Cannabis withdrawal in chronic, frequent cannabis smokers during sustained abstinence within a closed residential environment.
OBJECTIVE
Chronic, frequent cannabis smokers may experience residual and offset effects, withdrawal, and craving when abstaining from the drug. We characterized the prevalence, duration, and intensity of these effects in chronic frequent cannabis smokers during abstinence on a closed research unit.


METHODS
Non-treatment-seeking participants (N = 29 on admission, 66% and 34% remaining after 2 and 4 weeks) provided subjective effects data. A battery of five instruments was computer-administered daily to measure psychological, sensory, and physical symptoms associated with cannabinoid intoxication and withdrawal. Plasma and oral fluid specimens were concurrently collected and analyzed for cannabinoids. Outcome variables were evaluated as change from admission (Day 0) with regression models.


RESULTS
Most abstinence effects, including irritability and anxiety were greatest on Days 0-3 and decreased thereafter. Cannabis craving significantly decreased over time, whereas decreased appetite began to normalize on Day 4. Strange dreams and difficulty getting to sleep increased over time, suggesting intrinsic sleep problems in chronic cannabis smokers. Symptoms likely induced by residual drug effects were at maximum intensity on admission and positively correlated with plasma and oral fluid cannabinoid concentrations on admission but not afterward; these symptoms showed overall prevalence higher than cannabis withdrawal symptoms.


CONCLUSIONS
The combined influence of residual/offset drug effects, withdrawal, and craving was observed in chronic cannabis smokers during monitored abstinence. Abstinence symptoms were generally more intense in the initial phase, implying importance of early intervention in cannabis quit attempts. Sleep disturbance persisting for an extended period suggests that hypnotic medications could be beneficial in treating cannabis dependence.
Chemistry and Drug Metabolism, National Institute on Drug Abuse, National Institute of Health, Baltimore, Maryland.
Dayong
D
Lee
Jennifer R
JR
Schroeder
Erin L
EL
Karschner
Robert S
RS
Goodwin
Jussi
J
Hirvonen
David A
DA
Gorelick
Marilyn A
MA
Huestis
D000328:Adult; D001007:Anxiety / Q000150:complications / Q000523:psychology; D001066:Appetite; D002186:Cannabinoids / Q000097:blood / Q000378:metabolism; D066249:Craving; D006801:Humans; D007508:Irritable Mood; D008297:Male; D002189:Marijuana Abuse / Q000097:blood / Q000523:psychology*; D008875:Middle Aged; D012463:Saliva / Q000378:metabolism; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000523:psychology; D013375:Substance Withdrawal Syndrome / Q000097:blood / Q000150:complications / Q000523:psychology*; D063189:Symptom Assessment; D055815:Young Adult
D002186:Cannabinoids