Nichola Walker is an Advanced Nurse Practitioner and independent prescriber specialising in substance misuse, prison healthcare and trauma-informed care, with a research interest in emerging drugs and clinical stabilisation. Connect with her on LinkedIn.
Cannabis is changing faster than clinical practice. For many GPs, cannabis still conjures an image of herbal “weed” smoked in a joint, a relatively low‑potency product with predictable effects. But this bears little resemblance to what many young adults are actually using today. High‑potency herbal cannabis, tetrahydrocannabinol (THC) vape pens, concentrates, distillates, and flavoured oils now dominate youth consumption patterns, delivering doses of THC far beyond what most clinicians were trained to assess. High‑potency THC vapes are discreet, flavoured, and easy to use repeatedly throughout the day, enabling frequent “micro‑dosing” and sustained intoxication without the tell‑tale smell of smoke, a pattern increasingly reported among young adults.1,2
This shift matters. It alters clinical presentations, dependence risk, withdrawal patterns, and the conversations we need to have with patients. Yet in primary care, cannabis assessment often remains rooted in outdated assumptions. We ask how often someone uses cannabis, but not what they use, how they use it, or how strong it is. For a substance whose potency can vary ten‑fold, this is no longer enough.
Cannabis is no longer a uniform product. Increasing THC concentrations, the emergence of concentrates and vape cartridges, and changing patterns of use among young adults have important implications for assessment in primary care.
Retail data from California, where legalisation allows detailed tracking of purchasing patterns, offers a glimpse into the future. Young adults aged 21–24 overwhelmingly purchase vape pens, concentrates, and flavoured high‑potency products. Older adults still favour traditional flower.1 Although the UK does not have a legal retail market, the direction of travel is similar: rising potency, increased vaping, and growing availability of extracts through social networks and online channels.2
Even without legalisation, UK herbal cannabis now averages 14–20% THC, compared with 3–8% a decade ago.2 Concentrates such as “shatter”, “wax”, and “dabs” can exceed 60–90% THC. These products are increasingly used by young adults, often without awareness of the risks. Potency escalation is not a niche trend; it is a global one.3
Why potency matters in the consulting room
High‑potency THC changes everything. It increases the risk of acute anxiety, panic, paranoia, and transient psychotic symptoms.4 These presentations can mimic stimulant intoxication, trauma hyperarousal, or withdrawal from other substances. In young adults with underlying vulnerability, trauma histories, mood disorders, neurodiversity, the effects can be destabilising.
Dependence risk also rises with potency. Vape pens and concentrates deliver THC rapidly, producing stronger reinforcement and more severe withdrawal.4 Patients may describe irritability, sleep disturbance, low mood, appetite changes, and intense cravings, symptoms that are easily misattributed to stress, depression, or “burnout”, particularly when patients do not volunteer that they are using high‑potency products.
Vaping adds another layer. Many young adults do not consider vaping “proper cannabis use” and may not disclose it unless asked directly.1,2 High‑potency cannabis use can produce anxiety, agitation, perceptual changes, and withdrawal symptoms that resemble stimulant withdrawal, trauma hyperarousal, benzodiazepine withdrawal, or acute anxiety disorders, complicating early‑days assessment and risk management.4
Clinical vignette
A 22‑year‑old university student presents with worsening anxiety, insomnia, and intermittent panic attacks. Initial assessment focuses on academic pressures and mental health history. Only after further questioning does he disclose using THC vape cartridges throughout the day, purchased through social media contacts. He does not consider this to be, “cannabis use,” because he no longer smokes joints. His symptoms improve when use is reduced, but he reports irritability, sleep disturbance, and cravings during attempts to stop. This scenario illustrates how contemporary cannabis products may be overlooked if assessment focuses solely on frequency of use rather than product type, potency, and route of administration.
The gap between what clinicians ask and what young adults use
The traditional assessment question, “How often do you use cannabis?” no longer capture the reality of modern use. Two patients may both report, “daily cannabis use,” but one may smoke a low‑potency joint in the evening, while the other vapes 80% THC distillate throughout the day. The clinical implications are entirely different.
We need to update our questions.
A contemporary cannabis assessment in primary care
- Product: What form of cannabis do you use? (flower, vape cartridges, concentrates, edibles, synthetic cannabinoids)
- Potency: Do you know how strong it is? Have you noticed stronger effects than before?
- Pattern: How often do you use it? Throughout the day or mainly in the evening?
- Route: Do you vape, smoke, dab, or use edibles?
- Effects: Anxiety, panic, paranoia, dissociation, unusual perceptions?
- Dependence: What happens if you stop? Irritability, sleep problems, low mood, cravings?
- Context: Is it used for relaxation, emotional regulation, sleep, socialising, or coping with distress?
These questions open richer conversations and help identify risk earlier.
Young adults: a distinct clinical group
The traditional assessment question, “How often do you use cannabis?” no longer capture the reality of modern use.
Young adults are the primary consumers of high‑potency products.1 Branding, flavourings, and novelty strongly influence behaviour, features that resonate with youth culture but are rarely discussed in clinical settings.
Although some individuals report short‑term relief from distress, higher‑potency cannabis has been associated with greater risks of anxiety, psychotic experiences, dependence, and adverse mental health outcomes.4 This creates a cycle of relief and rebound that can be difficult to break.
Implications for primary care
GPs are uniquely placed to identify early signs of harm, particularly when young adults present with anxiety, sleep problems, mood instability, or emerging psychotic symptoms. Asking about cannabis use, and asking the right questions, can shift the trajectory of care.
Harm‑reduction advice must also evolve.
For example:
- Avoid concentrates or high‑potency vapes if prone to anxiety or panic.
- Avoid mixing cannabis with alcohol or benzodiazepines.
- Be aware that vaping can lead to more frequent use than smoking.
- Recognise that withdrawal from high‑potency products can mimic depression or anxiety.
These conversations do not require moral judgement; they require clinical curiosity and contemporary knowledge.
A changing landscape
Cannabis is no longer a uniform product. Increasing THC concentrations, the emergence of concentrates and vape cartridges, and changing patterns of use among young adults have important implications for assessment in primary care. Frequency of use remains important, but product type, potency, route of administration, and withdrawal symptoms may now be equally relevant.
Asking whether a patient uses cannabis is no longer enough; GPs increasingly need to ask what cannabis they use.
References
- Pechmann, C. et al. (2024) ‘Young adult retail purchases of cannabis, product category preferences and sales trends in California 2018–21’, Addiction.
- Priory Group (2025) Cannabis Statistics UK 2025: Facts, Figures & Trends.
- Pacula, R.L. and Smart, R. (2017) ‘Medical marijuana and marijuana legalisation’, Annual Review of Clinical Psychology, 13, pp. 397–419.
- Freeman, T.P. et al. (2021) ‘Cannabis potency and the risk of mental health and addiction: A review’, The Lancet Psychiatry, 8(8), pp. 735–754.
Featured Photo by Matthew Brodeur on Unsplash
