u003Cem\u003EAddict Behav\u003C\/em\u003E. 2012]. The cognitive-behavioral approach to relapse prevention is a flexible approach that introduces and rehearses coping skills to recognize triggers, avoid high-risk situations, cope with cravings, and unlearn maladaptive behavioral skills. Data suggest that this type of treatment is effective in achieving abstinence and reducing marijuana use [Hoch E et al. \u003Cem\u003EEur Neuropsychopharmacol\u003C\/em\u003E. 2012].\u003C\/p\u003E\u003Cp id=\u0022p-29\u0022\u003EDr Levin also highlighted a study that combined the use of CBT and abstinence-based vouchers [Budney AJ et al. \u003Cem\u003EJ Consult Clin Psychol\u003C\/em\u003E. 2006]. The results suggested that over the first 7 weeks, the vouchers were more successful in promoting abstinence than CBT; over time, however, the vouchers plus CBT had a significantly additive effect compared with either CBT alone or the vouchers alone at 3 months (both \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.05).\u003C\/p\u003E\u003Cp id=\u0022p-30\u0022\u003EFor patients who have difficulty reducing or discontinuing their marijuana use, pharmacologic approaches might be indicated. Although a single effective pharmacotherapy has not been identified, the medications or combinations that may be effective include naltrexone [Haney M et al. \u003Cem\u003ENeuropsychopharmacology\u003C\/em\u003E. 2015], gabapentin [Mason BJ et al. \u003Cem\u003ENeuropsychopharmacology\u003C\/em\u003E. 2012], n-acetylcysteine [Gray KM et al. \u003Cem\u003EAm J Psychiatry\u003C\/em\u003E. 2012], and nabilone [Bedi G et al. \u003Cem\u003EAddict Biol\u003C\/em\u003E. 2013].\u003C\/p\u003E\u003Cp id=\u0022p-31\u0022\u003EIn closing, Dr Levin urged clinicians to think about a realistic end point for measuring the effectiveness of interventions to reduce marijuana use. Although clinical trials often use continuous abstinence as an outcome measure, Dr Levin suggested that a less stringent measure may be more appropriate.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/11\/12.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlige\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlige\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}