By John Gever, Staff Writer, MedPage Today
Published: May 07, 2008
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.
Action Points
Explain to interested patients that the study found evidence that many marijuana users have withdrawal symptoms when they attempt to quit, leading to relapse in a large majority.
Point out that the study relied on participants' self-reports of past behaviors and experiences, and that the sample was demographically very different from national averages.
Note that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
WASHINGTON, May 7 -- Cannabis withdrawal is a real syndrome that clinicians must take into account when treating patients who are trying to quit using marijuana, a researcher said here.
One-third of pot smokers who reported a serious but unsuccessful past effort to quit resumed marijuana use because of withdrawal symptoms, David Gorelick, M.D., Ph.D., of the National Institute on Drug Abuse in Baltimore, reported at the American Psychiatric Association meeting.
That finding confirms a series of smaller studies that also identified a set of symptoms that emerge with marijuana cessation and disappear upon its resumption.
"I think the consensus now is that there is a cannabis withdrawal syndrome," Dr. Gorelick said. "[It] warrants attention during treatment of cannabis dependence."
Although the syndrome was not included in the DSM-IV diagnostic manual for psychiatric diseases, issued in 1994, Dr. Gorelick predicted it would be in the next version.
The findings came from questionnaires administered to 469 self-reported marijuana users 18 to 64 years old from the Baltimore area, who were recruited by advertisements and word of mouth.
About 28% reported more than 10,000 lifetime uses of marijuana, the equivalent of once-daily use for 27 years. More than half the sample reported at least 2,000 lifetime uses.
"We get the picture that these were heavier users," Dr. Gorelick said.
Some 90.6% had at least three dependence criteria as defined in DSM-IV's section on general substance dependence.
Fewer than half -- 42.4% -- said they had experienced withdrawal symptoms when they tried to quit.
Among those that did, reported symptoms were both physical and psychological, Dr. Gorelick said.
Physical symptoms were primarily gastrointestinal, such as stomach upset and nausea. Reported by about 12% to 23% of participants, they were less prevalent than the psychological symptoms.
Mood symptoms included irritability, anxiety, and sadness.
Other psychological symptoms were insomnia, increased or decreased appetite, increased or decreased libido, and boredom.
About one-third of the sample reported improved memory, and more than 90% reported marijuana cravings.
Of those reporting having had withdrawal symptoms, 78.4% said they began using marijuana again to reduce them.
"Withdrawal is a negative reinforcer for relapse," Dr. Gorelick said.
The most common dependence-associated behaviors among those who resumed marijuana use because of withdrawal symptoms were:
Using more than intended
Inability to cut down use
Spending a lot of time using
Giving up other activities in order to use
Dr. Gorelick cautioned that the study may not be generalizable to the population as a whole. About half the sample was unemployed, more than 70% were never married, and 80% were African-American. These characteristics differ substantially from the average profile of marijuana users nationally, he said.
The study also relied on participants' self-reports of past behaviors and experiences, which may not be entirely correct.
Kyle Kampman, M.D., of the University of Pennsylvania in Philadelphia, said the study "was very well done."
He said practitioners who treat substance abuse disorders were not inclined to doubt the findings. "Clinically, we see marijuana withdrawal," said Dr. Kampman, who was not involved with the study.
He is now part of a trial investigating oral delta-tetrahydrocannabinol, the main active ingredient in marijuana, as a potential treatment for marijuana withdrawal.
He said he was unaware of any other clinical studies of marijuana withdrawal treatments. Although cannabinoid drugs have been investigated for pain and other conditions, he did not know of commercial development activity in marijuana withdrawal.
"People are just now beginning to think about it," he said.
The study was funded by the National Institute on Drug Abuse.
The authors reported no potential conflicts of interest.
Primary source: American Psychiatric Association, abstract # 30
http://www.medpagetoday.com/MeetingCoverage/APA/9369
EPT
as i almost always have a small bud with me. aka my emergency survival kit. haha.
