Clinical management of cannabis withdrawal

Connor, Jason P.; Stjepanović, Daniel; Budney, Alan J.; Foll, Bernard Le; Hall, Wayne

doi:10.1111/add.15743

Cited by 53 publications

(21 citation statements)

References 91 publications

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“…The finding that cannabis use disorders are almost certain in any patient who meets criteria for CHS has significant implications for management guidelines, which recommend complete abstinence from cannabis. Most clinicians typically advise CHS patients to stop cannabis use immediately (“cold turkey”), which does not acknowledge the difficulty of withdrawal from chronic cannabis use, which may include cravings, irritability, worsening of mood or anxiety disorders, and insomnia, amongst others 41 . Although cannabis withdrawal is not life‐threatening, the effects are aversive enough that recidivism is extremely common.…”

Section: Discussionmentioning

confidence: 99%

“…Most clinicians typically advise CHS patients to stop cannabis use immediately ("cold turkey"), which does not acknowledge the difficulty of withdrawal from chronic cannabis use, which may include cravings, irritability, worsening of mood or anxiety disorders, and insomnia, amongst others. 41 Although cannabis withdrawal is not life-threatening, the effects are aversive enough that recidivism is extremely common. Unfortunately, cannabis-specific resources to help with withdrawal are uncommon and hard to access, and trials for medical therapy (including SSRI antidepressants, mixed-action antidepressants, bupropion, buspirone and atomoxetine) have not shown any benefit in the treatment of cannabis dependence.…”

Section: Cannabis Use Disordermentioning

confidence: 99%

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Cannabinoid hyperemesis syndrome in North America: evaluation of health burden and treatment prevalence

Andrews

Rehak

Woo

et al. 2022

Aliment Pharmacol Ther

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Summary Background Cannabinoid hyperemesis syndrome (CHS) is a poorly understood vomiting disorder associated with chronic cannabis use. Aims To characterise patients experiencing CHS in North America and to obtain a population‐based estimate of CHS treatment prevalence in Canada before and during the Covid‐19 pandemic Methods Internet survey of 157 CHS sufferers in Canada and the United States. Administrative health databases for the province of Alberta (population 5 million) were accessed to measure emergency department (ED) visits for vomiting, with a concurrent diagnostic code for cannabis use. Three time periods of 1 year were assessed: prior to recreational cannabis legalisation (2017–2018), after recreational legalisation (2018–2019) and during the first year of the Covid‐19 pandemic (2020–2021). Results Problematic cannabis use (defined as a CUDIT‐R score ≥8) was universal among the survey cohort, and 59% and 68% screening for moderate or worse anxiety or depression, respectively. The overall treatment prevalence of CHS across all ages increased from 15 ED visits per 100,000 population (95% CI, 14–17) prior to legalisation, to 21 (95% CI, 20–23) after legalisation, to 32 (95% CI, 31–35) during the beginning of the Covid‐19 pandemic (p < 0.001). Treatment prevalence among chronic cannabis users was as high as 6 per 1000 in the 16–24 age group. Conclusion Survey data suggest patients with CHS almost universally suffer from a cannabis use disorder, which has significant treatment implications. Treatment prevalence in the ED has increased substantially over a very short time period, with the highest rates seen during the Covid‐19 pandemic.

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Section: Discussionmentioning

confidence: 99%

Section: Cannabis Use Disordermentioning

confidence: 99%

Cannabinoid hyperemesis syndrome in North America: evaluation of health burden and treatment prevalence

Andrews

Rehak

Woo

et al. 2022

Aliment Pharmacol Ther

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“…We also asked adolescents to abstain from CU for the 24 hr prior to the assessment, which may have resulted in withdrawal effects for some. Notably however, THC positive toxicology results did not predict DM performance across tasks (excluding the IGT at T1), and withdrawal symptoms from cannabis among daily, heavy users usually peak within 2–6 days (Connor et al, 2022). The Wide Range Achievement Test–4th Edition Word Reading Subtest was used as a proxy for estimated IQ.…”

Section: Discussionmentioning

confidence: 99%

An exploratory follow-up study of cannabis use and decision-making under various risk conditions within adolescence.

Thompson¹,

Adams²,

Pacheco‐Colón³

et al. 2023

Neuropsychology

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Objective: Studies examining the associations between decision-making (DM) and cannabis use (CU) often use cross-sectional, adult samples, and composite scores or single tasks to assess DM. The present study explored differential associations between tasks assessing DM under various risk conditions (i.e., ambiguous vs. explicit; gain vs. loss) and CU frequency, CU-related problems, and CU disorder (CUD) onset across a 2-year period within adolescence. Method: Adolescents (n = 401, 90% Hispanic) aged 14-17 at baseline participated in five biannual assessments. CU frequency, CU-related problems, and CUD were assessed using the Drug Use History Questionnaire, Marijuana Problems Scale, and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition, respectively. DM was assessed using the Iowa gambling task (IGT), Game of Dice Task (GDT), and Cups Task. We used latent growth curve modeling to examine bidirectional associations between DM and escalation in CU frequency and CU-related problems, and discrete time survival analyses to determine whether baseline performance across DM tasks predicted CUD onset. Results: Baseline performance on the GDT predicted greater escalation in CU (β = .200, p = .008) and CUrelated problems (β = .388, p = .035). No other significant associations were found. Conclusions: DM under explicit risk may be a more salient risk factor for escalating CU and CU-related problems than DM under ambiguous risk. Deficits in executive functioning could partially explain the results. Findings suggest that neurocognitive development should inform prevention and intervention efforts focused on reducing CU. Given the exploratory nature of the present study, replication of findings is needed. Key PointsQuestion: Does performance on various DM tasks differentially predict escalation in cannabis use (CU) frequency, CU-related problems, and CU disorder among a predominantly Hispanic sample of adolescents? Findings: Baseline performance on a DM task under explicit risk (i.e., the GDT) predicted greater escalation in CU frequency and CU-related problems. Importance: Risky DM under explicit risk may be an important risk factor for escalation in CU frequency and CU-related problems. Next Steps: Given the exploratory nature of the present study, future research should aim to replicate our findings across other racial and ethnic groups.

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“…101 Symptom onset occurred at 24 to 48 hours after cessation and peak symptoms at 2 to 6 days. 101 Some studies have explored pharmacologic intervention for cannabis withdrawal, but most are limited by small sample size. Within the studies that used a standardized scoring system, for withdrawal, such as the 16-item marijuana withdrawal checklist or the 19-item cannabis withdrawal scale, 6 reported greater improvement of symptoms in individuals administered a cannabinoid medication versus placebo.…”

Section: Pharmacologic Treatment For Withdrawalmentioning

confidence: 99%

Cannabis and Pregnancy: A Review

Hayer,

Mandelbaum,

Watch

et al. 2023

Obstetrical &Amp; Gynecological Survey

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Importance Prenatal cannabis use is rising and is a major public health issue. Cannabis use in pregnancy and during lactation has been associated with increased maternal and offspring morbidity and mortality. Objective This review aims to summarize the existing literature and current recommendations for cannabis use during pregnancy or lactation. Evidence Acquisition A PubMed, Cochrane Library, and Google Scholar literature search using the following terms was performed to gather relevant data: “cannabis,” “cannabinoid,” “delta-9-tetrahydrocannabinol,” “THC,” “cannabidiol,” “fetal outcomes,” “perinatal outcomes,” “pregnancy,” and “lactation.” Results Available studies on cannabis use in pregnancy and during lactation were reviewed and support an association with increased risk of preterm birth, neonatal intensive care unit admission, low birth weight, and small-for-gestational-age infants. Conclusion and Relevance There is a critical need for research on the effects of cannabis use in pregnancy and during lactation. This is a necessary first step before furthering patient education, developing interventions, and targeting antenatal surveillance to ameliorate the adverse impacts on maternal and fetal health. Target Audience Obstetricians and gynecologists, family physicians, pediatricians Learning Objectives After participating in this activity, the learner should be better able to describe options for treatment of cannabis use disorder; explain common forms of cannabinoids available for use; and discuss screening options for cannabis use in pregnancy.

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Clinical management of cannabis withdrawal

Cited by 53 publications

References 91 publications

Cannabinoid hyperemesis syndrome in North America: evaluation of health burden and treatment prevalence

Cannabinoid hyperemesis syndrome in North America: evaluation of health burden and treatment prevalence

An exploratory follow-up study of cannabis use and decision-making under various risk conditions within adolescence.

Cannabis and Pregnancy: A Review

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