While the majority of patients will not develop an addiction to medicinal cannabis, the risk is real and warrants careful clinical consideration. The likelihood of addiction depends on multiple factors, including genetic predisposition, cannabis potency, and individual susceptibility.¹

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Research suggests that approximately 9–13% of cannabis users may develop a cannabis use disorder (CUD), and this risk applies to medicinal as well as recreational use.¹ As prescribers, clinicians play a central role in identifying patient risk profiles, establishing appropriate treatment parameters, and monitoring for signs of problematic use.

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Addiction is a complex condition characterised by a compulsive pattern of drug use despite negative consequences.² Cannabis addiction exists on a spectrum from mild to severe, with variable effects on psychological and physical wellbeing.

Can Patients Become Addicted to Medicinal Cannabis?

Cannabis addiction, while not the most likely outcome, is clinically possible — including with prescribed medicinal cannabis. Cannabis can become addictive because its primary active compound, delta-9-tetrahydrocannabinol (THC), activates the brain’s reward system, triggering dopamine release.³

With regular cannabis use, the brain may reinforce the association between the rewarding stimulus and the positive feelings experienced. Over time, this can lead to dysregulation of the reward system, whereby increasing amounts of THC are required to achieve the same effect — a process known as tolerance. This tolerance can contribute to escalating use patterns consistent with addictive behaviour.³

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Once dependence is established, patients may present with cravings, withdrawal symptoms, and difficulty controlling the amount or frequency of their cannabis use.⁴

Physical Dependence

Physical dependence occurs when the body adapts to a substance and produces withdrawal symptoms upon cessation or dose reduction. Not all patients prescribed medicinal cannabis will develop physical dependence; however, it may arise with regular or prolonged use, particularly at higher doses.⁵ Individual factors — including metabolism and physiology — also influence susceptibility.

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When exogenous cannabinoids interact with the body’s cannabinoid receptors, they affect physiological functions and — with extended use — can alter neurotransmitter activity in ways that influence mood, appetite, and sleep. Upon abrupt cessation or significant dose reduction, patients may experience the following physical withdrawal symptoms:⁶

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• Abdominal pain
• Shakiness or tremors
• Sweating
• Headache

Note: Fever and chills have been reported in some case literature but are not consistently supported across controlled withdrawal studies ⁶ and should not be considered core features of cannabis withdrawal syndrome.

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Physical symptoms typically emerge within a few days of cessation and may persist for several weeks, with significant individual variability in onset, severity, and duration.

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In general, cannabis does not produce physical dependence of the magnitude seen with opioids or benzodiazepines.⁷ If patients express concern about physical dependence, clinicians are advised to work collaboratively with them to establish a structured, supervised approach to cannabis use or cessation.

Psychological Dependence

As the brain adapts to the presence of cannabinoids, abrupt cessation or significant dose reduction may precipitate psychological withdrawal symptoms, including:⁸

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• Disturbed sleep patterns
• Irritability
• Anxiety
• Restlessness
• Impaired cognitive function

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Not all patients will experience these symptoms. Where they do occur, onset is typically within a few days of reducing or stopping cannabis, and symptoms generally resolve over several weeks.

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Psychological dependence — where a patient relies on cannabis to experience pleasure or to manage psychological distress — may progress to addiction if the patient cannot control or cease use independently. In such cases, close collaboration with the patient’s broader care team is recommended to mitigate addiction risk.

What is Cannabis Use Disorder?

Cannabis Use Disorder (CUD) is a diagnosable mental health condition recognised by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), defined as a pattern of cannabis use leading to clinically significant impairment or distress.⁹

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Diagnosis requires evaluation against DSM-5-specific criteria by the treating clinician or a relevant mental health specialist.

How Common is Cannabis Use Disorder?

CUD is relatively common among those who use cannabis regularly and in high quantities. Approximately 9% of all cannabis users may develop CUD, though this figure varies depending on frequency and intensity of use, individual susceptibility, and genetic and environmental factors.¹

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A 2022 Australian study published in Drug and Alcohol Review found that the prevalence of CUD among medicinal cannabis users was comparable to that in recreational users — underscoring the importance of ongoing monitoring even in a prescribed context.¹⁰

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Advising structured treatment breaks, where clinically appropriate, may help reduce CUD risk by supporting patients in maintaining control over their cannabis use and reducing cumulative exposure.

Reducing CUD Risk: Clinical Strategies

While CUD cannot always be prevented, clinicians can take proactive steps to reduce patient risk:

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• Comprehensive assessment: Conduct a thorough baseline evaluation of the patient’s medical history, symptoms, and overall health — including existing mental health conditions, substance use history, and genetic risk factors — prior to initiating medicinal cannabis.
• Personalised treatment planning: Tailor dosage, formulation, and frequency of use to the patient’s specific clinical needs. Avoid defaulting to high-potency formulations where lower-potency alternatives may be appropriate.
• Ongoing monitoring: Schedule regular follow-up appointments to assess treatment response, monitor for early signs of dependence or misuse, and adjust the treatment plan as required.
• Patient education: Clearly communicate the potential risks of cannabis use — including dependence and CUD — and provide guidance on strategies to minimise these risks. Discuss potential interactions with other medications.

Recognising Cannabis Use Disorder: DSM-5 Diagnostic Criteria

To meet the DSM-5 diagnostic threshold for CUD, a patient must demonstrate a problematic pattern of cannabis use resulting in significant impairment or distress, with at least two of the following criteria present within a 12-month period:¹¹

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• Using more cannabis or using it for longer than intended
• Persistent desire or unsuccessful efforts to cut down or control use
• Significant time spent obtaining, using, or recovering from cannabis
• Strong cravings or urges to use cannabis
• Failure to fulfil obligations at work, school, or home due to cannabis use
• Continued use despite persistent social or interpersonal problems caused by cannabis
• Withdrawal from or reduction of important activities due to cannabis use
• Use in physically hazardous situations
• Continued use despite knowledge of a physical or psychological problem caused or worsened by cannabis
• Tolerance (requiring more cannabis for the same effect, or diminished effect with the same amount)
• Withdrawal symptoms, or use of cannabis to avoid or relieve withdrawal

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Severity is classified as follows:
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• Mild: 2–3 symptoms
• Moderate: 4–5 symptoms
• Severe: 6 or more symptoms

Where CUD is suspected or confirmed, clinicians should screen formally and consider referral to counselling or behavioural therapy services, including Cognitive Behavioural Therapy (CBT), which has an established evidence base for CUD management.

Cannabis Withdrawal Symptoms

Not all patients who use medicinal cannabis will experience withdrawal symptoms. Risk is influenced by dosage, frequency, and duration of use. Where withdrawal does occur, the most commonly reported symptoms include:

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• Irritability
• Anxiety
• Restlessness
• Difficulty sleeping
• Decreased appetite
• Mood swings
• Fatigue
• Headaches
• Muscle aches
• Sweating
• Dizziness
• Nausea and/or vomiting

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Severity varies considerably between patients. While some will experience only mild symptoms, others may present with more significant distress — warranting clinical support and, where appropriate, gradual dose tapering rather than abrupt cessation.

Risk Factors for Cannabis Use Disorder

Addiction is not solely determined by the substance itself. Clinicians should consider the following patient-level risk factors when initiating or reviewing a medicinal cannabis prescription:

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Age of onset

CUD is significantly more common in patients who begin cannabis use at a young age. Evidence suggests the risk of developing CUD is 4–7 times higher in those who initiate use before age 18 compared to those who begin after age 25.¹²

Genetic predisposition

Genetic variation influences how individuals respond to cannabis, including how their brain’s reward system processes it. Variants in genes associated with the endocannabinoid system — such as the cannabinoid receptor 1 (CB1) gene — have been linked to increased risk of cannabis dependence.¹³

Comorbid mental health conditions

Patients with pre-existing psychiatric conditions — including depression, anxiety, and schizophrenia — may have heightened vulnerability to CUD. Cannabis use may worsen the symptoms of these conditions, while patients may simultaneously self-medicate with cannabis, creating a complex bidirectional relationship that warrants careful monitoring.¹⁴

Co-occurring substance use disorders

A history of addiction to other substances significantly increases the risk of CUD. Co-occurrence is associated with more severe and persistent cannabis use problems, worsened physical and mental health outcomes, and greater cognitive impairment.¹⁵

Cannabis potency

High-potency cannabis — characterised by elevated THC concentrations — is associated with an increased likelihood of developing CUD. Higher potency products may produce more intense psychoactive effects, contributing to faster tolerance development and greater risk of physical and psychological dependence.¹⁶

Managing Suspected Cannabis Use Disorder or Dependence

If a patient presents with signs of cannabis addiction or dependence, or reports that cannabis use is negatively affecting their quality of life, the following clinical strategies may be appropriate:

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• Review and adjust the treatment plan, including dosage and frequency
• Introduce structured, supervised tolerance breaks where clinically indicated
• Implement gradual dose reduction with the aim of reaching the lowest effective dose or cessation, as appropriate
• Consider changing the administration route (e.g., transitioning from inhaled to longer-acting oral formulations)
• Refer for psychological support, including Cognitive Behavioural Therapy (CBT)
• Help the patient identify triggers for excessive use and develop management strategies
• Support the development of a broader social and therapeutic support network
• Encourage lifestyle modifications — including improved nutrition and regular physical activity — as part of a holistic approach to wellbeing

Clinical Summary

While most patients prescribed medicinal cannabis will not develop an addiction, the risk is clinically meaningful and should not be overlooked.

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A thorough baseline assessment of each patient’s addiction risk — including mental health history, genetic factors, and substance use background — is essential for informed prescribing. Ongoing monitoring and early intervention remain the most effective tools for minimising harm.