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The cannabis withdrawal syndrome: current insights
#MMPMID28490916
Bonnet U
; Preuss UW
Subst Abuse Rehabil
2017[]; 8
(?): 9-37
PMID28490916
show ga
The cannabis withdrawal syndrome (CWS) is a criterion of cannabis use disorders
(CUDs) (Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition)
and cannabis dependence (International Classification of Diseases [ICD]-10).
Several lines of evidence from animal and human studies indicate that cessation
from long-term and regular cannabis use precipitates a specific withdrawal
syndrome with mainly mood and behavioral symptoms of light to moderate intensity,
which can usually be treated in an outpatient setting. Regular cannabis intake is
related to a desensitization and downregulation of human brain cannabinoid 1
(CB1) receptors. This starts to reverse within the first 2 days of abstinence and
the receptors return to normal functioning within 4 weeks of abstinence, which
could constitute a neurobiological time frame for the duration of CWS, not taking
into account cellular and synaptic long-term neuroplasticity elicited by
long-term cannabis use before cessation, for example, being possibly responsible
for cannabis craving. The CWS severity is dependent on the amount of cannabis
used pre-cessation, gender, and heritable and several environmental factors.
Therefore, naturalistic severity of CWS highly varies. Women reported a stronger
CWS than men including physical symptoms, such as nausea and stomach pain.
Comorbidity with mental or somatic disorders, severe CUD, and low social
functioning may require an inpatient treatment (preferably qualified detox) and
post-acute rehabilitation. There are promising results with gabapentin and
delta-9-tetrahydrocannabinol analogs in the treatment of CWS. Mirtazapine can be
beneficial to treat CWS insomnia. According to small studies, venlafaxine can
worsen the CWS, whereas other antidepressants, atomoxetine, lithium, buspirone,
and divalproex had no relevant effect. Certainly, further research is required
with respect to the impact of the CWS treatment setting on long-term CUD
prognosis and with respect to psychopharmacological or behavioral approaches,
such as aerobic exercise therapy or psychoeducation, in the treatment of CWS. The
up-to-date ICD-11 Beta Draft is recommended to be expanded by physical CWS
symptoms, the specification of CWS intensity and duration as well as gender
effects.
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