Marijuana Withdrawal Syndrome

From MEDTOX Scientific: For many years now, addiction professionals have proclaimed of a noticeable syndrome developing with users who suddenly stop smoking marijuana. A hallmark phenomenon that occurs with the use of powerful stimulant and depressant drugs, withdrawal syndrome is an uncomfortable and often painful experience that results from extended, chronic administration of a drug. Typically a withdrawal syndrome presents with symptoms that appear to be the exact opposite of an abused drug’s direct effects. Until recently, DSM-IV failed to include marijuana withdrawal as a syndrome worthy of diagnosis and treatment. But the National Epidemiologic Survey on Alcohol and Related Conditions examined a group of over 1100 regular marijuana users who did not binge drink or regularly use other drugs or narcotics. The respondents in the survey pointed to a marked set of symptoms that were experienced when they suddenly stopped the consumption of marijuana, the symptoms immediately resolved when marijuana use was restarted [1]. Withdrawal and abstinence syndrome symptoms are attributed to the action that THC and other cannabinoids have on sensitive receptors in the mid-brain. Cannabinoid receptors and relevant transmitters are not entirely understood but are known to influence serotonin, dopamine, acetylcholine and GABA in the brain.

Respondents to the marijuana withdrawal syndromes survey represented 44% of all those who admitted to regular use of marijuana. Those who responded to the survey reported three or more symptoms of cannabis withdrawal syndrome. Two types of withdrawal symptoms emerged in the survey: somatic and psychological. Somatic-related symptoms of withdrawal included weakness, psychomotor retardation and sleep disturbances. Psychological symptoms included depression, hyper anxiety and panic disorder. Respondents who experienced personality disorders concurrent to the use of cannabis found that the underlying personality problem was exacerbated and more pronounced upon withdrawal from marijuana.

This study points to the difficulties that a substantial number of marijuana users have in trying to stop using the drug and/or in maintaining periods of sobriety or non-use. Not all marijuana users experience this syndrome when they try to quit, but this survey reveals that a very substantial minority does have to weather the symptoms and discomfort. Motivated addicts may find it very difficult to stop marijuana use and may need pharmacologic assistance in completing the task. Additionally, the research indicates that people seeking to stop marijuana abuse may switch to other drugs of abuse to ease the discomfort and pain of withdrawal. Authors and experts associated with this study argue for cannabis withdrawal syndrome inclusion in DSM-V.

For community corrections and rehabilitation professionals, marijuana abuse is no laughing matter. Ignoring use and abuse of marijuana as nothing more than a harmless vice is unwise, especially in light of still increasing purity in THC concentration of commercial grade marijuana sold on the street. Prior essays in the MEDTOX Journal have cast light on the profound effects that cannabis use has on the anatomy of the brain and the functioning of the limbic system. Marijuana abuse should be taken seriously by all professionals who work with those who smoke it. Efforts should be made to guide marijuana users to programs and experts who specialize in the treatment of that type of addiction and dependency.

[1] Hasin DS et al. Cannabis withdrawal in the United States: Results from NESARC. J Clin Psychiatry 2008 Sep; 69:1354.

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