Progression of Cannabis Withdrawal Symptoms in People Using Medical Cannabis for Chronic Pain

Overview

Journal Addiction

Specialty Psychiatry

Date 2021 Jan 5

PMID 33400332

Citations 4

Authors

Lara N Coughlin

Mark A Ilgen

Mary Jannausch

Maureen A Walton

Kipling M Bohnert

Affiliations

Soon will be listed here.

Abstract

Background And Aims: Research from cohorts of individuals with recreational cannabis use indicates that cannabis withdrawal symptoms are reported by more than 40% of those using regularly. Withdrawal symptoms are not well understood in those who use cannabis for medical purposes. Therefore, we prospectively examined the stability of withdrawal symptoms in individuals using cannabis to manage chronic pain.

Design, Setting, Participants: Using latent class analysis (LCA) we examined baseline cannabis withdrawal to derive symptom profiles. Then, using latent transition analysis (LTA) we examined the longitudinal course of withdrawal symptoms across the time points. Exploratory analyses examined demographic and clinical characteristics predictive of withdrawal class and transitioning to more or fewer withdrawal symptoms over time. A cohort of 527 adults with chronic pain seeking medical cannabis certification or re-certification was recruited between February 2014 and June 2015. Participants were recruited from medical cannabis clinic waiting rooms in Michigan, USA. Participants were predominantly white (82%) and 49% identified as male, with an average age of 45.6 years (standard deviation = 12.8).

Measurements: Baseline, 12-month and 24-month assessments of withdrawal symptoms using the Marijuana Withdrawal Checklist-revised.

Findings: A three-class LCA model including a mild (41%), moderate (34%) and severe (25%) symptom class parsimoniously represented withdrawal symptoms experienced by people using medical cannabis. Stability of withdrawal symptoms using a three-class LTA at 12 and 24 months ranged from 0.58 to 0.87, with the most stability in the mild withdrawal class. Younger age predicted greater severity and worsening of withdrawal over time.

Conclusions: Adults with chronic pain seeking medical cannabis certification or re-certification appear to experience mild to severe withdrawal symptoms. Withdrawal symptoms tend to be stable over a 2-year period, but younger age is predictive of worse symptoms and of an escalating withdrawal trajectory.

Citing Articles

Substituting Medical Cannabis for Medications Among Patients with Rheumatic Conditions in the United States and Canada.

Boehnke K, Scott J, Martel M, Smith T, Bergmans R, Kruger D ACR Open Rheumatol. 2024; 6(12):826-835.

PMID: 39236308 PMC: 11638128. DOI: 10.1002/acr2.11717.

Climbing the Evidence Pyramid: Dosing Considerations for Medical Cannabis in the Management of Chronic Pain.

Jugl S, Goodin A, Brown J Med Cannabis Cannabinoids. 2023; 6(1):41-45.

PMID: 37124080 PMC: 10134049. DOI: 10.1159/000530251.

Changes in striatal dopamine release, sleep, and behavior during spontaneous Δ-9-tetrahydrocannabinol abstinence in male and female mice.

Kesner A, Mateo Y, Abrahao K, Ramos-Maciel S, Pava M, Gracias A Neuropsychopharmacology. 2022; 47(8):1537-1549.

PMID: 35478010 PMC: 9205922. DOI: 10.1038/s41386-022-01326-0.

Perceived Efficacy, Reduced Prescription Drug Use, and Minimal Side Effects of Cannabis in Patients with Chronic Orthopedic Pain.

Greis A, Larsen E, Liu C, Renslo B, Radakrishnan A, Wilson-Poe A Cannabis Cannabinoid Res. 2021; 7(6):865-875.

PMID: 34767730 PMC: 9784606. DOI: 10.1089/can.2021.0088.

References

Greene M, Kelly J . The prevalence of cannabis withdrawal and its influence on adolescents' treatment response and outcomes: a 12-month prospective investigation. J Addict Med. 2014; 8(5):359-67. PMC: 4176951. DOI: 10.1097/ADM.0000000000000064. View

Hesse M, Thylstrup B . Time-course of the DSM-5 cannabis withdrawal symptoms in poly-substance abusers. BMC Psychiatry. 2013; 13:258. PMC: 4015312. DOI: 10.1186/1471-244X-13-258. View

Livne O, Shmulewitz D, Lev-Ran S, Hasin D . DSM-5 cannabis withdrawal syndrome: Demographic and clinical correlates in U.S. adults. Drug Alcohol Depend. 2018; 195:170-177. PMC: 6359953. DOI: 10.1016/j.drugalcdep.2018.09.005. View

Wall M, Liu J, Hasin D, Blanco C, Olfson M . Use of marijuana exclusively for medical purposes. Drug Alcohol Depend. 2018; 195:13-15. PMC: 7006108. DOI: 10.1016/j.drugalcdep.2018.11.009. View

Lanz C, Mattsson J, Soydaner U, Brenneisen R . Medicinal Cannabis: In Vitro Validation of Vaporizers for the Smoke-Free Inhalation of Cannabis. PLoS One. 2016; 11(1):e0147286. PMC: 4718604. DOI: 10.1371/journal.pone.0147286. View

Budney A, Moore B, Vandrey R, Hughes J . The time course and significance of cannabis withdrawal. J Abnorm Psychol. 2003; 112(3):393-402. DOI: 10.1037/0021-843x.112.3.393. View

Levin K, Copersino M, Heishman S, Liu F, Kelly D, Boggs D . Cannabis withdrawal symptoms in non-treatment-seeking adult cannabis smokers. Drug Alcohol Depend. 2010; 111(1-2):120-7. PMC: 2930056. DOI: 10.1016/j.drugalcdep.2010.04.010. View

Lin L, Ilgen M, Jannausch M, Bohnert K . Comparing adults who use cannabis medically with those who use recreationally: Results from a national sample. Addict Behav. 2016; 61:99-103. PMC: 4915997. DOI: 10.1016/j.addbeh.2016.05.015. View

Compton W, Han B, Hughes A, Jones C, Blanco C . Use of Marijuana for Medical Purposes Among Adults in the United States. JAMA. 2016; 317(2):209-211. PMC: 7391484. DOI: 10.1001/jama.2016.18900. View

10.

Ware Jr J, Kosinski M, Keller S . A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996; 34(3):220-33. DOI: 10.1097/00005650-199603000-00003. View

11.

Budney A . Are specific dependence criteria necessary for different substances: how can research on cannabis inform this issue?. Addiction. 2006; 101 Suppl 1:125-33. DOI: 10.1111/j.1360-0443.2006.01582.x. View

12.

Park J, Wu L . Prevalence, reasons, perceived effects, and correlates of medical marijuana use: A review. Drug Alcohol Depend. 2017; 177:1-13. PMC: 5542049. DOI: 10.1016/j.drugalcdep.2017.03.009. View

13.

Ilgen M, Bohnert K, Kleinberg F, Jannausch M, Bohnert A, Walton M . Characteristics of adults seeking medical marijuana certification. Drug Alcohol Depend. 2013; 132(3):654-9. DOI: 10.1016/j.drugalcdep.2013.04.019. View

14.

Hoffmann D, Weber E . Medical marijuana and the law. N Engl J Med. 2010; 362(16):1453-7. DOI: 10.1056/NEJMp1000695. View

15.

Compton W, Han B, Jones C, Blanco C, Hughes A . Marijuana use and use disorders in adults in the USA, 2002-14: analysis of annual cross-sectional surveys. Lancet Psychiatry. 2016; 3(10):954-964. DOI: 10.1016/S2215-0366(16)30208-5. View

16.

Legleye S, Piontek D, Kraus L, Morand E, Falissard B . A validation of the Cannabis Abuse Screening Test (CAST) using a latent class analysis of the DSM-IV among adolescents. Int J Methods Psychiatr Res. 2013; 22(1):16-26. PMC: 6878590. DOI: 10.1002/mpr.1378. View

17.

Richmond M, Pampel F, Rivera L, Broderick K, Reimann B, Fischer L . Frequency and Risk of Marijuana Use among Substance-Using Health Care Patients in Colorado with and without Access to State Legalized Medical Marijuana. J Psychoactive Drugs. 2015; 47(1):1-9. DOI: 10.1080/02791072.2014.991008. View

18.

Budney A, Hughes J . The cannabis withdrawal syndrome. Curr Opin Psychiatry. 2006; 19(3):233-8. DOI: 10.1097/01.yco.0000218592.00689.e5. View

19.

Haney M, Ward A, Comer S, Foltin R, FISCHMAN M . Abstinence symptoms following smoked marijuana in humans. Psychopharmacology (Berl). 1999; 141(4):395-404. DOI: 10.1007/s002130050849. View

20.

Copersino M, Boyd S, Tashkin D, Huestis M, Heishman S, Dermand J . Cannabis withdrawal among non-treatment-seeking adult cannabis users. Am J Addict. 2006; 15(1):8-14. DOI: 10.1080/10550490500418997. View