Marijuana Withdrawal Syndrome a Real Entity

Pippa Wysong

August 08, 2003

Aug. 8, 2003 (Toronto) — Evidence is mounting for a true withdrawal syndrome that occurs after cessation of regular, heavy use of marijuana.

Although the consequences of withdrawal from marijuana are not as severe as those seen with other drugs such as cocaine or heroin, they are still clinically significant and worthy of assessment, said Alan Budney, PhD, associate professor of psychology and psychiatry at the University of Vermont in Burlington.

Dr. Budney spoke here today at the 111th annual conference of the American Psychological Association. He has done extensive research on dependency and withdrawal associated with heavy marijuana use. His interest in the topic was triggered by the fact that increasing numbers of people with marijuana dependency were actively seeking treatment and that many complained of withdrawal problems.

The question in the medical community has been whether there is indeed a true withdrawal syndrome, he said.

Using DSM-IV criteria to rate the dependency level of these patients and comparing it with those dependent on cocaine was revealing. Heavy marijuana users had on average 6.3 out of 9 criteria compared with 7.7 for cocaine users.

"You only need three to meet dependence. Although the dependence is lower than cocaine, its still pretty substantial," Dr. Budney said.

A previous short-term study by his lab revealed that daily users who quit for as few as three days displayed numerous withdrawal symptoms, including cravings, irritability, restlessness, headaches, loss of appetite, and depression.

In an effort to validate these findings, the researchers then launched a study that compared daily marijuana users who quit for 45 days to ex-users of the drug as a control group.

A total of 18 regular users and 12 control patients completed the study. The users smoked between one to eight times daily and were not seeking treatment to quit. Subjects were encouraged to quit for the study period by being paid increasing amounts of cash for the increasing number of days they were abstinent from the drug.

For five days prior to the quit period, smokers were told to smoke "as usual" (subjects were not given any drug by the researchers). Baseline physiology and psychological features were measured for both groups. The smokers then ceased use of marijuana for the next 45 days. Study participants phoned in almost daily to report symptoms.

Key findings revealed that the smokers had a peak of classic withdrawal symptoms by day two or three and "they stayed elevated significantly out to two or three weeks," Dr. Budney said.

There were no changes in the control group. After about three weeks, symptom levels of users were similar to those of control patients.

The researchers are now comparing withdrawal syndromes of heavy marijuana users to those of tobacco users. "We see pretty much the same pattern and same magnitude of results," over similar time courses, Dr. Budney said of the preliminary findings.

Typically, marijuana users do not show the severe psychiatric syndromes that are seen in severe opioid addiction, but this doesn't mean the syndrome isn't significant.

"There are some interesting neurobiological data that suggest what's going on in the [central nervous system] during withdrawal is really perhaps as important, if not more important than development of dependence, and [possibly] of the physical symptoms," he said.

Dr. Budney suggested that the DSM-V should include marijuana withdrawal.

Light or occasional users of the drug, such as once or twice weekly, would not experience the withdrawal effects, he said.

Dr. Budney "has done a most excellent job in bridging the gap between basic and clinical research on marijuana dependence," said James Zacny, PhD, associate professor of anesthesia at the University of Chicago and moderator of the session.

This study was funded by the U.S. National Institute on Drug Abuse.

APA 111th Annual Conference: Session 2081, Fellows Addresses. Presented Aug. 8, 2003.

Reviewed by Gary D. Vogin, MD

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