The time course and significance of cannabis withdrawal.

Abstract

Withdrawal symptoms following cessation of heavy cannabis (marijuana) use have been reported, yet their time course and clinical importance have not been established. A 50-day outpatient study assessed 18 marijuana users during a 5-day smoking-as-usual phase followed by a 45-day abstinence phase. Parallel assessment of 12 ex-users was obtained. A withdrawal pattern was observed for aggression, anger, anxiety, decreased appetite, decreased body weight, irritability, restlessness, shakiness, sleep problems, and stomach pain. Onset typically occurred between Days 1-3, peak effects between Days 2-6, and most effects lasted 4-14 days. The magnitude and time course of these effects appeared comparable to tobacco and other withdrawal syndromes. These effects likely contribute to the development of dependence and difficulty stopping use. Criteria for cannabis withdrawal are proposed.

Comparison of cannabis and tobacco withdrawal: Severity and contribution to relapse

“…The presence and magnitude of specific withdrawal symptoms were assessed using a version (17 items) of our Withdrawal Symptom Checklist, which includes common symptoms of both cannabis and tobacco withdrawal (Budney et al, 1999(Budney et al, , 2001(Budney et al, , 2003Hughes 2007). Each symptom was rated on a 0-3 scale (0 = not at all, 1= mild, 2 = moderate, 3 = severe) based on their experience during their recent period of abstinence.…”

“…The primary outcome measure, the Withdrawal Discomfort Score (WDS), was calculated by totaling scores from 9 items previously reported as common symptoms of withdrawal for both cannabis and tobacco: aggression, anger, appetite change (decreased for Cannabis, increased for Tobacco), depressed mood, irritability, anxiety/nervousness, restlessness, sleep difficulty, strange dreams (APA, 2000; Budney et al, 2004;Hughes, 2007;Vandrey et al, 2008). Prior studies have demonstrated that the individual Checklist items and the WDS scores change over time following abrupt cessation in a manner consistent with a true withdrawal syndrome (Budney et al, 2003(Budney et al, , 2004Hughes 2007), and the WDS has shown good internal consistency, α=.89 (Budney et al, 1999).…”

Sleep Disturbances: Implications for Cannabis Use, Cannabis Use Cessation, and Cannabis Use Treatment

“…A breadth of laboratory-based studies have identified sleep disturbance as a salient symptom of cannabis withdrawal [43][44][45][46]. Controlled studies have shown that sleep disturbances increase during periods of abstinence and remit during periods of cannabis use [43].…”

The endogenous cannabinoid system and the treatment of marijuana dependence

“…Analogous results were obtained in the ultrasonic vocalization emission test, which measures the number of stress-induced vocalizations emitted by rat pups removed from their nest . If confirmed in further behavioral models, these findings would suggest that inhibition of intracellular FAAH activity might offer an innovative target for the treatment of anxiety , which is also a feature of marijuana withdrawal (Kouri et al, 1999;Kouri and Pope, 2000;Budney et al, 2003).…”

“…The latter consists of a constellation of symptoms similar to those seen with nicotine withdrawal, which include irritability, sleep difficulty, decreased appetite, weight loss, and increased anger and irritability (Kouri et al, 1999;Kouri and Pope, 2000;Budney et al, 2003). There have been few pharmacological attempts to alleviate this syndrome (McRae et al, 2003), but one approach using oral D 9 -THC has recently shown significant promise (Haney et al, 2004).…”