Prolonged cannabis withdrawal in young adults with lifetime psychiatric illness

Abstract

Young adults with psychiatric illnesses are more likely to use cannabis and experience problems from use. It is not known whether those with a lifetime psychiatric illness experience a prolonged cannabis withdrawal syndrome with abstinence. Participants were fifty young adults, aged 18–25, recruited from the Boston-area in 2015–2016, who used cannabis at least weekly, completed the Structured Clinical Interview for DSM-IV to identify Axis I psychiatric diagnoses (PD+ vs PD−), and attained cannabis abstinence with a four-week contingency management protocol. Withdrawal symptom severity was assessed at baseline and at four weekly abstinent visits using the Cannabis Withdrawal Scale. Cannabis dependence, age of initiation, and rate of abstinence were similar in PD+ and PD− groups. There was a diagnostic group by abstinent week interaction, suggesting a difference in time course for resolution of withdrawal symptoms by group, F(4,46)=3.8, p=0.009, controlling for sex, baseline depressive and anxiety symptoms, and frequency of cannabis use in the prior 90 days. In post hoc analyses, there was a difference in time-course of cannabis withdrawal. PD− had significantly reduced withdrawal symptom severity in abstinent week one [t(46)=−2.2, p=0.03], while PD+ did not report improved withdrawal symptoms until the second abstinent week [t(46) =−4.1, p=0.0002]. Cannabis withdrawal symptoms improved over four weeks in young people with and without a lifetime psychiatric diagnosis. However, those with a psychiatric illness reported one week delayed improvement in withdrawal symptom severity. Longer duration of cannabis withdrawal may be a risk factor for cannabis dependence and difficulty quitting.

Is the Urine Cannabinoid Level Measured via a Commercial Point-of-Care Semiquantitative Immunoassay a Cannabis Withdrawal Syndrome Severity Predictor?

“…While this is in line with previous findings (42,43), it also supports the existence of a special population among chronic cannabis users with a delayed THC terminalphase elimination from the body (16,(43)(44)(45)(46). While prolonged CWS courses have previously been described and ascribed to psychiatric comorbidities (39,40), our late group showed no such association with psychiatric comorbidity nor with age nor cannabis history data. What we did find was a disproportionate female preponderance within the late group, with increased urine THC-COOH levels, but not with MWC scores.…”

“…Most of the study population (e.g., the "early" group; n = 58 including dropouts) had been discharged normally before day 16 due to sufficient clinical improvement levels. Conversely, the findings of the "late" group (n = 20), presenting with both considerable CWS intensity and urine THC-COOH levels, may indicate the existence of a distinct subset of THC users-around 30% in our sample-characterized by a protracted withdrawal course (38)(39)(40). The symptom patterns and trajectories of these two groups are consistent with those of the previously postulated CWS subtypes A and B (3), respectively.…”

Progression of cannabis withdrawal symptoms in people using medical cannabis for chronic pain

“…Those with more severe withdrawal symptoms tended to be younger and have poorer mental health. This finding fits within the context of prior work documenting that young adults with mental health conditions experienced greater severity and duration of withdrawal symptoms [47]. Taken together, these findings suggest that younger individuals with greater mental health problems might be at risk of greater consequences from use, have more difficulty abstaining from use and be more susceptible to relapse due to more acute and protracted withdrawal symptoms.…”

DSM-5 cannabis withdrawal syndrome: Demographic and clinical correlates in U.S. adults

“…This syndrome has been shown to contribute to ongoing cannabis use and disrupted daily living (Budney et al, 2004;ElSohly et al, 2016). Neurobiological (Haney et al, 1999a(Haney et al, , 1999bLichtman and Martin, 2002), clinical (Chung et al, 2008;Copersino et al, 2006;Cornelius et al, 2008;Schuster et al, 2017), neuroimaging (Hirvonen et al, 2012), and epidemiological studies (Agrawal et al, 2008;Budney and Hughes, 2006;Hasin et al, 2008) supported adding cannabis withdrawal as a syndrome (CWS) to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013) and as a criterion for CUD. CWS is diagnosed when within a week after cessation of heavy, prolonged use, ≥3 of 7 symptoms occur, including six behavioral or emotional symptoms and one or more of a list of physical symptoms (American Psychiatric Association, 2013).…”