Cannabis withdrawal syndrome (CWS) is prevalent among regular cannabis users, according to a meta-analysis published in JAMA Network Open. Over the past 2 decades, both use and dependence appear to have increased for cannabinoids, the most commonly used class of illegal drugs. Long-term risks include an elevated risk of addiction, altered brain development, impaired educational performance, chronic respiratory tract and psychotic disorders, motor vehicle accidents, and suicide.

After 7 days of reduced cannabis use, individuals may experience CWS, which includes at least 3 of the following symptoms: irritability, anger or aggression; nervousness or anxiety; sleep problems; appetite or weight disturbance; restlessness; depressed mood; and somatic symptoms such as headaches, sweating, nausea, vomiting, or abdominal pain. 

Anees Bahji, MD, of the department of psychiatry, Queen’s University, Kingston, Ontario, Canada, and colleagues conducted 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. They identified 47 studies for inclusion in the analysis, representing 23,528 participants (median age, 29.9 years; 69% men; 72% white).

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The overall prevalence of CWS among subjects reducing or discontinuing use of cannabis was 47%. However, the prevalence ranged widely depending on the population sample studied. Among studies that were population-based, the prevalence of CWS upon reduction or discontinuation of cannabis was 17%, whereas in outpatient samples it was 54%, and in studies using inpatient samples it was 87%. These differences were statistically significant (P < .001). 


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

Study limitations included the wide range of tools used to define cannabis use disorder and CWS, which resulted in a large degree of heterogeneity across studies, as well as the inability to include individual-level characteristics.

The investigators noted, “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.”

Disclosure: A study author reported receiving funding from a pharmaceutical company. See original study for full list of disclosures.

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. doi:10.1001/jamanetworkopen.2020.2370.