New research has found that more than half of individuals who use medical marijuana products for pain management also experience multiple withdrawal symptoms between uses. Furthermore, approximately 10% of the study participants experienced worsening sleep, mood, mental state, energy levels, and appetite over 2 years as they continued to use cannabis.

Many patients may not recognize that these symptoms are a result of the brain and body’s reaction to the absence of substances in cannabis products, whether they smoke, vape, eat, or apply products to their skin, according to the study authors. Cannabis withdrawal syndrome can occur when individuals experience more than a few withdrawal symptoms, and it can mean a higher risk of developing even more serious issues, such as cannabis use disorder.

To investigate the frequency of cannabis withdrawal syndrome, a team of investigators from the University of Michigan Medical School and the Veterans Affairs Ann Arbor Healthcare System conducted detailed surveys of 527 participants across 2 years. All were participating in the state’s system to certify people with certain conditions for use of medical cannabis and had non-cancer-related pain.

Analysis leader Lara Coughlin, PhD, said in a press release that many patients who use medical cannabis do so because other pain relievers have not worked, or they may want to avoid long-term use of opioid pain medications because they pose a risk of misuse and other adverse health consequences. In a press release, Coughlin said people who experience issues related to their cannabis use for pain should talk with their health care providers about receiving other pain treatments, such as cognitive behavioral therapy.

The investigators asked participants whether they had experienced any of 15 different symptoms when they had gone a significant time without using cannabis. Symptoms can include a general craving for cannabis products, anxiety, sleep difficulties, decreased appetite, restlessness, depressed mood, aggression, irritability, nausea, sweating, headache, stomach pain, strange dreams, increased anger, and shakiness.

The team used an analytic method to empirically group the participants into those who had no symptoms or mild symptoms at the start of the study, those who had moderate symptoms, and those who had severe withdrawal issues that included most or all of the symptoms. Participants were also asked how they used cannabis products, how often, and how long they’d been using them.

They then analyzed how things changed over time, surveying the patients 1 year and 2 years after their first surgery. At baseline, they found that 41% of the study participants fell into the mild symptom group, 34% were in the moderate group, and 25% were classified as severe. Over time, the investigators found that those who had started in the mild withdrawal group were likely to stay there, but some did progress to moderate withdrawal symptoms.

Patients in the moderate withdrawal group were more likely to go down in symptoms than up, and by the end of the study, the number of individuals in the severe category had dropped to 17%. In total, 13% of the participants had gone up to the next level of symptoms by the end of the first year and 8% had transitioned upward by the end of 2 years.

Sleep problems were the most commonly reported symptom across all 3 groups, and many in the mild group also reported cravings for cannabis. In the moderate group, the most common withdrawal symptoms were sleep problems, depressed mood, decreased appetite, craving, restlessness, anxiety, and irritability.

The severe withdrawal symptom group was much more likely to report all the symptoms except for excessive sweat. Nearly all of the participants in the severe group reported irritability, anxiety, and sleep problems. Notably, they were also more likely to be younger, longtime and frequent users of cannabis, and to have worse mental health. Older adults were less likely to go up in withdrawal symptom severity, whereas those who vaped were less likely to transition to a lower withdrawal-severity group.

“Some people report experiencing significant benefits from medical cannabis, but our findings suggest a real need to increase awareness about the signs of withdrawal symptoms developing to decrease the potential downsides of cannabis use, especially among those who experience severe or worsening symptoms over time,” Coughlin concluded.

REFERENCE
More than half of people using cannabis for pain experience multiple withdrawal symptoms [news release]. EurekAlert; January 8, 2021. https://www.eurekalert.org/pub_releases/2021-01/mm-u-mth010821.php. Accessed January 13, 2021.