Cannabis Withdrawal Syndrome Prevalent Among Regular Users

Anees Bahji, MD, PhD

Cannabis withdrawal syndrome was prevalent among regular cannabis users, according to new study findings.

The findings highlighted that clinicians must be aware of the high prevalence of cannabis withdrawal syndrome to counsel patients and support those reducing their use of the substance.

Anees Bahji, MD, and an investigative team examined abstracts and literature to estimate the prevalence of cannabis withdrawal syndrome among those with regular or dependent use of cannabinoids and identify factors associated with the syndrome. They found that the syndrome was particularly common among individuals in outpatient and inpatients settings and those with substance use disorders.

Bahji, from the psychiatry department at Queen’s University in Ontario, and the team used 8 electronic databases to conduce the systematic review: MEDLINE; Embase; PsycInfo; Web of Science; Allied and Complementary Medicine; Cumulative Index to Nursing and Allied Health Literature; ProQuest; and Psychiatry Online. The investigators used Medical Subject Headings and keywords related to cannabis withdrawal, cannabis use, and prevalence of epidemiologic factors.

Included studies were published in English and reported original research using an observational design that reported on cannabis withdrawal symptoms in individuals with regular or dependent cannabis or synthetic cannabinoid use.

The team abstracted study information, study and participant characteristics, condition information, and the prevalence of cannabis withdrawal symptoms.

Overall, Bahji and colleagues screened 3848 unique citations. They screened 86 in full and included 47 in the review, reporting on 50 unique cohorts. There were 23,518 participants represented across cohorts (median age, 29.9 years; 16,839 white [72%]; and 14,387 men [69%]. Half of the cohorts were of individuals who sought treatment.

The pooled prevalence of cannabis withdrawal symptoms was 47% (95% CI, 41-52), with significant heterogeneity between estimates. When stratified by source, the prevalence was 17% (95% CI, 13-21%) in population-based samples, 54% in outpatient samples (95% CI, 48-59), and 87% in inpatient groups (95% CI, 79-94), all significantly different (P <.001).

There were other factors associated with a higher chronic withdrawal symptom prevalence, including concurrent cannabis (P <.001), tobacco (P=.02), and other substance use disorders (P=.05), along with daily cannabis use (P <.001).

Cannabis withdrawal symptoms included depression or anxiety, and the investigators noted that sometimes regular users may seek cannabis to obtain short-term relief, unaware that use could perpetuate a longer-term withdrawal problem.

Clinicians must be aware of cannabis withdrawal symptoms because it was associated with clinically significant symptoms that could trigger the use of cannabis and lead to negative reinforcement for relapse during an attempt to quit. Clinical significance of withdrawal was shown by the fact that it could be impairing, that cannabis or other substances were used to relieve it with trouble quitting its use.

If clinicians were aware of the high prevalence of cannabis withdrawal symptoms and screened for them, particularly among those at higher risk, they could counsel and support patients who were reducing their cannabis use.

The study, “Prevalence of Cannabis Withdrawal Symptoms Among People With Regular or Dependence Use of Cannabinoids,” was published online in JAMA Network Open.