An example of withdrawal symptoms related to cannabis use. Photo credit: University of Michigan

More than half of people who use medical marijuana products for pain relief also experience clusters of multiple withdrawal symptoms when they are between uses, according to a new study.

Approximately 10% of the patients in the study experienced deteriorations in their sleep, mood, state of mind, energy, and appetite over the next two years as they continued to use cannabis.

Many of them may not realize that these symptoms are not due to their baseline condition but rather to their brain and body’s response to the lack of substances in the cannabis products that they smoke, vape, eat, or apply to their skin, the says Michigan Addiction Center University Psychologist who led the study.

When someone has more than a few such symptoms, it is called cannabis withdrawal syndrome – and it can mean a higher risk of developing even more serious problems, like a cannabis use disorder.

In the new study, published in the journal Addiction, a team from UM Medical School and VA Ann Arbor Healthcare Systems reports the results of detailed two-year surveys of 527 Michigan residents. All participated in the state’s system of certifying people with certain conditions to use medicinal cannabis and experiencing non-cancer pain.

“Some people report significant benefits from medicinal cannabis, but our results suggest that increasing awareness of the signs of withdrawal symptoms that develop can help reduce the potential downsides of cannabis use, especially in those who become severe over time or worsening symptoms really need to be reduced. ” says Lara Coughlin, Ph.D., the addiction psychologist who led the analysis.

Long-term study of medical cannabis use

The researchers asked patients if they had any of 15 different symptoms – from insomnia and nausea to irritability and aggression – when they had been without cannabis for a significant amount of time.

The researchers used an analytical method to empirically group the patients into those who had no symptoms or mild symptoms at the start of the study, those who had moderate symptoms (meaning they had multiple withdrawal symptoms), and those who had severe withdrawal problems , including most or all of the symptoms.

They then looked at how things had changed over time and interviewed patients a year and two years after their initial survey.

At the start of the study, 41% of the study participants fell into the group of mild symptoms, 34% into the moderate group and 25% as severe.

Medical cannabis misconceptions

Many people who turn to medical cannabis for pain do so because other pain relievers haven’t worked, says Coughlin, an assistant professor in the department of psychiatry who views patients as part of UM Addiction Treatment Services. You may also want to avoid long-term use of opioid pain relievers because they pose the risk of abuse and other harmful effects.

She notes that people who experience problems related to their cannabis use for pain should speak to their health care providers about other pain treatments, including psychosocial treatments such as cognitive behavioral therapy.

The perception of cannabis as “harmless” is incorrect, she says. It contains substances called cannabinoids that act on the brain – and which, over time, can cause the brain to react when these substances are absent.

In addition to the general craving for cannabis, withdrawal symptoms can include anxiety, insomnia, decreased appetite, restlessness, depressed mood, aggression, irritability, nausea, sweating, headache, stomach pain, strange dreams, increased anger, and shakiness.

Previous research has shown that the more symptoms and severity of symptoms a person has, the less likely they are to be able to reduce their cannabis use, to stop using it, or to stay away from it once they stop.

They may mistakenly believe that the symptoms are due to their underlying medical conditions and may even increase the amount or frequency of their cannabis use to counteract the effect. This leads to a cycle of increasing consumption and increasing withdrawal.

According to Coughlin, individuals who choose to use a cannabis product for medicinal purposes should discuss the amount, route of administration, frequency, and type of cannabis product with their regular health care provider. You should also familiarize yourself with the symptoms of cannabis withdrawal and let their provider know if you are experiencing them.

The urge to use cannabis after a period of non-use, such as shortly after waking up, can be a sign of withdrawal syndrome, she notes. This also applies to the inability to limit use without cravings or other withdrawal symptoms.

Since there is no medically recognized standard for the dosage of medicinal cannabis for various diseases, patients are often faced with a variety of cannabis products that differ in strength and route of administration. Some products might pose a higher risk of developing withdrawal symptoms than others, says Coughlin.

For example, people who smoked cannabis tended to have more severe withdrawal symptoms than others, while people who vaped cannabis reported symptoms that tended to stay the same or get worse, but generally did not get better over time.

As more states legalize cannabis for medical or general purposes, including several states that will legalize its use based on last November’s election results, use is expected to increase.

More about the study

Researchers asked patients how they consumed cannabis products, how often and for how long they had consumed them, as well as their mental and physical health, education, and employment status.

Over time, those who started in the mild withdrawal symptoms group likely stayed there, but some made progress to alleviate the withdrawal symptoms.

People in the moderate withdrawal group were more likely to have symptoms than they were severe, and by the end of the study the number of people in the severe category had decreased to 17%. Overall, 13% of patients had progressed to the next symptom level by the end of the first year, and 8% had moved up by the end of two years.

Insomnia was the most common symptom in all three groups, and many in the mild group also reported cravings for cannabis. In the moderate group, the most common withdrawal symptoms were sleep disorders, depressive moods, decreased appetite, cravings, restlessness, anxiety, and irritability.

The group with severe withdrawal symptoms was much more likely to report all symptoms except sweats. Almost all participants in this group reported irritability, anxiety, and trouble sleeping. They were also more likely to have been long-term and frequent cannabis users.

Those in the severe group were more likely to be younger and in poorer mental health. Older adults were less likely to increase the severity of withdrawal symptoms, while those who vaped cannabis were less likely to move into a group with lower withdrawal rates.

The study did not assess nicotine use nor attempt to distinguish between symptoms that might also be related to breakthrough pain or diagnosed / undiagnosed mental illness during abstinence.

Future directions

Coughlin and colleagues hope that future research can further examine cannabis withdrawal symptoms in medicinal cannabis patients, including the effects of various attempts at abstinence, different routes of use and administration, and interaction with other physical and mental health determinants. Most of the research on cannabis withdrawal has been done on recreational users, or “snapshot” examines medical cannabis patients at a point in time.

Further research could help identify those who are at greatest risk of developing problems and reduce the risk of cannabis use disorder progressing if someone repeatedly uses cannabis despite its severe effects on their life and functioning.

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More information:
Lara N. Coughlin et al., Progression of Cannabis Withdrawal Symptoms in People Using Medical Cannabis for Chronic Pain, Addiction (2021). DOI: 10.1111 / add.15370 Provided by the University of Michigan

Quote: More than half of the people who use cannabis for pain experience multiple withdrawal symptoms (2021, January 8), reported on January 9, 2021 from https://medicalxpress.com/news/2021-01-people-cannabis -pain-multiple-symptoms.html were retrieved

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