47% of individuals reducing or discontinuing cannabis use will suffer cannabis withdrawal syndrome, study.

"Cannabis withdrawal syndrome is common in heavy or prolonged users who reduce or discontinue cannabis use".

Cannabis and cannabinoids are the most frequently used illicit psychoactive drugs in the world, and their use and dependence have increased over the past several decades. Although popular perception is that cannabis is relatively harmless, there is substantial evidence to support an association between cannabis use and several medical, neurocognitive, functional, and psychosocial short and long-term complications.

A meta-analysis recently published in JAMA Network Open  has found that Cannabis Withdrawal Syndrome (CWS) is prevalent among heavy or prolonged cannabis and cannabinoid users.

What is Cannabis Withdrawal Syndrome?

CWS requires the presence of at least three of the following symptoms developing within 7 days of reducing or discontinuing cannabis use: irritability, anger or aggression; nervousness or anxiety; sleep disorders; appetite or weight disturbance; restlessness; depressed mood; and somatic symptoms such as headaches, sweating, nausea, vomiting, or abdominal pain.

“The overall prevalence of CWS among subjects reducing or discontinuing use of cannabis was 47%”.

Study design

The study was conducted by Anees Bahji, MD, and colleagues of the Department of Psychiatry, Queen’s University, Kingston, Ontario, Canada, and involved a literature search using MEDLINE, Embase, PsycINFO, Web of Science, the Cumulative Index to Nursing and Allied Health Literature, ProQuest, Allied and Complementary Medicine, and Psychiatry online, supplemented by manual searches of reference lists of included articles.

Medical Subject Headings (MESH) and key words used in the search include; cannabis withdrawal, cannabis use, and prevalence of epidemiologic factors

Articles were included if they (1) were published in English, (2) reported on individuals with regular use of cannabinoids or cannabis use disorder as a primary study group, (3) reported on the prevalence of CWS or CWS symptoms using a validated instrument, (4) reported the prevalence of CWS, and (5) used an observational study design (eg, cohort or cross-sectional).

Study findings

Authors identified 47 studies for inclusion in the analysis, representing 23,528 participants with median age of 29.9 years (SD 9.0 years). 69% of the participants were men and 72% were white.

Higher CWS prevalence was found among men and those who had concurrent cannabis (P =.<.001), tobacco (P =.02), and other substance use disorders (P =.05), as well as individuals reporting daily cannabis use (P <.001).

The overall pooled prevalence of CWS among subjects reducing or discontinuing use of cannabis was 47% with wide ranges depending on the population sample studied as shown:

• Among population-based studies, 17%
• Among outpatient samples, 54%
• Among inpatient samples, 87%

These differences were statistically significant (P < .001). 

Study limitations

Large heterogeneity across reviewed studies was a significant limitation of the report. This was due to differences in the definition of cannabis use disorder and CWS among different researchers. Inability to include individual-level characteristics was an additional limitation.

Takeaway

For purposes of counselling patients and supporting individuals who are reducing their use of cannabis, the authors urge that “Clinicians should be aware of CWS as it is associated with clinically significant symptoms, which can trigger resumption of cannabis use and serve as negative reinforcement for relapse during a quit attempt.”

Reference

Bahji A, Stephenson C, Tyo R, Hawken ER, Seitz DP. Prevalence of cannabis withdrawal symptoms among people with regular or dependent use of cannabinoids: a systematic review and meta-analysis. JAMA Network Open. 2020;3:e202370

Published: April 25, 2020

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