Picture a gigantic, inverted pyramid resting on a wee, small point. The apex has become the base.

Cannabis Prohibition —which generates billions of US dollars for therapists, law enforcers, and bureaucrats— now depends almost entirely on the existence of “Cannabis Use Disorders” as defined by the American Psychiatric Association. No longer can the “experts” claim that smoking marijuana causes lung cancer and COPD (thanks to the very thorough clinical trial led by UCLA’s Donald Tashkin, MD).  The actual pulmonary insult is Bronchitis, which disappears within weeks when one stops smoking.

In the latest version of the psychiatrists’ Diagnostic and Statistical Manual, the absurdity of defining arrests as symptoms of a medical disorder was dropped. The authors of DSM-V also ditched the vague terms “abuse” and “dependence” for the more understandable —and widely applicable— word “craving,” which peaks during “withdrawal.”

The DSM-V definition of withdrawal is an exercise in sophistry, a linguistic three-card monte… The patient must have experienced three or more symptoms, all of which are very closely related if not synonymous: “Irritability, anger or aggression,” “Nervousness or anxiety,” “Restlessness,” and “Depressed —plus “Sleep difficulty,” which is usually a function of anxiety. “Calling Dr. Roget, white courtesy telephone, please…”  

What follows is “Treatment for Cannabis Use Disorders: A Case Report” by Christina Brezing, MD, and Frances Levin, MD, published June 30 on Psychiatric Times (http://www.psychiatrictimes.com).  The authors use the self-congatulatory terms “evidence” or “evidence-based” nine times. They report “no conflicts of interest concerning the subject matter of this article” although they both owe their livelihoods to The Treatment Racket.


Dr. Brezing is a Fellow in Addiction Psychiatry at the New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons in New York City; Dr. Levin is Kennedy-Leavy Professor of Clinical Psychiatry, Columbia University College of Physicians and Surgeons, Chief of the Division on Substance Abuse, and Director of the Addiction Psychiatry Fellowship Program at New York Presbyterian Hospital.

The authors report no conflicts of interest concerning the subject matter of this article.

  1. Bedi G, Cooper ZD, Haney M. Subjective, cognitive and cardiovascular dose-effect profile of nabilone and dronabinol in marijuana smokers. Addict Biol. 2013;18:872-881.
  2. Haney M, Cooper ZD, Bedi G, et al. Nabilone decreases marijuana withdrawal and a laboratory measure of marijuana relapse. Neuropsychopharmacol. 2013;38:1557-1565.
  3. Cooper ZD, Foltin RW, Har CL, et al. A human laboratory study investigating the effects of quetiapine on marijuana withdrawal and relapse in daily marijuana smokers. Addict Biol. 2013;18:993-1002.
  4. Herrmann ES, Cooper ZD, Bedi G, et al. Effects of zolpidem alone and in combination with nabilone on cannabis withdrawal and a laboratory model of relapse in cannabis users. Psychopharmacol. 2016; 233:2469-2478.
  5. Haney M, Hart CL, Vosburg SK, et al. Effects of baclofen and mirtazapine on a laboratory model of marijuana withdrawal and relapse. Psychopharmacol. 2010;211:233-244.
  6. Levin FR, Mariani JJ, Pavlicova M, et al. Dronabinol and lofexidine for cannabis use disorder: a randomized, double-blind, placebo-controlled trial. Drug Alcohol Dep. 2016;159:53-60.
  7. Sherman BJ, McRae-Clark AL. Treatment of cannabis use disorder: current science and future outlook. Pharmacother. 2016;36:511-535.
  8. Levin FR, Mariani JJ, Brooks DJ, et al. Dronabinol for the treatment of cannabis dependence: a randomized, double-blind, placebo-controlled trial. Drug Alcohol Dep. 2011;116:142-150.
  9. Penetar DM, Looby AR, Ryan ET, et al. Bupropion reduces some of the symptoms of marihuana withdrawal in chronic marihuana users: a pilot study. Subst Abuse. 2012;6:63-71.
  10. Mason BJ, Crean R, Goodell V, et al. A proof-of-concept randomized controlled study of gabapentin: effects on cannabis use, withdrawal and executive function deficits in cannabis-dependent adults. Neuropsychopharmacol. 2012;37:1689-1698.
  11. Allsop DJ, Lintzeris N, Copeland J, et al. Cannabinoid replacement therapy (CRT): nabiximols (Sativex) as a novel treatment for cannabis withdrawal. Clin Pharm Ther. 2015;97:571-574.
  12. McRae AL, Brady KT, Carter RE. Buspirone for treatment of marijuana dependence: a pilot study. Am J Addictions. 2006;15:404.
  13. McRae-Clark AL, Carter RE, Killeen TK, et al. A placebo-controlled trial of buspirone for the treatment of marijuana dependence. Drug Alcohol Dep. 2009;105:132-138.
  14. Gray KM, Carpenter MJ, Baker NL, et al. A double-blind randomized controlled trial of N-acetylcysteine in cannabis-dependent adolescents. Am J Psychiatry. 2012;169:805-812.
  15. Gray KM, Sonne SC, McClure EA, et al. A randomized placebo-controlled trial of N-acetylcysteine for cannabis use disorders in adults. Drug Alcohol Depend. 2017. (In press)
  16. Miranda R Jr, Treloar H, Blanchard A, et al. Topiramate and motivational enhancement therapy for cannabis use among youth: a randomized placebo-controlled pilot study. Addict Biol. 2016;22:779-790.
  17. Sherman BJ, Baker NL, McRae-Clark AL. Effect of oxytocin pretreatment on cannabis outcomes in a brief motivational intervention. Psychiatry Res. 2017;249:318-320.
  18. Haney M, Ramesh D, Glass A, et al. Naltrexone maintenance decreases cannabis self-administration and subjective effects in daily cannabis smokers. Neuropsychopharmacol. 2015;40:2489-2498.
  19. Cornelius JR, Bukstein OG, Douaihy AB, et al. Double-blind fluoxetine trial in comorbid MDD-CUD youth and young adults. Drug Alcoh Dep. 2010; 112:39-45.
  20. Kelly MA, Pavlicova M, Glass A, et al. Do withdrawal-like symptoms mediate increased marijuana smoking in individuals treated with venlafaxine-XR? Drug Alcohol Dep. 2014;144:42-46.
  21. Levin FR, Mariani J, Brooks DJ, et al. A randomized double-blind, placebo-controlled trial of venlafaxine-extended release for co-occurring cannabis dependence and depressive disorders. Addict. 2013;108:1084-1094.