In general, administering THC as treatment for CUD carries an element of clinical and ethical concern due to the emerging evidence suggesting that cannabis products with high levels of THC have detrimental effects on mental health and cognitive function among adult and youth users . These concerns are very relevant considering the high rates of psychiatric co-morbidity and negative neurocognitive impact in youth and adults with CUD . Furthermore, the concerns are particularly pertinent with adolescents and emerging adults, as the developing brain is believed to be more susceptible to the adverse effects of cannabis exposure, and THC may interfere with neurodevelopmental processes influenced by the endocannabinoid system . However, in the studies that included cognitive assessment, findings suggest that THC-containing cannabinoid treatment decrease cognitive performance: one study found that 8 mg/day of nabilone  worsened psychomotor task performance , and another found that dronabinol worsened psychomotor task performance and working memory .

While studies of nabiximols reported no differences in adverse events between treatment and placebo groups ,grow lights for cannabis some studies found adverse events related to dronabinol, such as dry mouth, rapid hear, flushing and hypotension . In studies that reported serious adverse events, these were deemed not study related . A final point that is relevant to consider is that THC may interfere with daily functioning, because of its cognitive impairing effects. For example, dronabinol has been found to impair driving performance in a dose-dependent manner , which has implications for potential risk of road accidents attributable to medicinal use of THC in treatment of CUD. As reviewed in Section 5.2, the effect of FAAH inhibitors and CBD on CUD has been much less studied, but evidence from the first two placebo-controlled RCTs in adults with cannabis dependence suggests that FAAH inhibitors can reduce withdrawal symptoms and cannabis use, and that CBD can reduce cannabis use. Furthermore, there were no differences between control groups and groups receiving FAAH inhibitors or CBD regarding adverse outcomes . A key concern about administering pharmacotherapies to youth is their safety. In the only trial to date, the FAAH inhibitor PF-04457845 was administered to male adults aged 18-55.

The trial did not include females of childbearing potential due to the previous lack of safety and toxicity data on PF-04457845. Now that these data are available, a subsequent phase 2b trial is being conducted in males and females aged 18–60 . Due to a lack of safety or toxicity data in younger people, the potential of PF-04457845 in treating youth CUD is currently unclear. There is also limited data on the safety of THC administration in youth, with only one study to date administering THC to adolescent volunteers , as well as the already mentioned concerns about the impact on the developing brain. While the safety and efficacy of CBD for treating CUD in youth is yet to be established, the potential safety of administering CBD is supported by several trials of CBD as a treatment for severe treatment-resistant epilepsy in children . Furthermore, an emerging literature suggests that CBD contains opposing neural, cognitive, and behavioral effects that interact with, and may counteract, some of the harmful effects of THC on cognitive functions, anxiety, and psychotic symptoms . Some studies also point to a greater addiction potential in products with high levels of THC and low levels of CBD .

These effects are mirrored in functional imaging studies, which have revealed opposing acute effects of THC and CBD in areas pivotal to the examined cognitive processes including amygdala ; striatum, grow cannabis hippocampus, and prefrontal cortex ; and auditory and visual cortex .Taken together, these findings point to a safer profile of CBD compared to THC. A potential benefit of cannabinoid treatment in general is that it may be more acceptable than traditional treatment  among cannabis using youth and adults, especially non-treatment seekers. In the only placebo-controlled RCT conducted with CBD so far, retention rates were very high: out of 82 randomized individuals with CUD, only 5 participants did not complete treatment , and in the only placebo-controlled RCT of FAAH inhibitors, 17 % dropped out of placebo and active treatment groups . Overall, drop-out rates were higher and more mixed in studies on THC-based cannabinoid treatment, see also Table 1. As such, cannabinoid medication – particularly non-THC based – may potentially help address the problem of low treatment uptake in youth.