Young Medical Cannabis Patients More Likely to Experience Withdrawal Symptoms, Finds Study
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Younger users of medical cannabis and those with poorer mental health are the most likely to experience severe cannabis withdrawal symptoms from medical use, and consequently the most susceptible to relapse when trying to reduce their use, say researchers from the University of Michigan Addiction Center.
Following a two-year longitudinal study, the researchers concluded that cannabis withdrawal should be considered on a scale of severity, rather than as distinct subtypes of withdrawal syndromes. Under such a scale, symptom severity would generally stay steady over time for patients experiencing only mild or moderate withdrawal.
Withdrawal as a spectrum
The new study followed the health of nearly 530 patients in Michigan who were receiving medical cannabis for severe or chronic pain management, all of whom had some level of cannabis withdrawal symptomology. At the study outset, and then again after 12 and 24 months, patients were invited to complete a 15-item assessment for various cannabis withdrawal symptoms, including sleeping problems, irritability, and anxiety.
Cross-sectional analysis of the baseline reports identified three general classes of withdrawal, equivalent to mild, moderate, and severe symptoms.
The largest portion of the cohort only reported mild symptoms of cannabis withdrawal during periods of abstinence, and had a very low probability of reporting most withdrawal symptoms – with the exception of some sleeping difficulties and cravings.
Patients in the moderate withdrawal bracket – which made up just under 35 percent of the study group – generally reported more sleeping difficulties and cravings, as well as depressed moods, decreased appetites, restlessness, anxiety, and irritability during periods without cannabis use.
One-in-four patients returned results correlating with severe cannabis withdrawal, reporting all of the earlier symptoms but to a higher degree. Of the 14 total items assessed by the symptom questionnaire, the only item not endorsed by patients with severe withdrawal was excessive sweating.
Younger people have greater odds of withdrawal worsening over time
On examining the symptoms reported by patients over the entire course of the two-year study, the researchers found that most patients remained within their initial withdrawal bracket across the duration of the study.
Additionally, patients in the moderate severity bracket, who did move between groups, were more likely to have their symptoms improve than worsen. Many of those in the severe bracket also made improvements. By the end of the study term, only 17 percent of participants remained in the severe bracket – down from 25 percent at the outset of the study.
Consequently, the researchers believe that interventions, such as reducing total cannabis use in order to lessen feelings of withdrawal and the use of alternative forms of pain management, could be effective treatments for those with worse withdrawal symptoms.
However, the researchers also noticed a concerning trend; patients with the most severe withdrawal symptoms were more likely to be younger and to have poorer mental health. These younger patients were also more likely than older counterparts to transition into a more severe withdrawal class over the course of the study. Patients who reported vaping as a main form of intake were also less likely to transition into a lower severity symptom group.
Whether vaping plays a specific part in the trend observed in young people is still unclear, but the researchers believe their findings do indicate that younger people with more challenging mental health problems could be at risk of greater consequences from cannabis use, having more difficulty in abstaining from that use, and so be more susceptible to relapse brought upon by severe feelings of withdrawal.
What does this mean for medical cannabis patients?
According to the scientists behind the new study, many medical cannabis patients may be suffering from cannabis withdrawal, but mistakenly chalk up their symptoms to a flare-up of their underlying condition.
“Some people report experiencing significant benefits from medical cannabis, but our findings suggest a real need to increase awareness about the signs of withdrawal symptoms developing to decrease the potential downsides of cannabis use, especially among those who experience severe or worsening symptoms over time,” Lara Coughlin, PhD, the addiction psychologist who led the analysis, said in a statement.
While this study has identified younger people as a particular group of interest, Coughlin hopes that the research will also inspire other studies, which could will help characterize the effects of different consumption methods and any possible relations to mental and physical health factors.
Additionally, while most research on cannabis withdrawal symptoms and problematic cannabis use has focused on recreational users, this study is a clear example of the need to perform similar investigations with medical cannabis users, in order to identify any at-risk demographics that might need to be specially supported by physicians.