Navigating Cannabis and Cannabinoid Use in Today’s Clinical Practice

In this episode of ASAM Practice Pearls, Drs. Stephen Taylor and Takeo Toyoshima address the misconception that cannabis is not addictive. They discuss how clinicians can better understand the cannabis products their patients are using, navigate the changing legal landscape, and assess for cannabis use disorder using the “Three Cs” framework. The conversation highlights treatment strategies like motivational interviewing and harm reduction, managing cannabis withdrawal, the risk of psychosis from high-potency products, and emerging pharmacotherapy options. Throughout the episode, they offer practical strategies for keeping patients engaged in care.  

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Stephen M. Taylor, MD, MPH, DFAPA, DFASAM

Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.

Expert

Takeo Toyoshima, MD

Dr. Takeo Toyoshima is the interim program director for the UCSF Addiction Psychiatry Fellowship. He completed medical school at UCLA, then psychiatry residency, addiction psychiatry fellowship, and forensic psychiatry fellowship at UCSF. His main clinical duties are at the San Francisco VA Health Care System, both in the Addiction Recovery Treatment Services' outpatient and intensive outpatient programs and in the Veterans Justice Outreach Clinic, which treats patients who are criminal justice-involved. In these settings, Dr. Toyoshima supervises UCSF medical students, psychiatry residents, addiction psychiatry fellows, and forensic psychiatry fellows, in addition to other allied health profession trainees. He concurrently serves as the VA site director for the UCSF Psychiatry and the Law Program. Outside of UCSF, Dr. Toyoshima also works in clinical and forensic private practice and serves in various roles in organized medicine (American Psychiatric Association, Northern California Psychiatric Society, California Society of Addiction Medicine, American Academy of Addiction Psychiatry, etc.). His clinical interests are in the intersection of psychiatry, addiction, and forensic matters. 

📖 Show Segments

• 00:05 - Introduction 
• 01:13 - How to Approach the Conversation with Patients 
• 03:51 - Clarifying Terms and Product Use with Patients
• 05:52 - Legal and Regional Differences
• 08:45 - Addressing Patient’s Perceived Pros and Cons of Cannabis
• 11:19 - Assessing for Cannabis Use Disorder
• 13:53 - What if a Patient Doesn’t Want to Stop?
• 15:49 - Approaching Drug Testing with Patients
• 17:43 - Recommended Treatment Options
• 20:02  - Cannabis Withdrawal Symptoms
• 22:08 - Considerations for Adolescents
• 23:21 - The Risk of Psychosis
• 24:46 - Harm Reduction
• 27:22 - Signs of Cannabis Toxicity 
• 31:46 - Key Takeaways
• 33:20 - Conclusion and Additional Learning Opportunity 

📋 Key Takeaways

• Cannabis addiction is real and common: Around 10% of people who start using become addicted, and around 30% of current users meet criteria for cannabis use disorder (CUD). 
• Ask about products, routes, and potency: Flower, concentrates, edibles, and vapes carry very different risk profiles. Higher potency can lead to faster tolerance and withdrawal.  
• Work collaboratively with your patients: Let patients educate you about their use, be curious, and use motivational interviewing techniques in conversation.