SAMHSA’s New Advisory Tells Doctors: Cannabis Use Disorder Is Real, and You Need to Screen for It

The Advisory and Why It Matters Now

Cannabis is the most-used federally controlled substance in the United States, and use has grown substantially alongside legalization across more than two dozen states. Yet the clinical conversation in primary care has not kept pace. Many physicians lack training in identifying Cannabis Use Disorder (CUD), conflate recreational or medical use with disorder, or are uncertain how to approach screening and referral.

SAMHSA’s May 2026 advisory PEP26-07-003, titled “Addressing Cannabis Use Disorder in Primary Care Settings—A Lifespan Approach,” is designed to close that gap. It provides clinical guidance specifically for primary care providers — pediatricians, family medicine physicians, geriatricians, OB/GYNs — on how to screen, assess, and refer patients across every stage of life.

Approximately 5.8 million Americans meet criteria for Cannabis Use Disorder in a given year, according to SAMHSA’s National Survey on Drug Use and Health. Fewer than 10% receive any treatment. CUD is not a diagnosis invented by abstinence-focused policymakers — it describes a clinically meaningful pattern of impaired control, continued use despite harm, craving, and withdrawal that affects a meaningful subset of regular cannabis users.

A Lifespan Approach: Who Is at Risk at Every Age

The advisory’s central contribution is its age-stratified framework. Different developmental windows carry different risks:

Adolescents (12–17): The developing brain is significantly more vulnerable to cannabis’s effects. THC potency has increased roughly four-fold since the 1990s, and the high-potency concentrates common in legal markets were not what most of the foundational research was conducted on. CUD in adolescence is associated with elevated rates of psychosis, impaired educational attainment, and increased risk of other substance use disorders. The advisory includes specific screening tools for this age group and guidance on motivational interviewing adapted for adolescent patients.

Young adults (18–25): Peak prevalence of CUD. This is the age of highest use rates and highest risk for disorder developing into entrenched pattern. The advisory emphasizes frequency and product-type assessment — daily use of high-THC concentrate is categorically different from occasional low-potency flower.

Middle adulthood (26–64): Rising use in this age group, often self-reported as stress management or sleep aid. The advisory notes that cannabis-induced anxiety disorders and cannabis-induced psychosis can emerge in middle adulthood, particularly with high-potency products.

Older adults (65+): Fastest-growing use demographic. Older adults use cannabis for pain, sleep, and anxiety — often without informing their physicians. Drug interactions (blood thinners, sedatives, cardiac medications) are a clinical concern. The advisory specifically addresses this population.

Pregnancy: Cannabis remains the most commonly used illicit substance during pregnancy. Evidence links prenatal exposure to adverse neurodevelopmental outcomes. The advisory provides guidance for OB providers.

The Medical Marijuana Distinction

One of the advisory’s most practically significant contributions is a clinical framework for distinguishing medical marijuana use from Cannabis Use Disorder.

This distinction matters because legalization has blurred the clinical landscape. Patients with a medical marijuana recommendation may be using cannabis intentionally and therapeutically — but may also have developed a use disorder concurrent with authorized medical use. The two are not mutually exclusive.

SAMHSA directs providers to assess:

• Frequency and dose: Daily use of high-THC products is a risk factor regardless of authorization
• Withdrawal symptoms: Insomnia, irritability, appetite loss, and anxiety upon stopping are diagnostic criteria for CUD
• Impaired control: Failed attempts to cut back, continued use despite interpersonal or health consequences
• THC exposure level: Product type (flower vs. concentrate) and potency
• Therapeutic intent vs. compulsion: Is use voluntary and deliberate, or driven by craving?

A patient using medical marijuana for documented chronic pain, with consistent dosing and no impaired control, is not CUD. A patient who has tried repeatedly to reduce cannabis use, experiences withdrawal when stopping, and continues despite relationship conflict or work problems — even if they have a medical card — may be.

Treatment: What Works, and What’s Still Lacking

The advisory is candid about treatment gaps. There are no FDA-approved medications for Cannabis Use Disorder. Behavioral therapies — cognitive behavioral therapy (CBT), motivational enhancement therapy (MET), and contingency management — have the strongest evidence base, but access to providers trained in these approaches is limited and geographically concentrated.

The advisory recommends:

1. Brief intervention in the primary care visit (the FRAMES model)
2. Referral to evidence-based outpatient treatment when CUD criteria are met
3. Monitoring for co-occurring psychiatric conditions, particularly anxiety, depression, and psychosis
4. Patient education on product potency, risk of use disorder, and specific risks during adolescence and pregnancy

Why This Matters for People in Recovery

Cannabis use disorder is the second most common SUD in the United States after alcohol — more common than stimulant or opioid use disorders. It has been underdiagnosed and undertreated partly because cannabis is perceived as “not a real problem” and partly because legalization has created cultural confusion about use vs. disorder.

SAMHSA’s advisory is a signal: the federal public health apparatus is taking CUD seriously as a clinical entity, at every age, in primary care settings. If you are concerned about your cannabis use or someone else’s, the question worth asking is not “is cannabis legal here?” but “is this use causing harm?”

Rize can connect you with providers who treat cannabis use disorder with evidence-based approaches, including CBT and motivational enhancement therapy.

Rize can connect you with providers who treat cannabis use disorder with evidence-based approaches, including CBT and motivational enhancement therapy.

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