Use this worksheet during intake or when a patient discloses cannabis use or interest. It helps identify absolute contraindications, relative risk factors, and medication interactions that require discussion.
Cannabis Risk Assessment
Pre-screening for patients considering or currently using cannabis
Absolute Contraindications
If any of these apply, cannabis use is not recommended.
Personal history of psychotic disorders (schizophrenia, schizoaffective disorder)
Currently pregnant or actively planning pregnancy
Currently breastfeeding
Under 25 with first-degree family history of psychotic disorders
Unstable cardiovascular disease (recent MI, unstable angina, arrhythmia)
Active non-cannabis substance use disorder
Relative Contraindications (Requires Clinical Discussion)
These do not necessarily preclude use but require careful risk-benefit discussion.
History of anxiety or panic disorder (THC may exacerbate)
History of depression (complex, dose-dependent relationship)
History of any substance use disorder, including cannabis
Under 25 years old (brain development concerns)
Current benzodiazepine or opioid use (additive CNS depression)
Liver disease (affects cannabinoid metabolism)
Respiratory disease, if considering inhalation route
Operating heavy machinery or commercial driving
Current Medications to Review for Interactions
Cannabis (especially CBD) inhibits CYP3A4 and CYP2C19 enzymes. Check any of the following:
Blood thinners (warfarin, heparin) — increased INR/bleeding risk
SSRIs / SNRIs — potential increased side effects
Benzodiazepines — additive sedation, increased levels
Opioids — additive CNS depression
Anti-seizure medications (clobazam, valproate) — altered levels
Immunosuppressants (tacrolimus, cyclosporine) — altered levels
Statins — potential increased levels and side effects
Other CYP3A4/CYP2C19 substrates: ___________________
Assessment Notes & Recommendations
For support with quitting or cutting back on cannabis, visit our companion site CannabisDependence.org