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PRACTICE GUIDELINES
OFFICE-BASED TREATMENT GUIDELINE FOR CANNABIS WITHDRAWAL
The TSPP Executive Council approved the Guideline initially on
April 4, 2004 and a revision on November 12, 2004.
The Guideline as recommended by the Professional Practices Committee was
tentatively approved by the Executive Council on April 6, 2003, subject to
review by members. The Guideline was published in the June/July 2003 TSPP
Newsletter for membership review and comment.
Cannabis (Marijuana) dependence in those who have ever tried the drug is
estimated at 10-15%. 5% of 18-year olds are estimated to be daily smokers.
Regular use (at least weekly) over several years leads to dependence (using
DSM-IV and ICD-10 criteria) in 57-92% of individuals.
In spite of dependence criteria being met in many marijuana users, is there a
withdrawal syndrome? Cannabis withdrawal is not included in DSM-IV. That there
is withdrawal is suggested however by research in both animal and human studies.
Human studies are confounded by lack of consistency in time of onset and time of
completion of symptoms presumed to be secondary to cannabis withdrawal, as well
as by personality variables that influence reporting of symptoms.
The following facts seem to be established:
1. Discontinuing cannabis may lead to unpleasant effects.
2. The effects are brief, not severe, and usually do not produce…”clinically
significant distress or impairment”…(part of the criteria in DSM-IV for
withdrawal states).
3. The most common symptoms are:
a. Insomnia
b. Decreased appetite
c. Agitation (irritability, anxiety)
d. Gastro-intestinal distress is less common but may include pain and nausea.
4. Onset of symptoms may begin within four hours of last use and last no more
than one week.
Treatment
1. Symptomatic
a. Sleep Disturbance- Trazodone, Zolpidam (Ambien), Benadryl
b. Agitation, anxiety, irritability- brief use (1-2 days) of low doses of
Clonazepam.
The symptoms are mild, brief and, in part, may reflect the frustration of not
having available the desired substance rather than physiological induced
symptoms.
References:
Smith, N. A review of the published literature into cannabis withdrawal symptoms
in human users. Addiction, 97, 621-632, 2002.
Haney M, Ward A, Comer, S, Foltin R, Fischman, M. Abstinence symptoms following
smoked marijuana in humans. Psychopharmacology, 1999, Vol 141 Issue 4, p 395,
10p
Wiesbeck, G, Schuckit, M. An evaluation of the history of a marijuana withdrawal
syndrome in a large population. Addiction, Oct 96, Vol 91 Issue 10, p 1469, 10p,
4 charts
Farrell, M. Cannabis dependence and withdrawal. Addiction 1999, 94 (9),
1277-1278
Heishman S, Singleton E, Liguori A. Marijuana craving questionnaire: development
and initial validation of a self-report instrument. Addiction (2001) 96,
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