title: Abstinence phenomena of chronic cannabis-addicts prospectively monitored during controlled inpatient detoxification: cannabis withdrawal syndrome and its correlation with delta-9-tetrahydrocannabinol and -metabolites in serum.
abstract: OBJECTIVE
  To investigate the course of cannabis withdrawal syndrome (CWS) within a controlled inpatient detoxification setting and to correlate severity of CWS with the serum-levels of delta-9-tetrahydrocannabinol (THC) and its main metabolites 11-hydroxy-delta-9-tetrahydrocannabinol (THC-OH) and 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH).
  
  
  METHODS
  Thirty-nine treatment-seeking chronic cannabis dependents (ICD-10) were studied on admission and on abstinent days 2, 4, 8 and 16, using a CWS-checklist (MWC) and the Clinical Global Impression-Severity scale (CGI-S). Simultaneously obtained serum was analysed to its concentration of THC, THC-OH and THC-COOH.
  
  
  RESULTS
  MWC peaked on day 4 (10.4 ± 4.6 from 39 points) and declined to 2.9 ± 2.4 points on day 16. Women had a significantly stronger CWS than men. The CWS was dominated by craving>restlessness>nervousness>sleeplessness. CGI-S peaked with 5 out of 7 points. On admission, THC and its metabolites did negatively correlate with the severity of CWS. There was no significant correlation afterwards, no matter if CWS was medicated or not. THC-OH in serum declined most rapidly below detection limit, on median at day 4. At abstinence day 16, the THC-levels of 28.2% of the patients were still above 1g/ml (range: 1.3 to 6.4 ng/ml).
  
  
  CONCLUSIONS
  CWS increased and then decreased without any correlation between its severity and the serum-levels of THC or its main metabolites after admission. According to the CGI-S, most patients achieved the condition of 'markedly ill'. Serum THC-OH was most clearly associated with recent cannabis use. Residual THC was found in the serum of almost one-third of the patients at abstinence day 16.
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg/Essen, Castrop-Rauxel, Germany. Electronic address: udo.bonnet@uni-due.de.
authors.forename: U
authors.initials: U
authors.lastname: Bonnet
authors.affiliation: Department of Addictive Behavior and Addiction Medicine, LVR-Klinikum Essen, University of Duisburg/Essen, Essen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Specka
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg/Essen, Castrop-Rauxel, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Stratmann
authors.affiliation: MVZ synlab Leverkusen GmbH, Leverkusen, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Ochwadt
authors.affiliation: Department of Addictive Behavior and Addiction Medicine, LVR-Klinikum Essen, University of Duisburg/Essen, Essen, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Scherbaum
mesh_terms: D000328:Adult; D013759:Dronabinol / Q000031:analogs & derivatives* / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000534:rehabilitation*; D010343:Patient Admission; D011379:Prognosis; D011446:Prospective Studies; D013223:Statistics as Topic; D013375:Substance Withdrawal Syndrome / Q000097:blood* / Q000175:diagnosis*; D055815:Young Adult
chemical_list: C001427:11-hydroxy-delta(9)-tetrahydrocannabinol; D013759:Dronabinol; C025351:delta(9)-tetrahydrocannabinolic acid
keywords: Cannabis-withdrawal syndrome; Chronic cannabis addicts; Serum THC-COOH; Serum THC-OH; Serum Δ-9-tetrahydrocannabinol