ICD-11 Criteria for Disorders Due to Use of Cannabis (6C41)
Disorders due to use of cannabis
are characterised by the pattern and consequences of cannabis use. Cannabis is
the collective term for a range of psychoactive preparations of the cannabis
plant, Cannabis sativa, and related species and hybrids. Cannabis contains
cannabinoids, a class of diverse chemical compounds that act on endogenous
cannabinoid receptors that modulate neurotransmitter release in the brain. The
principal psychoactive cannabinoid is δ-9-tetrahydrocannabinol (THC). Cannabis
is typically smoked in the form of the flowering heads or leaves of the
marijuana plant; tobacco is often mixed with cannabis when smoked. There are
also cannabis oils that are prepared from these same sources. These
preparations vary considerably in their THC potency. Cannabis has predominantly
central nervous system depressant effects and produces a characteristic
euphoria that may be part of the presenting features of Cannabis Intoxication,
which may also include impairment in cognitive and psychomotor functioning.
Cannabis has dependence-producing properties resulting in Cannabis Dependence
in some people and Cannabis Withdrawal when use is reduced or discontinued.
Cannabis is associated with a range of Cannabis-Induced Mental Disorders.
Exclusions:
- Disorders due to use of synthetic cannabinoids (6C42)
- Hazardous use of cannabis (QE11.1)
6C41.0 Episode of Harmful Use of Cannabis
An episode of use of cannabis that
has caused damage to a person’s physical or mental health or has resulted in
behaviour leading to harm to the health of others. Harm to health of the
individual occurs due to one or more of the following: (1) behaviour related to
intoxication; (2) direct or secondary toxic effects on body organs and systems;
or (3) a harmful route of administration. Harm to health of others includes any
form of physical harm, including trauma, or mental disorder that is directly
attributable to behaviour due to cannabis intoxication on the part of the
person to whom the diagnosis of single episode of harmful use applies. This
diagnosis should not be made if the harm is attributed to a known pattern of
cannabis use.
Exclusions:
- Cannabis dependence (6C41.2)
- Harmful pattern of use of cannabis (6C41.1)
6C41.1 Harmful Pattern of Use of Cannabis
A pattern of cannabis use that has
caused damage to a person’s physical or mental health or has resulted in
behaviour leading to harm to the health of others. The pattern of cannabis use
is evident over a period of at least 12 months if substance use is episodic or
at least one month if use is continuous (i.e., daily or almost daily). Harm to
health of the individual occurs due to one or more of the following: (1)
behaviour related to intoxication; (2) direct or secondary toxic effects on
body organs and systems; or (3) a harmful route of administration. Harm to
health of others includes any form of physical harm, including trauma, or
mental disorder that is directly attributable to behaviour related to cannabis
intoxication on the part of the person to whom the diagnosis of Harmful pattern
of use of cannabis applies.
Exclusions:
- Cannabis dependence (6C41.2)
- Episode of harmful use of cannabis (6C41.0)
6C41.10 Harmful pattern of Use of Cannabis, Episodic
A pattern of episodic or
intermittent cannabis use that has caused damage to a person’s physical or
mental health or has resulted in behaviour leading to harm to the health of
others. The pattern of episodic cannabis use is evident over a period of at
least 12 months. Harm to health of the individual occurs due to one or more of
the following: (1) behaviour related to intoxication; (2) direct or secondary
toxic effects on body organs and systems; or (3) a harmful route of
administration. Harm to health of others includes any form of physical harm,
including trauma, or mental disorder that is directly attributable to behaviour
related to cannabis intoxication on the part of the person to whom the
diagnosis of Harmful pattern of use of cannabis applies.
Exclusions:
- Episode of harmful use of cannabis (6C41.0)
- Cannabis dependence (6C41.2)
6C41.11 Harmful Pattern of Use of Cannabis, Continuous
A pattern of continuous (daily or
almost daily) cannabis use that has caused damage to a person’s physical or
mental health or has resulted in behaviour leading to harm to the health of
others. The pattern of continuous cannabis use is evident over a period of at
least one month. Harm to health of the individual occurs due to one or more of
the following: (1) behaviour related to intoxication; (2) direct or secondary
toxic effects on body organs and systems; or (3) a harmful route of
administration. Harm to health of others includes any form of physical harm,
including trauma, or mental disorder that is directly attributable to behaviour
related to cannabis intoxication on the part of the person to whom the diagnosis
of Harmful pattern of use of cannabis applies.
Exclusions:
- Episode of harmful use of cannabis (6C41.0)
- Cannabis dependence (6C41.2)
6C41.1Z Harmful Pattern of Use of Cannabis, Unspecified
6C41.2 Cannabis Dependence
Cannabis dependence is a disorder
of regulation of cannabis use arising from repeated or continuous use of
cannabis. The characteristic feature is a strong internal drive to use
cannabis, which is manifested by impaired ability to control use, increasing
priority given to use over other activities and persistence of use despite harm
or negative consequences. These experiences are often accompanied by a
subjective sensation of urge or craving to use cannabis. Physiological features
of dependence may also be present, including tolerance to the effects of
cannabis, withdrawal symptoms following cessation or reduction in use of
cannabis, or repeated use of cannabis or pharmacologically similar substances
to prevent or alleviate withdrawal symptoms. The features of dependence are
usually evident over a period of at least 12 months but the diagnosis may be
made if cannabis use is continuous (daily or almost daily) for at least 3
months.
Exclusions:
- Episode of harmful use of cannabis (6C41.0)
- Harmful pattern of use of cannabis (6C41.1)
6C41.20 Cannabis Dependence, Current use
Current cannabis dependence with
use of cannabis within the past month.
Exclusions:
- Episode of harmful use of cannabis (6C41.0)
- Harmful pattern of use of cannabis (6C41.1)
6C41.21 Cannabis Dependence, Early Full Remission
After a diagnosis of cannabis
dependence, and often following a treatment episode or other intervention
(including self-help intervention), the individual has been abstinent from
cannabis during a period lasting from between 1 and 12 months.
Exclusions:
- Episode of harmful use of cannabis (6C41.0)
- Harmful pattern of use of cannabis (6C41.1)
6C41.22 Cannabis Dependence, Sustained Partial remission
After a diagnosis of cannabis
dependence, and often following a treatment episode or other intervention
(including self-help intervention), there is a significant reduction in
cannabis consumption for more than 12 months, such that even though cannabis
use has occurred during this period, the definitional requirements for
dependence have not been met.
Exclusions:
- Episode of harmful use of cannabis (6C41.0)
- Harmful pattern of use of cannabis (6C41.1)
6C41.23 Cannabis Dependence, Sustained Full Remission
After a diagnosis of cannabis
dependence, and often following a treatment episode or other intervention
(including self-intervention), the person has been abstinent from cannabis for
12 months or longer.
Exclusions:
- Episode of harmful use of cannabis (6C41.0)
- Harmful pattern of use of cannabis (6C41.1)
6C41.2Z Cannabis Dependence, Unspecified
6C41.3 Cannabis Intoxication
Cannabis intoxication is a
clinically significant transient condition that develops during or shortly
after the consumption of cannabis that is characterised by disturbances in
consciousness, cognition, perception, affect, behaviour, or coordination. These
disturbances are caused by the known pharmacological effects of cannabis and
their intensity is closely related to the amount of cannabis consumed. They are
time-limited and abate as cannabis is cleared from the body. Presenting
features may include inappropriate euphoria, impaired attention, impaired
judgment, perceptual alterations (such as the sensation of floating, altered
perception of time), changes in sociability, increased appetite, anxiety,
intensification of ordinary experiences, impaired short-term memory, and
sluggishness. Physical signs include conjunctival injection (red or bloodshot
eyes) and tachycardia.
Coding
Note: Code
aslo the causing condition
Inclusions:
- "Bad trips" due to cannabinoids
Exclusions:
- Cannabinoid poisoning (NE60)
- Possession trance disorder (6B63)
6C41.4 Cannabis Withdrawal
Cannabis withdrawal is a
clinically significant cluster of symptoms, behaviours and/or physiological
features, varying in degree of severity and duration, that occurs upon
cessation or reduction of use of cannabis in individuals who have developed
Cannabis dependence or have used cannabis for a prolonged period or in large
amounts. Presenting features of Cannabis withdrawal may include irritability,
anger or aggressive behaviour, shakiness, insomnia, restlessness, anxiety,
depressed or dysphoric mood, decreased appetite and weight loss, headache,
sweating or chills, abdominal cramps and muscle aches.
Coding Note: Code aslo the causing condition
6C41.5 Cannabis-Induced Delirium
Cannabis-induced delirium is
characterised by an acute state of disturbed attention and awareness with
specific features of delirium that develops during or soon after substance
intoxication or withdrawal or during the use of cannabis. The amount and
duration of cannabis use must be capable of producing delirium. The symptoms
are not better explained by a primary mental disorder, by use of or withdrawal
from a different substance, or by another health condition that is not
classified under Mental, behavioural and neurodevelopmental disorders.
Coding Note: Code aslo the causing condition
6C41.6 Cannabis-Induced Psychotic Disorder
Cannabis-induced psychotic
disorder is characterised by psychotic symptoms (e.g. delusions,
hallucinations, disorganised thinking, grossly disorganised behaviour) that
develop during or soon after intoxication with or withdrawal from cannabis. The
intensity or duration of the symptoms is substantially in excess of
psychotic-like disturbances of perception, cognition, or behaviour that are
characteristic of Cannabis intoxication or Cannabis withdrawal. The amount and
duration of cannabis use must be capable of producing psychotic symptoms. The
symptoms are not better explained by a primary mental disorder (e.g.
Schizophrenia, a Mood disorder with psychotic symptoms), as might be the case
if the psychotic symptoms preceded the onset of the cannabis use, if the
symptoms persist for a substantial period of time after cessation of the
cannabis use or withdrawal, or if there is other evidence of a pre-existing
primary mental disorder with psychotic symptoms (e.g. a history of prior
episodes not associated with cannabis use).
Coding Note: Code aslo the causing condition
6C41.7 Certain Specified Cannabis-Induced mental orBehavioural Disorders
Coding Note: Code aslo the causing condition
6C41.70 Cannabis-Induced Mood Disorder
Cannabis-induced mood disorder is
characterised by mood symptoms (e.g., depressed or elevated mood, decreased
engagement in pleasurable activities, increased or decreased energy levels)
that develop during or soon after intoxication with or withdrawal from
cannabis. The intensity or duration of the symptoms is substantially in excess
of mood disturbances that are characteristic of Cannabis intoxication or
Cannabis withdrawal. The amount and duration of cannabis use must be capable of
producing mood symptoms. The symptoms are not better explained by a primary
mental disorder (e.g., a Depressive disorder, a Bipolar disorder,
Schizoaffective disorder), as might be the case if the mood symptoms preceded
the onset of the cannabis use, if the symptoms persist for a substantial period
of time after cessation of the cannabis use or withdrawal, or if there is other
evidence of a pre-existing primary mental disorder with mood symptoms (e.g., a
history of prior episodes not associated with cannabis use).
Coding Note: Code aslo the causing condition
6C41.71 Cannabis-Induced Anxiety Disorder
Cannabis-induced anxiety disorder
is characterised by anxiety symptoms (e.g., apprehension or worry, fear,
physiological symptoms of excessive autonomic arousal, avoidance behaviour) that
develop during or soon after intoxication with or withdrawal from cannabis. The
intensity or duration of the symptoms is substantially in excess of anxiety
symptoms that are characteristic of Cannabis intoxication or Cannabis
withdrawal. The amount and duration of cannabis use must be capable of
producing anxiety symptoms. The symptoms are not better explained by a primary
mental disorder (e.g., an Anxiety and Fear-Related Disorder, a Depressive
Disorder with prominent anxiety symptoms), as might be the case if the anxiety
symptoms preceded the onset of the cannabis use, if the symptoms persist for a
substantial period of time after cessation of the cannabis use or withdrawal,
or if there is other evidence of a pre-existing primary mental disorder with anxiety
symptoms (e.g., a history of prior episodes not associated with cannabis use).
Coding Note: Code aslo the causing condition
6C41.Y Other
specified disorders due to use of cannabis6C41.Z Disorders
due to use of cannabis, unspecified
REFERENCE:
International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.
https://creativecommons.org/licenses/by-nc-nd/3.0/igo/
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