stephanie First discussoion
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Cannabis Use Disorder
Cannabis use disorder (CUD) is noted to be the third most common substance used worldwide after the use of tobacco and alcohol. Cannabis can be used by numerous methods including smoking, vaping, dabbing, ingesting, and topical creams. CUD affects about 10% of the population of frequent cannabis users and about 50% of chronic daily users which may account for cognitive impairment, mediocre school, or work performance and psychiatric disorders (Gorelick, 2024). CUD is defined by a repeated pattern of challenging cannabis use that has caused a significant disturbance or distress in a person’s life with at least 2 symptoms arising over a 12-month span. A key feature of CUD is the absence of control over cannabis consumption despite being aware of its harmful consequences. It can be categorized as mild, moderate, and severe, depending on the presenting symptoms (Coelho et al., 2024). The acute intoxication of cannabis presents with varied symptoms depending on the level of delta-9-tetrahydrocannabinol (THC). The physical sign of intoxication includes tachycardia, blood pressure fluctuations, red eyes, dry mouth, slurred speech, and unsteady movement (Gorelick, 2024). The physiological effects that patients may often present with includes euphoria, relaxation, sedation, and increased appetite (the “munchies”) (Gorelick, 2024). Cannabis can also impair cognitive abilities especially relating to attention, memory, learning, and focus. When patients present in the emergency room with cannabis they may also present with psychiatric symptoms of anxiety, agitation or psychosis along with chest pain, palpitations, nausea or vomiting (due to cannabinoid hyperemesis syndrome). The screening for individuals for CUD is usually activated by signs or symptoms noted from the patient’s history or the physical exam. Patients usually present with unexplained impairments in social, academic, or work-related functioning, and worsening depressive or anxiety symptoms. Key physical symptoms include chronic red eyes, yellowing of fingertips, increased appetite, or cannabis odor on clothing (Gorelick, 2024). A screening tool that has been widely utilized in the assessment of CUD is the Cannabis Use Disorders Identification Test Revised (CUDIT-R). This screening tool encompasses 8 self-reported items which assess cannabis consumption, behaviors, consequences and dependence symptoms (Coelho et al., 2024).
Sedative, Hypnotics, and Anxiolytic
Sedative, hypnotics, and anxiolytic includes medications like benzodiazepines, z-hypnotics, and related medication which are predominately prescription medications used for sleep and anxiety. A vast number of these medications are considered under the Drug Enforcement Administration (Bushnell et al., 2025). Sedative, Hypnotics, and anxiolytic (SHA) use disorder is defined as a substantial impairment or distress due to the recurrent use of SHA usage. The impairment can include failure to fulfill obligations at work, school or home, health issues, persistent or increased use of SHA, and unsuccessful attempts to control use (Bushnell et al., 2025). The evaluation of a patient with SHA disorder depends on the patient’s history and physical examination. Although it is essential to identify the substance it may not always be possible to have drug screens available. At times the patient history may not be dependable especially in situation of overdose or suicide attempts. The physical exam is essential as observed signs can assist in cluing in the intoxicant that the patient consumed. Observation on physiological excitation, depression or mixed symptoms can help to hone in to the intoxicant. Other observations that may assist in the diagnosis includes changes in odor, pupil size, mental state, and neuromuscular abnormalities (Bushnell et al., 2025). Patients presenting with benzodiazepine toxicity usually present with symptoms of CNS depression but with stable vital signs. Usually, patients present with sleepiness but are easy to be aroused to be able to provide a history (Simone & Bobrin, 2023). When patients present with a sedative combined with other substances they often present with decreased mental function, slurred speech, and ataxia but severe toxicity often results in stupor or coma (Simone & Bobrin, 2023). Patients presenting with hypnotic toxicity presents with similar symptoms but also present with symptoms of complex sleep behaviors like sleepwalking, sleep-driving, and eating while not fully awake (Simone & Bobrin, 2023).
Similarities
The similarities between both substances use disorders is that both disorders are due to the misuse of a substance that causes impairment in work, school, and can cause health issues. The increase in frequency of both substances results in patients seeking higher potency of dosages and physical dependence. Both patients presenting with SHA use and cannabis use disorder presents with euphoria, sedation, relaxation. Lastly, the treatment of both conditions requires behavioral interventions.
Second response: Tami
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The use and abuse of sedative-hypnotics and anxiolytics by the general public is quite prevalent in today’s societies worldwide. Although typically administered in medical settings under the care of medical professionals, or by prescription, these pharmaceutical drugs have made their way into many homes illegally only to be used inappropriately by individuals who have gained access to them. (Simone & Bobrin, 2025).
Anxiolytics are in a class of drugs that are used to treat individuals with panic disorders, generalized anxiety disorders, and various other uses while sedatives (hypnotics) are used more so to treat mental health disorders such as insomnia. (Simone & Bobrin, 2025).
These classes of drugs have a high risk for dependency which can lead to an individual misusing them and developing a substance use disorder.
Unlike sedatives-hypnotics and anxiolytics, which are pharmaceutical drugs and more prevalent in the adult population, cannabis comes from a plant of the Cannabaceae family that contains multiple biologically active compounds. By contrast, this drug is very popular among teenagers and adolescents and is the most commonly used drug in the United States. (Patel & Marwaha, 2024).
To differentiate between these substance-use disorders (SUDs) and stages of abuse, a comprehensive assessment, as well as screening tools, should be implemented and completed by health care providers to help determine a diagnosis. “The goal of screening is to identify substance use that increases the risk for health consequences and to develop an action plan based on severity.” This can aid the provider in developing a personalized treatment plan for each patient. One such screening tool that was developed and is recommended by the World Health Organization (WHO) is the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). This eight-question screening tool is brief and helps identify an individual’s dangerous and/or dependent substance use. Assessment of the patient’s physical and mental status (impairment) along with negative consequences of drug use should also be obtained and considered when deciding on a treatment plan that should consist of pharmacologic and therapeutic interventions. (Volkow & Blanco, 2023).
