Article by Angela Stelmakowich, Growth Op
A U.S. study found that over half of patients who use medical marijuana for chronic pain had withdrawal systems during even short consumption breaks, a situation that could up the chance of developing cannabis use disorder (CUD) and that demands people better understand signs of withdrawal.
Published in Addiction, researchers report the patients “experience clusters of multiple withdrawal symptoms when they’re between uses,” notes an article by Michigan Medicine, University of Michigan (U of M). As cannabis use continued over two years, about 10 per cent of subjects witnessed worsening symptoms, including those related to sleep, mood, mental state, energy and appetite, the university post shows.
For recreational weed, studies indicate cannabis withdrawal symptoms have been reported by 40-plus per cent of regular users, states the study abstract. That said, withdrawal symptoms are not well understood in medical marijuana users.
The study team from the U of M Medical School and the V.A. Ann Arbor Healthcare System considered responses from respondents one and two years after being surveyed.
The 527 Michigan residents, all with non-cancer-related chronic pain, were seeking medical cannabis certification or recertification between February 2014 and June 2015, the study states. They were asked if they experienced any of 15 symptoms — craving for cannabis, anxiety, sleep difficulties, decreased appetite, restlessness, depressed mood, aggression, irritability, nausea, sweating, headache, stomach pain, strange dreams, increased anger and shakiness — after not using for a significant time.
At baseline, 41 per cent of people were classified in the mild withdrawal symptom group, 34 per cent were in the moderate group (experienced multiple symptoms) and 25 per cent were in the severe group (had most or all symptoms).
Overall, 13 per cent of participants saw their withdrawal symptoms rise to the next level by the end of the first year, and eight per cent transitioned upward by the end of two years, the university reports.
Specifically, those in the mild group were likely to stay there, although some did progress to moderate withdrawal symptoms; those in the moderate group were more likely to see their symptoms go down than up; and people in the severe category dropped to 17 per cent. As well, participants who smoked cannabis tended to have more severe withdrawal symptoms than others, according to the study. Compare that to those who vaped their medical cannabis, reporting symptoms that tended to stay the same or worsen, but generally did not improve, over time.
Regardless of the group, sleep problems were the most common symptom. Those in the severe group were “more likely to report all the symptoms except sweatiness,” the university reports. They were also more likely to be long-time and frequent users of weed, to have worse mental health and to be younger.
“Withdrawal symptoms tend to be stable over a two-year period, but younger age is predictive of worse symptoms and of an escalating withdrawal trajectory,” study authors caution. Older adults, for their part, “were less likely to go up in withdrawal symptom severity,” adds the university.
A recently released study out of Saskatchewan found a three-fold co-morbid association between CUD with major depression and CUD with generalized anxiety disorder.
Yet another concern identified by researchers in the Michigan study was that many people may not understand that their symptoms do not relate to their underlying condition, but, rather, to “their brain and body’s reaction to the absence of substances in the cannabis products they’re smoking, vaping, eating or applying to their skin,” the university notes.
Because of that perceived link, some of these people “may even increase the amount or frequency of their cannabis use to try to counteract the effect, leading to a cycle of increasing use and increasing withdrawal,” it points out.
The need to enhance awareness is particularly important “among those who experience severe or worsening symptoms over time,” emphasizes Lara Coughlin, Ph.D., a study author and a psychiatry professor at the U of M.
When patients experience more than a few related symptoms, Coughlin explains that it’s called cannabis withdrawal syndrome. She suggests this syndrome can mean a higher risk of developing even more serious issues, including CUD, which the university post defines as “when someone uses cannabis repeatedly despite major impacts on their lives and ability to function.”
A study published in 2019 notes that “medical-only users appear to use it [marijuana] for evidence-based medical reasons and have lower prevalence of substance use disorder than other marijuana users.” Even so, “because most medical marijuana users also use non-medically, screening for psychiatric disorders and prevention efforts for cannabis use disorder should be implemented when authorizing medical marijuana,” it recommends.