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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Host

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. 
• Use the three Cs to assess CUD: Screen for issues with Control, Consequences, and Cravings, then map findings to the DSM-5 criteria together with the patient. 
• Recognize cannabis withdrawal: Withdrawal symptoms affect 20–50% of daily users and can include both psychiatric and physical symptoms, such as appetite changes, nausea and vomiting, mild tremors, temperature dysregulation, irritability, anxiety, and mood changes. Sometimes, what patients attribute to anxiety or poor appetite may actually be withdrawal. 
• Psychosis is a serious risk: Studies show around a 40% conversion to a schizophrenia diagnosis after a cannabis-induced psychotic episode, especially with high-potency products. 
• No FDA-approved medications exist: Gabapentin and N-Acetylcysteine (NAC) are off-label pharmacotherapy options that show evidence for treating CUD, but treating co-occurring psychiatric disorders is equally important. 
• Harm reduction is a valid goal: Reducing potency, spacing out use, switching routes, and building in breaks are practical steps when a patient isn’t ready for abstinence. 
• Keep patients coming back: The therapeutic relationship is the most powerful tool, so focus on patient goals and follow-up.  
• Know your legal landscape and testing limitations: Laws vary by state. Standard urine screens will not detect synthetic cannabinoids, and THC metabolites can persist for weeks. 

🔗 Resources

• ASAM’s 57th Annual Conference: Register HERE
  • Focus Session: High Risk at Every Stage: Cannabis Exposure During Critical Periods of Development   
• ASAM 2025 Review Course: Psychiatric Co-morbidities: Complexities of Diagnosis and Care: Register HERE  
• ASAM 56th Annual Conference: 
  • Cannabinoids and Pregnancy: ASAM Members, Patients and the Public – A Vital Discourse/Debate: Register HERE 
  • Anyone Can Treat!: Master Youth Cannabis Use Treatment for Your Practice Setting: Register HERE 
• A Simple Guide to Pot, THC and How Much is Too Much: Ramos Barreda A, De Leon K, Urmas S. Los Angeles Times. April 20, 2018. Accessed March 24, 2026.  
• Cannabis/Marijuana Use Disorder: Yale Medicine. July 24, 2024. Accessed March 30, 2026.  
• Rates and Predictors of Conversion to Schizophrenia or Bipolar Disorder Following Substance-Induced Psychosis: Starzer MSK, Nordentoft M, Hjorthøj C. Am J Psychiatry. 2018;175(4):343-350. doi:10.1176/appi.ajp.2017.17020223
• The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research: National Academies of Sciences, Engineering, and Medicine. 2017. Washington, DC: The National Academies Press.
• Transition From Substance-Induced Psychosis to Schizophrenia Spectrum Disorder or Bipolar Disorder: Rognli EB, Heiberg IH, Jacobsen BK, Høye A, Bramness JG. Am J Psychiatry. 2023;180(6):437-444. doi:10.1176/appi.ajp.22010076
• Understanding Your Risk for Cannabis Use Disorder: Centers for Disease Control and Prevention. December 5, 2024. Accessed March 30, 2026. 

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In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.