Study suggests more than half of people who use cannabis for pain have multiple withdrawal symptoms

Washington: And about 10% of patients in the study experienced worsening of their sleep, mood, mental state, energy, and appetite over the next two years as they continued to use cannabis.

Many of them may not recognize that these symptoms are not from their underlying condition, but from the reaction of their brain and body to the absence of substances in the cannabis products they smoke. , vape, eat, or apply to their skin, the University says. from the Michigan Addiction Center psychologist who led the study.

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

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

“Some people report obtaining significant benefits from medical cannabis, but our results suggest a real need for more awareness of the signs of withdrawal symptoms that develop to reduce the potential harms of cannabis use, especially in those experiencing symptoms. severe or worsening over time, ”says Lara Coughlin, Ph.D., the addiction psychologist who conducted the analysis.

A long-term study on the use of medical cannabis

The researchers asked the patients if they experienced any of 15 different symptoms – ranging from sleep disturbances and nausea to irritability and aggression – after they had gone without using cannabis for a long time.

The researchers used an analytical method to empirically group 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 that included most or all of the symptoms.

They then looked at how things have changed over time, surveying patients a year and two years after their first survey.

Initially, 41% of study participants were in the mild symptom group, 34% in the moderate group, and 25% were classified as severe.

Misconceptions about medical cannabis

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 drug treatment services. UM. They may also want to avoid long-term use of opioid pain relievers, as they present a risk of misuse and other adverse health consequences.

She notes that people who have problems with their cannabis use for pain should discuss with their health care providers the option of receiving other pain treatments, including psychosocial treatments such as cognitive therapy. -behavioral.

The perception of cannabis as “harmless” is not correct, she says. It contains substances called cannabinoids which work on the brain – and which over time can cause the brain to respond when these substances are absent.

In addition to a general urge to use cannabis, withdrawal symptoms may include anxiety, sleep disturbances, decreased appetite, restlessness, depressed mood, aggression, letting go. irritability, nausea, sweating, headache, upset stomach, strange dreams, increased anger and tremors.

Previous research has shown that the more symptoms and severity a person has, the less likely they are to cut back on cannabis use, stop using it, or stay away from it once they quit. .

They may mistakenly think that the symptoms are occurring due to their underlying medical condition, and may even increase the amount or frequency of their cannabis use to try and counter the effect – leading to a cycle of increased blood pressure. consumption and increased weaning.

Coughlin says that people who decide to use a cannabis product for medical purposes should discuss the amount, route of administration, frequency and type of the cannabis product with their usual health care provider. They should also familiarize themselves with the symptoms of cannabis withdrawal and tell their provider if they are experiencing them.

Feeling 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. The same is true of the inability to reduce its use without experiencing a craving or other withdrawal symptoms.

Since there is no medically accepted standard for dosing medical cannabis for different conditions, patients are often faced with a wide range of cannabis products that vary in strength and route of administration. Some products might be more at risk of developing withdrawal symptoms than others, Coughlin says.

For example, people who smoked cannabis tended to have more severe withdrawal symptoms than others, while people who smoked cannabis reported symptoms that tended to stay the same or worsen, but which did not. generally did not improve 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.

Learn more about the study

Researchers asked patients how they used cannabis products, how often and for how long they had been using them, as well as their mental and physical health, education, and work status.

Over time, those who started in the mild withdrawal symptoms group were likely to stay there, but some progressed to moderate withdrawal symptoms.

People in the moderate withdrawal group were more likely to decrease symptoms than increase, and by the end of the study, the number of people in the severe category had fallen to 17%. In all, 13 percent of patients had progressed to the next symptom level by the end of the first year, and 8 percent had gone up after two years.

Problems sleeping was the most common symptom in all three groups, and many members of the light group also reported cravings for cannabis. In the moderate group, the most common withdrawal symptoms were trouble sleeping, depressed mood, decreased appetite, craving, restlessness, anxiety, and irritability.

The severe withdrawal symptoms group was much more likely to report all symptoms except sweating. Almost all of the participants in this group reported irritability, anxiety, and problems sleeping. They were also more likely to be long-term and frequent users of cannabis.

People in the severe group were more likely to be younger and to have poorer mental health. Older adults were less likely to increase the severity of withdrawal symptoms, while those who vaped cannabis were less likely to switch to a weaker withdrawal group.

The study did not assess nicotine use or attempt to distinguish between symptoms that might also be related to breakthrough pain or diagnosed / undiagnosed mental health issues during abstinence.

Future directions

Coughlin and his colleagues hope that future research can further explore the symptoms of cannabis withdrawal in medical cannabis patients, including the impact of different abstention attempts, different types of use and routes of administration, and the interaction with other factors of physical and mental health. Most of the research on cannabis withdrawal has focused on recreational users, or “snapshot” focuses on medical cannabis patients at one point in time.

Further research could help identify those most at risk of developing problems and reduce the risk of progression to a cannabis use disorder, that is, when a person uses cannabis. on several occasions despite major impacts on his life and his ability to function.