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Bortolato M, Braccagni G, Pederson CA, Floris G, Fite PJ. "Weeding out" violence? Translational perspectives on the neuropsychobiological links between cannabis and aggression. AGGRESSION AND VIOLENT BEHAVIOR 2024; 78:101948. [PMID: 38828012 PMCID: PMC11141739 DOI: 10.1016/j.avb.2024.101948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Recent shifts in societal attitudes towards cannabis have led to a dramatic increase in consumption rates in many Western countries, particularly among young people. This trend has shed light on a significant link between cannabis use disorder (CUD) and pathological reactive aggression, a condition involving disproportionate aggressive and violent reactions to minor provocations. The discourse on the connection between cannabis use and aggression is frequently enmeshed in political and legal discussions, leading to a polarized understanding of the causative relationship between cannabis use and aggression. However, integrative analyses from both human and animal research indicate a complex, bidirectional interplay between cannabis misuse and pathological aggression. On the one hand, emerging research reveals a shared genetic and environmental predisposition for both cannabis use and aggression, suggesting a common underlying biological mechanism. On the other hand, there is evidence that cannabis consumption can lead to violent behaviors while also being used as a self-medication strategy to mitigate the negative emotions associated with pathological reactive aggression. This suggests that the coexistence of pathological aggression and CUD may result from overlapping vulnerabilities, potentially creating a self-perpetuating cycle where each condition exacerbates the other, escalating into externalizing and violent behaviors. This article aims to synthesize existing research on the intricate connections between these issues and propose a theoretical model to explain the neurobiological mechanisms underpinning this complex relationship.
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Affiliation(s)
- Marco Bortolato
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
- Consortium for Translational Research on Aggression and Drug Abuse (ConTRADA), University of Kansas, Lawrence, KS, USA
| | - Giulia Braccagni
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Casey A. Pederson
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gabriele Floris
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
- Center for Substance Abuse Research, Temple University, Philadelphia, PA, USA
- Department of Neural Sciences, Temple University, Philadelphia, PA, USA
| | - Paula J. Fite
- Consortium for Translational Research on Aggression and Drug Abuse (ConTRADA), University of Kansas, Lawrence, KS, USA
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
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Eckard ML, Kinsey SG. Differential disruption of response alternation by precipitated Δ 9-THC withdrawal and subsequent Δ 9-THC abstinence in mice. Pharmacol Biochem Behav 2024; 236:173718. [PMID: 38272272 PMCID: PMC10955601 DOI: 10.1016/j.pbb.2024.173718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/01/2024] [Accepted: 01/22/2024] [Indexed: 01/27/2024]
Abstract
In addition to overt somatic symptoms, cannabinoid withdrawal can also manifest as disruptions in motivation and attention. Experimental animal models using operant-conditioning approaches reveal these differences, in either antagonist-precipitated or spontaneous withdrawal models. However, these processes have yet to be characterized in the same subjects simultaneously. To differentiate between motivational and attentional processes disrupted in cannabinoid withdrawal, the current study used a response alternation task in which a fixed-ratio (FR) schedule repeatedly alternated between two spatially distinct response options throughout daily training sessions. This task yielded traditional measures of motivation (e.g., response latency) as well as attention (e.g., responses to the incorrect side). After two weeks of training, male and female C57BL/6 J mice either received vehicle or Δ9-THC (10 mg/kg, s.c.) twice daily for 5 days. On the 6th day, all mice received their final injection of vehicle or Δ9-THC followed 30 min later by injection of the CB1 receptor selective inverse agonist rimonabant (2 mg/kg, i.p.) to precipitate withdrawal. Testing continued for 3 days post-rimonabant to assess how THC abstinence impacted task performance. Whereas rimonabant decreased response rates to equal degrees in THC-treated and vehicle-treated mice, THC-treated mice showed longer session times, longer response latencies, and more errors per reinforcer. Only THC-treated mice showed a longer latency to switch after committing an error reflecting that precipitated withdrawal impacted measures of both motivation and attention. During the 3-day abstinence window, performance of vehicle-treated mice returned to baseline, but THC-treated mice continued to show disruptions in motivational measures. Importantly, attentional measures (errors and latency to switch after an error) were unaffected by THC abstinence. These data suggest that precipitated and "spontaneous" cannabinoid withdrawal may be qualitatively and quantitatively distinct withdrawal conditions with precipitated withdrawal disrupting both attentional and motivational processes, while abstinence may only affect motivation.
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Affiliation(s)
| | - Steven G Kinsey
- School of Nursing, University of Connecticut, Storrs, CT, USA
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Asano T, Takemoto H, Horita T, Tokutake T, Izuo N, Mochizuki T, Nitta A. Sleep disturbance after cessation of cannabis administration in mice. Neuropsychopharmacol Rep 2023; 43:505-512. [PMID: 36905178 PMCID: PMC10739061 DOI: 10.1002/npr2.12329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/12/2023] Open
Abstract
Cannabis withdrawal syndrome (CWS) in humans is characterized by various somatic symptoms, including sleep disturbances. In the present study, we investigated sleep alterations in mice after the cessation of arachidonylcyclopropylamide (ACPA), a cannabinoid type 1 receptor agonist, administration. ACPA-administered mice (ACPA mice) displayed an increased number of rearings after the cessation of ACPA administration compared to saline-administered mice (Saline mice). Moreover, the number of rubbings was also decreased in ACPA mice compared with those of the control mice. Electroencephalography (EEG) and electromyography (EMG) were measured for 3 days after the cessation of ACPA administration. During ACPA administration, there was no difference in the relative amounts of total sleep and wake time between ACPA and Saline mice. However, ACPA-induced withdrawal decreased total sleep time during the light period in ACPA mice after ACPA cessation. These results suggest that ACPA cessation induces sleep disturbances in the mouse model of CWS.
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Affiliation(s)
- Takashi Asano
- Department of Pharmaceutical Therapy and Neuropharmacology, Faculty of Pharmaceutical SciencesGraduate School of Medicine and Pharmaceutical Sciences, University of ToyamaToyamaJapan
| | - Hiroki Takemoto
- Department of Pharmaceutical Therapy and Neuropharmacology, Faculty of Pharmaceutical SciencesGraduate School of Medicine and Pharmaceutical Sciences, University of ToyamaToyamaJapan
| | - Tomoya Horita
- Department of Pharmaceutical Therapy and Neuropharmacology, Faculty of Pharmaceutical SciencesGraduate School of Medicine and Pharmaceutical Sciences, University of ToyamaToyamaJapan
| | - Tomohiro Tokutake
- Department of Pharmaceutical Therapy and Neuropharmacology, Faculty of Pharmaceutical SciencesGraduate School of Medicine and Pharmaceutical Sciences, University of ToyamaToyamaJapan
| | - Naotaka Izuo
- Department of Pharmaceutical Therapy and Neuropharmacology, Faculty of Pharmaceutical SciencesGraduate School of Medicine and Pharmaceutical Sciences, University of ToyamaToyamaJapan
| | - Takatoshi Mochizuki
- Department of BiologyGraduate School of Science & Engineering, University of ToyamaToyamaJapan
| | - Atsumi Nitta
- Department of Pharmaceutical Therapy and Neuropharmacology, Faculty of Pharmaceutical SciencesGraduate School of Medicine and Pharmaceutical Sciences, University of ToyamaToyamaJapan
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Martin EL, Baker NL, Sempio C, Christians U, Klawitter J, McRae-Clark AL. Sex differences in endocannabinoid tone in a pilot study of cannabis use disorder and acute cannabis abstinence. Addict Biol 2023; 28:e13337. [PMID: 37753564 PMCID: PMC10539022 DOI: 10.1111/adb.13337] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/28/2023]
Abstract
Cannabis use disorder (CUD) presents differently in men and women, particularly in symptoms of cannabis withdrawal. Novel pharmacotherapeutic interventions for CUD, such as those that target the endocannabinoid (eCB) system, must be developed in a manner consistent with these sex differences. The present pilot study sought to prospectively assess sex differences in cannabis withdrawal in a small sample of adults with moderate-to-severe CUD and to determine if withdrawal was associated with peripheral eCB and eCB congener tone. Men and women (n = 5/sex) completed 2 weeks of study participation separated by 1 month; in the latter week, participants abstained from cannabis use. Each week, participants attended in-person laboratory visits during which blood was drawn repeatedly to assess plasma eCB and eCB congener tone. Participants also completed multiple daily ambulatory assessments to assess cannabis use and withdrawal symptoms. As anticipated, women reported a greater increase in withdrawal symptoms during the abstinent week [Δ = 9.4 (SE = 1.1); p < 0.001] than men [Δ = 1.2 (SE = 1.2); p = 0.35]. Sex differences in levels of the eCB N-arachidonoylethanolamide (AEA), as well as the eCB congeners stearoylethanolamide (SEA) and linoleylethanolamide (LEA), were evident during abstinence at the morning time point only (p's < 0.05). LEA was associated with withdrawal symptom expression in both sexes [β = 0.16 (SE = 0.09)] and palmitoylethanolamide (PEA) [β = 0.22 (SE = 0.13)] and 2-arachidonoylglycerol (2-AG) [β = 0.32 (SE = 0.15)] were associated with withdrawal symptoms in women only. Pharmacotherapeutic development for CUD should consider evident sex differences in eCB and eCB congener tone during abstinence and their associations with cannabis withdrawal, as eCB-based interventions may produce differential effects by sex.
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Affiliation(s)
- Erin L. Martin
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC USA
| | - Nathaniel L. Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC USA
| | - Cristina Sempio
- iC42 Clinical Research and Development, Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Uwe Christians
- iC42 Clinical Research and Development, Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Jost Klawitter
- iC42 Clinical Research and Development, Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO USA
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Aimee L. McRae-Clark
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC USA
- Ralph H. Johnson VA Medical Center, Charleston, SC USA
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Ansell EB, Bedillion MF, Farris SR, Gilbert JM, Koch MM, Thureen SE. Cannabis use breaks in young adults: The highs and lows of tolerance breaks. Drug Alcohol Depend 2023; 249:109951. [PMID: 37329730 PMCID: PMC10561190 DOI: 10.1016/j.drugalcdep.2023.109951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/04/2023] [Accepted: 05/29/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND/PURPOSE Cannabis tolerance breaks, or T-breaks, are believed to benefit persons who use cannabis (PUCs) by decreasing tolerance levels to cannabis. However, no prior research, to our knowledge, has compared the effects of T-breaks and other use breaks on cannabis use patterns and outcomes. The current study examined whether the occurrence of cannabis use breaks (tolerance and other use breaks), or the duration of these breaks, is associated with changes in hazardous cannabis use (CUDIT-R), CUD severity, cannabis use frequency, and withdrawal symptoms over a 6-month follow-up. METHODS Young adults, who recreationally use cannabis, (N=170, 55.9% female, Mean age=21 yo) completed baseline and on-time 6-month assessments of hazardous cannabis use (CUDIT-R), CUD severity, cannabis use frequency, and withdrawal symptoms. The occurrence of cannabis use breaks and the duration of these breaks during the intervening period was assessed at 6 months. RESULTS Taking a T-break was associated with an increase in hazardous cannabis use and CUD severity at 6 months. When considering cannabis use breaks for other reasons, a longer break was associated with a significant decrease in hazardous cannabis use (CUDIT-R), CUD severity, and cannabis use frequency at 6 months. CONCLUSION Findings from our study suggest recreational PUCs who take a T-break may be at greater risk for problematic cannabis use. In addition, taking a longer cannabis use break for other reasons may have beneficial effects on cannabis-related outcomes. The ability to abstain from cannabis for other reasons may be protective while individuals who take T-breaks may be important targets for intervention and prevention.
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Affiliation(s)
- Emily B Ansell
- Penn State University, Department of Biobehavioral Health, University Park, PA16802, United States.
| | - Margaret F Bedillion
- Penn State University, Department of Biobehavioral Health, University Park, PA16802, United States
| | - Shayna R Farris
- Penn State University, Department of Biobehavioral Health, University Park, PA16802, United States
| | - Jack M Gilbert
- Penn State University, Department of Biobehavioral Health, University Park, PA16802, United States
| | - Mackensie M Koch
- Penn State University, Department of Biobehavioral Health, University Park, PA16802, United States
| | - Sydney E Thureen
- Penn State University, Department of Biobehavioral Health, University Park, PA16802, United States
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Sherman BJ, Brasher ZE, Baker NL, McRae-Clark AL, Froeliger BE. Restructuring reward: A pilot study to enhance natural reward response in adults with cannabis use disorder. Drug Alcohol Depend 2023; 249:110830. [PMID: 37329729 PMCID: PMC10398752 DOI: 10.1016/j.drugalcdep.2023.110830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Hedonic dysregulation is a core mechanism of addiction. There is a dearth of research on hedonic dysregulation in cannabis use disorder (CUD). The current study tested whether personalized scripted imagery may be an efficacious approach to remediate reward functioning in adults with CUD. METHODS Adults with CUD (n=10) and non-CUD controls (n=12) completed a single session personalized scripted imagery procedure. Non-drug (i.e. natural) reward and neutral scripts were transcribed and participants listened to the scripts in counterbalanced order. Primary outcomes included positive affect (PA), galvanic skin response (GSR), and cortisol and were assessed at four timepoints. Mixed effects models were used to compare between and within subject effects. RESULTS Mixed effects models revealed a Condition (reward vs. neutral) X Group (CUD vs. control) interaction (p=0.01) on PA response, indicating blunted PA response to the neutral script relative to the reward script in CUD participants. Likewise, GSR response in CUD participants was decreased in response to the neutral script relative to the reward script (p=0.034; interaction n.s.). An interaction effect of Group X PA on cortisol response was found (p=.036) indicating that cortisol was positively correlated with PA in healthy control participants, but not CUD participants. CONCLUSIONS Adults with CUD may demonstrate acute deficits in hedonic tone under neutral conditions relative to healthy controls. Personalized scripted imagery may be an efficacious tool to remediate hedonic dysregulation in CUD. Cortisol may play a role in healthy positive affect regulation warranting further investigation.
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Affiliation(s)
- Brian J Sherman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, United States.
| | - Zoe E Brasher
- Department of Psychiatry, University of California, Los Angeles, United States
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, United States
| | - Aimee L McRae-Clark
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, United States; Department of Neuroscience, Medical University of South Carolina, United States; Ralph H. Johnson, VA Medical Center, Charleston, SC, United States
| | - Brett E Froeliger
- Departments of Psychiatry and Psychological Sciences, University of Missouri, United States
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Mills L, Lee JC, Boakes R, Colagiuri B. Reduction in caffeine withdrawal after open-label decaffeinated coffee. J Psychopharmacol 2023; 37:181-191. [PMID: 36628993 DOI: 10.1177/02698811221147152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Withdrawal from addictive drugs can be reduced by administering placebo deceptively, but in the clinic it is unethical to deceive the patient. Open-label placebo effects have been observed across a range of psychophysiological phenomena, and may also apply to drug withdrawal. METHOD 24-hour abstinent heavy coffee drinkers (N = 61) rated their caffeine withdrawal symptoms before being allocated to one of three groups. The Deceptive group was given decaffeinated coffee (decaf) and told it was caffeinated, the Open-Label group given decaf and told it was decaf and the Control group given water and told it was water. After 45 min, caffeine withdrawal was measured again. All participants rated their expectancies of withdrawal reduction from caffeinated coffee, decaf and water prior to being randomised and the end of the study. RESULTS There was a significant 9.5-point reduction in caffeine withdrawal in the Open-Label group (95% confidence interval (CI): 4.7, 14.3; p = 0.002), which was 8.6 points less than the Deceptive group (95%CI: 0.4, 16.8; p = 0.014) but 8.9 points greater than the Control group (95%CI: 0.6, 17.2; p = 0.012). Pre-randomisation, participants expected caffeinated coffee to reduce their withdrawal symptoms the most, followed by water and decaf, Pre-randomisation expectancy of withdrawal was only associated with amount of withdrawal reduction in the Deceptive group. CONCLUSION It appears as if open-label placebo caffeine (i.e. decaf) can reduce caffeine withdrawal symptoms, even when people do not hold a conscious expectancy it will do so. There may be ways to integrate open-label placebo procedures into clinical interventions for drug dependence without violating informed consent.
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Affiliation(s)
- Llewellyn Mills
- Discipline of Addiction Medicine, Central Clinical School, University of Sydney, NSW, Australia.,Drug and Alcohol Services, South Eastern Sydney Local Health District, NSW, Australia
| | - Jessica C Lee
- School of Psychology, University of New South Wales, NSW, Australia
| | - Robert Boakes
- School of Psychology, University of Sydney, NSW, Australia
| | - Ben Colagiuri
- School of Psychology, University of Sydney, NSW, Australia
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Zuo CS, Davis KA, Lukas SE. Lower dACC glutamate in cannabis users during early phase abstinence. Neuropsychopharmacology 2022; 47:1969-1975. [PMID: 35484401 PMCID: PMC9485248 DOI: 10.1038/s41386-022-01321-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 03/10/2022] [Accepted: 03/31/2022] [Indexed: 11/08/2022]
Abstract
Glutamate plays an important role in continued use of and relapse to abused substances. However, its involvement in cannabis withdrawal is still unclear. We hypothesize that regional glutamate is associated with the cannabis withdrawal syndrome and recently examined possible association of glutamate with cannabis withdrawal, using magnetic resonance spectroscopy (MRS), in non-treatment-seeking cannabis users. We recruited 26 frequent cannabis users and 11 age-matched non-using controls. Of the 37, 20 users (8f/12m) and 10 controls (5f/5m) completed a verified 21-day abstinence protocol. Dorsal anterior cingulate cortex (dACC) glutamate and γ-amino butyric acid (GABA) were measured with proton MRS at baseline and on abstinent days 7 and 21 in conjunction with measures of cannabis withdrawal and craving (MCQ), sleep difficulties (PSQI) and mood state. We used ANOVA to examine group differences in glutamate and GABA from baseline through day 21 and used linear regression to evaluate correlations between intra-individual glutamate and withdrawal symptoms. We found that self-reported anxiety severity (HAMA) was correlated with urinary THC/Cr ratios at baseline (r = 0.768, p = 0.000076) and abstinent day 7 (r = 0.5636, p = 0.0097), dACC glutamate was significantly lower in the users compared with the controls from baseline through day 21 (F = 5.90, p = 0.022), changes in glutamate between baseline and abstinent day 21 had a significantly negative correlation with corresponding changes in craving (r = -0.72, p = 0.005) after adjusting for age, consumption of alcohol/cigarettes, sleep difficulties, and urinary THC levels. These findings provide preliminary evidence that dACC glutamate is associated with the cannabis withdrawal syndrome.
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Affiliation(s)
- Chun S Zuo
- McLean Imaging Center, McLean Hospital, Harvard Medical School, Belmont, MA, 02478, USA.
| | - Katherine A Davis
- McLean Imaging Center, McLean Hospital, Harvard Medical School, Belmont, MA, 02478, USA
| | - Scott E Lukas
- McLean Imaging Center, McLean Hospital, Harvard Medical School, Belmont, MA, 02478, USA
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Sullivan RM, Wallace AL, Stinson EA, Montoto KV, Kaiver CM, Wade NE, Lisdahl KM. Assessment of Withdrawal, Mood, and Sleep Inventories After Monitored 3-Week Abstinence in Cannabis-Using Adolescents and Young Adults. Cannabis Cannabinoid Res 2022; 7:690-699. [PMID: 34678051 PMCID: PMC9587800 DOI: 10.1089/can.2021.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Introduction: Among adolescents and young adults, cannabis use is prevalent. Prior studies characterizing withdrawal effects in this age range have primarily included treatment seeking or comorbid psychiatric samples; these studies have identified several affected domains, especially sleep, mood, and anxiety. The present study compared a community (i.e., nontreatment seeking) sample of cannabis-using and control participants on mood, anxiety, sleep, and withdrawal inventories during the course of a monitored 3-week cannabis abstinence period. Materials and Methods: Seventy-nine adolescent and young adult participants (cannabis-using group=37 and control group=42) were recruited from the community to undergo 3 weeks of confirmed abstinence (i.e., urine and sweat patch toxicology) and completion of Cannabis Withdrawal Symptom Criteria, State-Trait Anxiety Inventory, Beck's Depression Inventory, and Pittsburgh Sleep Quality Index across the study period. Repeated measures and cross-sectional regressions were used to examine main effects of group and interactions with time (where appropriate), while accounting for recent alcohol use and cotinine levels. Results: Cannabis-using participants reported higher mood (p=0.006), overall withdrawal (p=0.009), and sleep-related withdrawal (p<0.001) symptoms across abstinence compared to controls. Overall withdrawal severity (p=0.04) and sleep-related withdrawal symptoms (p=0.02) demonstrated a quadratic trajectory across the monitored abstinence periods, with an increase from baseline and subsequent decreases in symptom severity. No differences of anxiety scores (p=0.07) or trajectories (p=0.18) were observed. By study completion, groups did not differ among sleep quality components (all p's>.05). Conclusions: These findings revealed that nontreatment-seeking cannabis-using adolescents and young adults reported heightened total withdrawal symptoms during a 3-week sustained abstinence period relative to controls. Cannabis-using participants demonstrated an increase in withdrawal symptom trajectory during the first week followed by decreased symptoms from weeks 2 to 3, which contrasts with prior linear decreases observed in cannabis-using adolescent and young adults. More mood symptoms were observed in the cannabis-using group even while excluding for comorbid psychopathologies-along with significantly more sleep problems during the abstinence period. Implications include the necessity to provide psychoeducation for recreational, nontreatment-seeking cannabis-using individuals about cannabis withdrawal, mood symptoms, and sleep quality difficulties when cannabis cessation is attempted, to improve likelihood of long-term sustained abstinence.
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Affiliation(s)
- Ryan M. Sullivan
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Alexander L. Wallace
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Elizabeth A. Stinson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Karina V. Montoto
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Christine M. Kaiver
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Natasha E. Wade
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Krista M. Lisdahl
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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Factors Associated With Past-year and Lifetime Prevalence of Cannabis Withdrawal: A Secondary Analysis. CANADIAN JOURNAL OF ADDICTION 2022. [DOI: 10.1097/cxa.0000000000000155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Kurt Tunagur EM, Yazici AB, Guzel D, Tunagur MT, Ermis C, Suda MA, Yazici E. Investigating associations between appetite-regulating hormones, aggression and craving in males with cannabis use disorder. Drug Alcohol Depend 2022; 238:109577. [PMID: 35905593 DOI: 10.1016/j.drugalcdep.2022.109577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/23/2022] [Accepted: 07/11/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Aggression and craving are common and important withdrawal symptoms in cannabis use disorder. The present study investigated the association between appetite-regulating hormones, aggression, and craving during cannabis withdrawal syndrome (CWS). METHODS Fifty-six male subjects diagnosed with cannabis withdrawal and 45 healthy males were included in the study. The Substance Craving Scale, the Buss-Perry Aggression Questionnaire, and the State-Trait Anxiety Inventory were implemented at baseline. Blood samples were drawn to measure ghrelin, leptin, adiponectin, and resistin levels in the serum. Then, the Point Subtraction Aggression Paradigm (PSAP) was applied. Bloodwork and psychometric assessment procedures were re-implemented after the PSAP. At the 7-day follow-up, psychometric assessments and hormone measurements were repeated in the CWS group. RESULTS Baseline serum ghrelin and adiponectin levels were lower in the CWS group than controls at baseline. After PSAP, there was a significant increase in ghrelin levels of patients with CWS compared to controls. Patients yielded higher aggression scores, while there was no significant correlation between hormonal changes and PSAP findings. At 7-day follow, ghrelin and resistin levels significantly increased, while serum leptin decreased in patients with CWS. Finally, there was a positive association between craving and resistin levels. CONCLUSIONS Our results present the changes in appetite-regulating hormones. Long-term follow-up studies are needed to shed light on neuroendocrinological aspects of cannabis withdrawal.
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Affiliation(s)
| | | | - Derya Guzel
- Department of Physiology, Sakarya University, 54290 Sakarya, Turkey
| | | | - Cagatay Ermis
- Diyarbakır Children's Hospital, 21000 Diyarbakır, Turkey
| | - Mehmet Akif Suda
- Department of Psychiatry, Sakarya University, 54290 Sakarya, Turkey
| | - Esra Yazici
- Department of Psychiatry, Sakarya University, 54290 Sakarya, Turkey
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The association between the five-factor model of personality and problem cannabis use: A meta-analysis. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2022.111635] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Haney M, Bedi G, Cooper ZD, Herrmann ES, Reed SC, Foltin RW, Kingsley PJ, Marnett LJ, Patel S. Impact of cyclooxygenase‐2 inhibition on cannabis withdrawal and circulating endocannabinoids in daily cannabis smokers. Addict Biol 2022; 27:e13183. [DOI: 10.1111/adb.13183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/07/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Margaret Haney
- New York State Psychiatric Institute New York New York USA
- Columbia University Irving Medical Center New York New York USA
| | - Gillinder Bedi
- Centre for Youth Mental Health The University of Melbourne and Substance Use Research Group, Orygen Melbourne Australia
| | - Ziva D. Cooper
- Los Angeles Cannabis Research Initiative, Jane & Terry Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry and Biobehavioral Sciences, Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine University of California Los Angeles California USA
| | - Evan S. Herrmann
- Division of Therapeutics and Medical Consequences National Institute on Drug Abuse Bethesda Maryland USA
| | - Stephanie Collins Reed
- New York State Psychiatric Institute New York New York USA
- Columbia University Irving Medical Center New York New York USA
| | - Richard W. Foltin
- New York State Psychiatric Institute New York New York USA
- Columbia University Irving Medical Center New York New York USA
| | - Philip J. Kingsley
- A.B. Hancock Jr. Memorial Laboratory for Cancer Research, Departments of Biochemistry, Chemistry, and Pharmacology Vanderbilt University Nashville Tennessee USA
| | - Lawrence J. Marnett
- A.B. Hancock Jr. Memorial Laboratory for Cancer Research, Departments of Biochemistry, Chemistry, and Pharmacology Vanderbilt University Nashville Tennessee USA
| | - Sachin Patel
- Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center Nashville Tennessee USA
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14
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Penzel N, Sanfelici R, Antonucci LA, Betz LT, Dwyer D, Ruef A, Cho KIK, Cumming P, Pogarell O, Howes O, Falkai P, Upthegrove R, Borgwardt S, Brambilla P, Lencer R, Meisenzahl E, Schultze-Lutter F, Rosen M, Lichtenstein T, Kambeitz-Ilankovic L, Ruhrmann S, Salokangas RKR, Pantelis C, Wood SJ, Quednow BB, Pergola G, Bertolino A, Koutsouleris N, Kambeitz J, Dwyer D, Ruef A, Kambeitz-Ilankovic L, Sen Dong M, Erkens A, Gussmann E, Haas S, Hasan A, Hoff C, Khanyaree I, Melo A, Muckenhuber-Sternbauer S, Kohler J, Ozturk OF, Popovic D, Rangnick A, von Saldern S, Sanfelici R, Spangemacher M, Tupac A, Urquijo MF, Weiske J, Wosgien A, Kambeitz J, Ruhrmann S, Rosen M, Betz L, Lichtenstein T, Blume K, Seves M, Kaiser N, Penzel N, Pilgram T, Lichtenstein T, Wenzel J, Woopen C, Borgwardt S, Andreou C, Egloff L, Harrisberger F, Lenz C, Leanza L, Mackintosh A, Smieskova R, Studerus E, Walter A, Widmayer S, Upthegrove R, Wood SJ, Chisholm K, Day C, Griffiths SL, Lalousis PA, Iqbal M, Pelton M, Mallikarjun P, Stainton A, Lin A, Salokangas RKR, Denissoff A, Ellila A, From T, Heinimaa M, Ilonen T, Jalo P, Laurikainen H, Lehtinen M, Luutonen A, Makela A, Paju J, Pesonen H, Armio Säilä RL, Sormunen E, Toivonen A, Turtonen O, Solana AB, Abraham M, Hehn N, Schirmer T, Brambilla P, Altamura C, Belleri M, Bottinelli F, Ferro A, Re M, Monzani E, Percudani M, Sberna M, D’Agostino A, Del Fabro L, Perna G, Nobile M, Alciati A, Balestrieri M, Bonivento C, Cabras G, Fabbro F, Garzitto M, PiCCuin S, Bertolino A, Blasi G, Antonucci LA, Pergola G, Caforio G, Faio L, Quarto T, Gelao B, Romano R, Andriola I, Falsetti A, Barone M, Passatiore R, Sangiuliano M, Lencer R, Surman M, Bienek O, Romer G, Dannlowski U, Meisenzahl E, Schultze-Lutter F, Schmidt-Kraepelin C, Neufang S, Korda A, Rohner H. Pattern of predictive features of continued cannabis use in patients with recent-onset psychosis and clinical high-risk for psychosis. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:19. [PMID: 35264631 PMCID: PMC8907166 DOI: 10.1038/s41537-022-00218-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/31/2022] [Indexed: 11/09/2022]
Abstract
Continued cannabis use (CCu) is an important predictor for poor long-term outcomes in psychosis and clinically high-risk patients, but no generalizable model has hitherto been tested for its ability to predict CCu in these vulnerable patient groups. In the current study, we investigated how structured clinical and cognitive assessments and structural magnetic resonance imaging (sMRI) contributed to the prediction of CCu in a group of 109 patients with recent-onset psychosis (ROP). We tested the generalizability of our predictors in 73 patients at clinical high-risk for psychosis (CHR). Here, CCu was defined as any cannabis consumption between baseline and 9-month follow-up, as assessed in structured interviews. All patients reported lifetime cannabis use at baseline. Data from clinical assessment alone correctly classified 73% (p < 0.001) of ROP and 59 % of CHR patients. The classifications of CCu based on sMRI and cognition were non-significant (ps > 0.093), and their addition to the interview-based predictor via stacking did not improve prediction significantly, either in the ROP or CHR groups (ps > 0.065). Lower functioning, specific substance use patterns, urbanicity and a lack of other coping strategies contributed reliably to the prediction of CCu and might thus represent important factors for guiding preventative efforts. Our results suggest that it may be possible to identify by clinical measures those psychosis-spectrum patients at high risk for CCu, potentially allowing to improve clinical care through targeted interventions. However, our model needs further testing in larger samples including more diverse clinical populations before being transferred into clinical practice.
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Affiliation(s)
- Nora Penzel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Group of Psychiatric Neuroscience, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Rachele Sanfelici
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Max-Planck Institute of Psychiatry, Munich, Germany
| | - Linda A Antonucci
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Department of Education, Psychology, Communication, University of Bari, Bari, Italy
| | - Linda T Betz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Kang Ik K Cho
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul Cumming
- Department of Nuclear Medicine, Bern University Hospital, Bern, Switzerland.,School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia.,International Research Lab in Neuropsychiatry, Neuroscience Research Institute, Samara State Medical University, Samara, Russia
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Oliver Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.,MRC London Institute of Medical Sciences, Hammersmith Hospital, London, W12 0NN, UK.,Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, W12 0NN, UK.,South London and Maudsley NHS Foundation Trust, London, SE5 8AF, UK
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Max-Planck Institute of Psychiatry, Munich, Germany
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK.,Early Intervention Service, Birmingham Womens and Childrens NHS Foundation Trust, Birmingham, UK
| | - Stefan Borgwardt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCUS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany.,Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany.,Otto Creutzfeldt Center for Behavioral and Cognitive Neuroscience, University of Münster, Münster, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.,Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marlene Rosen
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany
| | - Theresa Lichtenstein
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Stephan Ruhrmann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Melbourne, VIC, Australia
| | - Stephen J Wood
- Institute for Mental Health, University of Birmingham, Birmingham, UK.,Orygen, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Boris B Quednow
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital of the University of Zurich, Lenggstr. 31, 8032, Zurich, Switzerland
| | - Giulio Pergola
- Group of Psychiatric Neuroscience, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Alessandro Bertolino
- Group of Psychiatric Neuroscience, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Max-Planck Institute of Psychiatry, Munich, Germany.,Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - Joseph Kambeitz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany.
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15
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Wallis D, Coatsworth JD, Mennis J, Riggs NR, Zaharakis N, Russell MA, Brown AR, Rayburn S, Radford A, Hale C, Mason MJ. Predicting Self-Medication with Cannabis in Young Adults with Hazardous Cannabis Use. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031850. [PMID: 35162872 PMCID: PMC8834899 DOI: 10.3390/ijerph19031850] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/02/2022] [Accepted: 02/05/2022] [Indexed: 02/04/2023]
Abstract
Using cannabis to reduce psychological and physical distress, referred to as self-medication, is a significant risk factor for cannabis use disorder. To better understand this high-risk behavior, a sample of 290 young adults (ages 18–25; 45.6% female) were recruited from two U.S. universities in January and February of 2020 to complete a survey about their cannabis use and self-medication. Results: seventy-six percent endorsed using cannabis to reduce problems such as anxiety, sleep, depression, pain, loneliness, social discomfort, and concentration. When predicting reasons for self-medication with cannabis, logistic regression models showed that lower CUDIT-R scores, experiencing withdrawal, living in a state where cannabis was illegal, and being female were all associated with higher rates of self-medication. Withdrawal symptoms were tested to predict self-medication with cannabis, and only insomnia and loss of appetite were significant predictors. To further explore why young adults self-medicate, each of the original predictors were regressed on seven specified reasons for self-medication. Young adults experiencing withdrawal were more likely to self-medicate for pain. Participants living where cannabis is legal were less likely to self-medicate for anxiety and depression. Living where cannabis is illegal also significantly predicted self-medicating for social discomfort—though the overall model predicting social discomfort was statistically non-significant. Finally, female participants were more likely to self-medicate for anxiety. These results suggest widespread self-medication among young adults with likely CUD and underscore the complexity of their cannabis use. The findings have implications for understanding why young adults use cannabis in relation to psychological and physical distress and for accurately treating young adults with cannabis use disorder.
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Affiliation(s)
- Dorothy Wallis
- Center for Behavioral Health Research, College of Social Work, The University of Tennessee Knoxville, 1618 Cumberland Avenue, Knoxville, TN 37996, USA; (N.Z.); (C.H.)
- Correspondence: (D.W.); (J.D.C.); (M.J.M.)
| | - J. Douglas Coatsworth
- Center for Behavioral Health Research, College of Social Work, The University of Tennessee Knoxville, 1618 Cumberland Avenue, Knoxville, TN 37996, USA; (N.Z.); (C.H.)
- Correspondence: (D.W.); (J.D.C.); (M.J.M.)
| | - Jeremy Mennis
- Department of Geography and Urban Studies, Temple University, Philadelphia, PA 19122, USA;
| | - Nathaniel R. Riggs
- CSU Prevention Research Center, Colorado State University, Fort Collins, CO 80523, USA; (N.R.R.); (A.R.)
| | - Nikola Zaharakis
- Center for Behavioral Health Research, College of Social Work, The University of Tennessee Knoxville, 1618 Cumberland Avenue, Knoxville, TN 37996, USA; (N.Z.); (C.H.)
| | - Michael A. Russell
- Biobehavioral Health, Penn State College of Health and Human Development, University Park, State College, PA 16802, USA;
| | - Aaron R. Brown
- Department of Social Work, Western Carolina University, Cullowhee, NC 28723, USA;
| | - Stephanie Rayburn
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO 80523, USA;
| | - Aubrie Radford
- CSU Prevention Research Center, Colorado State University, Fort Collins, CO 80523, USA; (N.R.R.); (A.R.)
| | - Christopher Hale
- Center for Behavioral Health Research, College of Social Work, The University of Tennessee Knoxville, 1618 Cumberland Avenue, Knoxville, TN 37996, USA; (N.Z.); (C.H.)
| | - Michael J. Mason
- Center for Behavioral Health Research, College of Social Work, The University of Tennessee Knoxville, 1618 Cumberland Avenue, Knoxville, TN 37996, USA; (N.Z.); (C.H.)
- Correspondence: (D.W.); (J.D.C.); (M.J.M.)
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16
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Zuo CS, Davis KA, Kuppe MK, Dahlgren MK, Gruber S, Fitzmaurice GM, Lukas SE. Elevated striatal glutamate + glutamine in recreational cannabis users during abstinence. J Psychiatr Res 2022; 146:192-200. [PMID: 34999370 PMCID: PMC8803139 DOI: 10.1016/j.jpsychires.2021.12.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/10/2021] [Accepted: 12/19/2021] [Indexed: 02/03/2023]
Abstract
Cannabis withdrawal symptoms contribute to relapse, but the underlying mechanism remains unclear. We hypothesize that cannabis withdrawal may be associated with a reset of regional γ-amino butyric acid (GABA) and glutamate concentrations secondary to changes in the endocannabinoid system during abstinence and conducted a study on this issue. We used magnetic resonance spectroscopy (MRS) to detect the associated changes of these neurochemicals in twenty-six frequent, recreational cannabis users and eleven age-matched non-using controls. Twenty users (8F/12M) and ten control (5F/5M) participants completed a verified 21-day abstinence period. Striatal GABA and glutamine concentrations were measured at baseline and on abstinence days 7 and 21 in conjunction with measures of cannabis withdrawal symptoms and mood state. Cannabis users reported increased self-reported ratings of cannabis-withdrawal-symptoms on abstinence day 7 relative to controls. Striatal glutamate + glutamine (Glx) group concentrations were elevated in cannabis users at baseline and abstinence days 7 and 21 (F = 7.16, p = 0.012), and changes in GABA concentration and withdrawal symptoms between baseline and abstinence day 7 were positively correlated (r = 0.550, p = 0.010). In addition, baseline striatal GABA concentrations were negatively correlated with withdrawal symptoms on abstinence day 7 (r = -0.680, p = 0.003). Our data demonstrate that striatal Glx was elevated in cannabis users and baseline striatal GABA correlated with withdrawal during the abstinence. In addition, striatal GABA may temporally correlate with self-reported withdrawal symptoms during the initial days of abrupt cannabis abstinence. These findings provide preliminary evidence that striatal GABA and Glx are associated with the severity of cannabis withdrawal.
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Affiliation(s)
- Chun S Zuo
- McLean Imaging Center, McLean Hospital, Harvard Medical School, Belmont, MA, 02478, USA.
| | - Katherine A Davis
- McLean Imaging Center, McLean Hospital, Harvard Medical School, Belmont, MA, 02478, USA
| | - Madeline K Kuppe
- Cognitive and Clinical Neuroimaging Core, McLean Hospital, Harvard Medical School, Belmont, MA, 02478, USA
| | - M Kathryn Dahlgren
- Cognitive and Clinical Neuroimaging Core, McLean Hospital, Harvard Medical School, Belmont, MA, 02478, USA
| | - Staci Gruber
- Cognitive and Clinical Neuroimaging Core, McLean Hospital, Harvard Medical School, Belmont, MA, 02478, USA
| | - Garrett M Fitzmaurice
- Laboratory for Psychiatric Biostatistics, McLean Hospital, Harvard Medical School, Belmont, MA, 02478, USA
| | - Scott E Lukas
- McLean Imaging Center, McLean Hospital, Harvard Medical School, Belmont, MA, 02478, USA
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17
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Analyzing the Behavior of Cannabis Users during the COVID-19 Confinement in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111324. [PMID: 34769848 PMCID: PMC8583130 DOI: 10.3390/ijerph182111324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022]
Abstract
The impact of the COVID-19 pandemic on our lives is unquestionable, including in the area of substance consumption. This study aimed to evaluate the changes in the pattern of cannabis use during the Spanish COVID-19 lockdown and confinement, and to analyze the variations in the reported motives for cannabis use and withdrawal symptoms. A cross-sectional retrospective study was conducted between April and May 2020, using an instrument that included two time points. Time 1 collected retrospective information on the participants’ habits (N = 89; 73% male; mean age = 29.01) prior to confinement and Time 2 collected the same information during the confinement. Sociodemographic data were collected, as well as the frequency of substance use, cannabis use patterns, sources of cannabis, perceived availability of drugs and cannabis price, and the Marijuana Motives Measure questionnaire and the Cannabis Withdrawal Scale were used. Results showed a decrease in both cannabis use and consumption due to enhancement and social motives. All reported sources of cannabis experienced a reduction except for the Internet, which experienced a significant increase. There was a positive correlation between withdrawal symptoms and coping motives before and during the lockdown. These findings will allow professionals to better develop both prevention and intervention strategies.
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18
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Coughlin LN, Ilgen MA, Jannausch M, Walton MA, Bohnert KM. Progression of cannabis withdrawal symptoms in people using medical cannabis for chronic pain. Addiction 2021; 116:2067-2075. [PMID: 33400332 PMCID: PMC8363170 DOI: 10.1111/add.15370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/26/2020] [Accepted: 11/30/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS Research from cohorts of individuals with recreational cannabis use indicates that cannabis withdrawal symptoms are reported by more than 40% of those using regularly. Withdrawal symptoms are not well understood in those who use cannabis for medical purposes. Therefore, we prospectively examined the stability of withdrawal symptoms in individuals using cannabis to manage chronic pain. DESIGN, SETTING, PARTICIPANTS Using latent class analysis (LCA) we examined baseline cannabis withdrawal to derive symptom profiles. Then, using latent transition analysis (LTA) we examined the longitudinal course of withdrawal symptoms across the time points. Exploratory analyses examined demographic and clinical characteristics predictive of withdrawal class and transitioning to more or fewer withdrawal symptoms over time. A cohort of 527 adults with chronic pain seeking medical cannabis certification or re-certification was recruited between February 2014 and June 2015. Participants were recruited from medical cannabis clinic waiting rooms in Michigan, USA. Participants were predominantly white (82%) and 49% identified as male, with an average age of 45.6 years (standard deviation = 12.8). MEASUREMENTS Baseline, 12-month and 24-month assessments of withdrawal symptoms using the Marijuana Withdrawal Checklist-revised. FINDINGS A three-class LCA model including a mild (41%), moderate (34%) and severe (25%) symptom class parsimoniously represented withdrawal symptoms experienced by people using medical cannabis. Stability of withdrawal symptoms using a three-class LTA at 12 and 24 months ranged from 0.58 to 0.87, with the most stability in the mild withdrawal class. Younger age predicted greater severity and worsening of withdrawal over time. CONCLUSIONS Adults with chronic pain seeking medical cannabis certification or re-certification appear to experience mild to severe withdrawal symptoms. Withdrawal symptoms tend to be stable over a 2-year period, but younger age is predictive of worse symptoms and of an escalating withdrawal trajectory.
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Affiliation(s)
- Lara N. Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan
| | - Mark A. Ilgen
- Addiction Center, Department of Psychiatry, University of Michigan,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System
| | - Mary Jannausch
- Addiction Center, Department of Psychiatry, University of Michigan,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System
| | - Maureen A. Walton
- Addiction Center, Department of Psychiatry, University of Michigan,Injury Prevention Center, University of Michigan
| | - Kipling M. Bohnert
- Addiction Center, Department of Psychiatry, University of Michigan,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System,Department of Epidemiology and Biostatistics, Michigan State University
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19
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Covelo A, Eraso-Pichot A, Fernández-Moncada I, Serrat R, Marsicano G. CB1R-dependent regulation of astrocyte physiology and astrocyte-neuron interactions. Neuropharmacology 2021; 195:108678. [PMID: 34157362 DOI: 10.1016/j.neuropharm.2021.108678] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/24/2021] [Accepted: 06/17/2021] [Indexed: 12/12/2022]
Abstract
The endocannabinoid system (ECS) is involved in a variety of brain functions, mainly through the activation of the type-1 cannabinoid receptors (CB1R). CB1R are highly expressed throughout the brain at different structural, cellular and subcellular locations and its activity and expression levels have a direct impact in synaptic activity and behavior. In the last few decades, astrocytes have arisen as active players of brain physiology through their participation in the tripartite synapse and through their metabolic interaction with neurons. Here, we discuss some of the mechanisms by which astroglial CB1R at different subcellular locations, regulate astrocyte calcium signals and have an impact on gliotransmission and metabolic regulation. In addition, we discuss evidence pointing at astrocytes as potential important sources of endocannabinoid synthesis and release. Thus, we summarize recent findings that add further complexity and establish that the ECS is a fundamental effector of astrocyte functions in the brain. This article is part of the special issue on 'Cannabinoids'.
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Affiliation(s)
- Ana Covelo
- Institut national de la santé et de la recherche médicale (INSERM), U1215 NeuroCentre Magendie, Bordeaux, 33077, France; University of Bordeaux, Bordeaux, 33077, France
| | - Abel Eraso-Pichot
- Institut national de la santé et de la recherche médicale (INSERM), U1215 NeuroCentre Magendie, Bordeaux, 33077, France; University of Bordeaux, Bordeaux, 33077, France
| | - Ignacio Fernández-Moncada
- Institut national de la santé et de la recherche médicale (INSERM), U1215 NeuroCentre Magendie, Bordeaux, 33077, France; University of Bordeaux, Bordeaux, 33077, France
| | - Román Serrat
- Institut national de la santé et de la recherche médicale (INSERM), U1215 NeuroCentre Magendie, Bordeaux, 33077, France; University of Bordeaux, Bordeaux, 33077, France; INRAE, Nutrition and Integrative Neurobiology, UMR 1286, 33077, Bordeaux, France
| | - Giovanni Marsicano
- Institut national de la santé et de la recherche médicale (INSERM), U1215 NeuroCentre Magendie, Bordeaux, 33077, France; University of Bordeaux, Bordeaux, 33077, France.
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20
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Kesner AJ, Lovinger DM. Cannabis use, abuse, and withdrawal: Cannabinergic mechanisms, clinical, and preclinical findings. J Neurochem 2021; 157:1674-1696. [PMID: 33891706 PMCID: PMC9291571 DOI: 10.1111/jnc.15369] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 12/14/2022]
Abstract
Cannabis sativa is the most widely used illicit drug in the world. Its main psychoactive component is delta‐9‐tetrahydrocannabinol (THC), one of over 100 phytocannabinoid compounds produced by the cannabis plant. THC is the primary compound that drives cannabis abuse potential and is also used and prescribed medically for therapeutic qualities. Despite its therapeutic potential, a significant subpopulation of frequent cannabis or THC users will develop a drug use syndrome termed cannabis use disorder. Individuals suffering from cannabis use disorder exhibit many of the hallmarks of classical addictions including cravings, tolerance, and withdrawal symptoms. Currently, there are no efficacious treatments for cannabis use disorder or withdrawal symptoms. This makes both clinical and preclinical research on the neurobiological mechanisms of these syndromes ever more pertinent. Indeed, basic research using animal models has provided valuable evidence of the neural molecular and cellular actions of cannabis that mediate its behavioral effects. One of the main components being central action on the cannabinoid type‐one receptor and downstream intracellular signaling related to the endogenous cannabinoid system. Back‐translational studies have provided insight linking preclinical basic and behavioral biology research to better understand symptoms observed at the clinical level. This narrative review aims to summarize major research elucidating the molecular, cellular, and behavioral manifestations of cannabis/THC use that play a role in cannabis use disorder and withdrawal.
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Affiliation(s)
- Andrew J Kesner
- Laboratory for Integrative Neuroscience, National Institute on Alcohol Abuse and Alcoholism, Center on Compulsive Behaviors, National Institutes of Health, Bethesda, MD, USA
| | - David M Lovinger
- Laboratory for Integrative Neuroscience, National Institute on Alcohol Abuse and Alcoholism, Center on Compulsive Behaviors, National Institutes of Health, Bethesda, MD, USA
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21
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Abu-Amna M, Salti T, Khoury M, Cohen I, Bar-Sela G. Medical Cannabis in Oncology: a Valuable Unappreciated Remedy or an Undesirable Risk? Curr Treat Options Oncol 2021; 22:16. [PMID: 33439370 DOI: 10.1007/s11864-020-00811-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 01/11/2023]
Abstract
OPINION STATEMENT The use of the cannabis plant by cancer patients has been rising significantly in the past few years worldwide, primarily driven by public demand. There is an obvious need for more reliable scientific data, pharmacology information, a better understanding of its mode of action, and available clinical evidence supporting its robust use. Physicians must complete a thorough medical assessment, screening for potential drugs, or treatment contraindications before allowing its consumption. In light of the growing popularity of cannabis usage, it is highly essential that, in the near future, the medical community will be able to provide practical recommendations and explicit guidelines, including doses, and that cannabinoid concentrations in the used products are defined regarding its prescription before any medical procedure involving its usage is authorized. Here, we review and describe the favorable outcomes demonstrating the benefits of cannabis as an adjunctive treatment to conventional medicines for chemotherapy-induced nausea, vomiting, and cancer-related pain (primarily refractory chronic or neuropathic pain). Although not yet substantial enough, the treatment of anorexia, insomnia, depression, and anxiety is also seemingly favorable. To date, reports regarding its anti-neoplastic effects or its potent immunosuppressive properties influencing response to immunotherapy are still very conflicting and controversial. Thus, with the current state of evidence, cannabis use is not advisable as initial treatment, as an adjunct or an advanced line of care. In the coming years, we expect that preclinical data and animal models will shift to the clinical arena, and more patients will be recruited for clinical trials, and their reports will advance the field. Thus, physicians should prescribe cannabis only if careful clarification and consideration is provided together with a follow-up response evaluation.
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Affiliation(s)
- Mahmoud Abu-Amna
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel
| | - Talal Salti
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 320002, Haifa, Israel
| | - Mona Khoury
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 320002, Haifa, Israel
| | - Idan Cohen
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel
| | - Gil Bar-Sela
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel. .,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 320002, Haifa, Israel.
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22
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Norberg MM, Barnier E, Weidemann G, Chakerian K, Cornish JL, Rapee RM. Randomised pilot study of cannabis cue exposure: Reducing cue reactivity while building tolerance. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Melissa M. Norberg
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia,
| | - Ellise Barnier
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia,
| | - Gabrielle Weidemann
- School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia,
| | - Kara Chakerian
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia,
| | - Jennifer L. Cornish
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia,
| | - Ronald M. Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia,
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Abstract
The Australian Federal Government legalised access to medicinal cannabis in 2016 More than 100 different cannabis products are now available to prescribe. Most are oral preparations (oils) or capsules containing delta-9-tetrahydrocannabinol or cannabidiol. Dried-flower products are also available As most products are unregistered drugs, prescribing requires approval under the Therapeutic Goods Administration Special Access Scheme-B or Authorised Prescriber Scheme Special Access Scheme Category B applications can be made online, with approval usually being given within 24–48 hours. However, supply chain problems may delay dispensing by the pharmacy By the end of 2019, over 28,000 prescribing approvals had been issued to patients, involving more than 1400 doctors, mostly GPs. More than 70,000 approvals are projected by the end of 2020 Most prescriptions are for chronic non-cancer pain, anxiety, cancer-related symptoms, epilepsy and other neurological disorders. However, the evidence supporting some indications is limited Many doctors are cautious about prescribing cannabis. While serious adverse events are rare, there are legitimate concerns around driving, cognitive impairment and drug dependence with products containing delta-9-tetrahydrocannabinol. Cannabidiol-only products pose fewer risks
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Affiliation(s)
- Jonathon C Arnold
- University of Sydney.,National Institute of Integrative Medicine, Melbourne
| | - Tamara Nation
- University of Sydney.,National Institute of Integrative Medicine, Melbourne
| | - Iain S McGregor
- University of Sydney.,National Institute of Integrative Medicine, Melbourne
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24
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Feinstein A, Meza C, Stefan C, Staines WR. Discontinuing cannabis improves depression in people with multiple sclerosis: A short report. Mult Scler 2020; 27:636-639. [PMID: 32589554 DOI: 10.1177/1352458520934070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
To assess whether symptoms of depression change when people with multiple sclerosis (pwMS) discontinue cannabis use, 40 cognitively impaired pwMS who smoked cannabis almost daily were randomly assigned to either a cannabis continuation (CC) or cannabis withdrawal (CW) group. Both groups were followed for 28 days. All participants completed the Hospital Anxiety and Depression Scale. At day 28 the 11-nor-9-carboxy-Δ9-tetrahydro-cannabinol (THCCOOH)/creatinine ratio in the CW group declined to zero (p = 0.0001), but remained unchanged in the CC group (p = 0.709). Depression scores in those pwMS who were using cannabis to manage their depression remained statistically unchanged in the CC group, but declined in the CW group (p = 0.006). Despite pwMS using cannabis to help their mood, depression improved significantly off the drug. Our finding provides a cautionary note in relation to cannabis use in pwMS, at least with respect to depression.
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Affiliation(s)
- Anthony Feinstein
- Sunnybrook Health Sciences Centre, Division of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Cecilia Meza
- Sunnybrook Health Sciences Centre, Division of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Cristiana Stefan
- Clinical Laboratory and Diagnostic Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - W Richard Staines
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
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25
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Bahji A, Stephenson C, Tyo R, Hawken ER, Seitz DP. Prevalence of Cannabis Withdrawal Symptoms Among People With Regular or Dependent Use of Cannabinoids: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e202370. [PMID: 32271390 PMCID: PMC7146100 DOI: 10.1001/jamanetworkopen.2020.2370] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Cannabis withdrawal syndrome (CWS)-a diagnostic indicator of cannabis use disorder-commonly occurs on cessation of heavy and prolonged cannabis use. To date, the prevalence of CWS syndrome has not been well described, nor have the factors potentially associated with CWS. OBJECTIVES To estimate the prevalence of CWS among individuals with regular or dependent use of cannabinoids and identify factors associated with CWS. DATA SOURCES A search of literature from database inception to June 19, 2019, was performed using MEDLINE, Embase, PsycINFO, Web of Science, the Cumulative Index to Nursing and Allied Health Literature, ProQuest, Allied and Complementary Medicine, and Psychiatry online, supplemented by manual searches of reference lists of included articles. STUDY SELECTION Articles were included if they (1) were published in English, (2) reported on individuals with regular use of cannabinoids or cannabis use disorder as a primary study group, (3) reported on the prevalence of CWS or CWS symptoms using a validated instrument, (4) reported the prevalence of CWS, and (5) used an observational study design (eg, cohort or cross-sectional). DATA EXTRACTION AND SYNTHESIS All abstracts, full-text articles, and other sources were reviewed, with data extracted in duplicate. Cannabis withdrawal syndrome prevalence was estimated using a random-effects meta-analysis model, alongside stratification and meta-regression to characterize heterogeneity. MAIN OUTCOMES AND MEASURES Cannabis withdrawal syndrome prevalence was reported as a percentage with 95% CIs. RESULTS Of 3848 unique abstracts, 86 were selected for full-text review, and 47 studies, representing 23 518 participants, met all inclusion criteria. Of 23 518 participants included in the analysis, 16 839 were white (72%) and 14 387 were men (69%); median (SD) age was 29.9 (9.0) years. The overall pooled prevalence of CWS was 47% (6469 of 23 518) (95% CI, 41%-52%), with significant heterogeneity between estimates (I2 = 99.2%). When stratified by source, the prevalence of CWS was 17% (95% CI, 13%-21%) in population-based samples, 54% in outpatient samples (95% CI, 48%-59%), and 87% in inpatient samples (95% CI, 79%-94%), which were significantly different (P < .001). Concurrent cannabis (β = 0.005, P < .001), tobacco (β = 0.002, P = .02), and other substance use disorders (β = 0.003, P = .05) were associated with a higher CWS prevalence, as was daily cannabis use (β = 0.004, P < .001). CONCLUSIONS AND RELEVANCE These findings suggest that cannabis withdrawal syndrome appears to be prevalent among regular users of cannabis. Clinicians should be aware of the prevalence of CWS in order to counsel patients and support individuals who are reducing their use of cannabis.
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Affiliation(s)
- Anees Bahji
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
- Department of Psychiatry, Queen’s University, Kingston, Ontario, Canada
| | - Callum Stephenson
- Queen’s University School of Kinesiology and Health Studies, Kingston, Ontario, Canada
| | - Richard Tyo
- Department of Psychiatry, Queen’s University, Kingston, Ontario, Canada
| | - Emily R. Hawken
- Department of Psychiatry, Queen’s University, Kingston, Ontario, Canada
| | - Dallas P. Seitz
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
- Department of Psychiatry, Queen’s University, Kingston, Ontario, Canada
- Cumming School of Medicine, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
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Taylor L, Crockett J, Tayo B, Checketts D, Sommerville K. Abrupt withdrawal of cannabidiol (CBD): A randomized trial. Epilepsy Behav 2020; 104:106938. [PMID: 32036242 DOI: 10.1016/j.yebeh.2020.106938] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/23/2019] [Accepted: 01/17/2020] [Indexed: 11/27/2022]
Abstract
RATIONALE The rationale of this study was to assess occurrence of withdrawal symptoms induced by abrupt cessation of cannabidiol (CBD) after prolonged administration in healthy volunteers. METHODS Thirty volunteers were randomized to receive 750 mg of a plant-derived pharmaceutical formulation of highly purified CBD in oral solution (100 mg/mL; Epidiolex® in the United States and Epidyolex® in Europe) twice daily (b.i.d.) for 4 weeks (Part 1) followed by 2 weeks of 750 mg b.i.d. CBD (Part 2, Arm 1) or matched placebo (Part 2, Arm 2). All volunteers completed the Cannabis Withdrawal Scale (CWS) and the 20-item Penn Physician Withdrawal Checklist (PWC-20) on days -1, 21, 28, 31, 35, 42, and at follow-up. RESULTS Median CWS and PWC-20 scores slightly decreased from Part 1 to Part 2. Median CWS scores ranged from 0.0 to 4.0 (out of a possible 190) in Arm 1 and 0.0 to 0.5 in Arm 2. Median PWC-20 scores were 0.0 (out of a possible 60) in both arms. Twenty-nine (97%) volunteers in Part 1 reported all-causality treatment-emergent adverse events (AEs); the most commonly reported was diarrhea (63%). In Part 2, Arm 1, 6 (67%) volunteers reported all-causality AEs; the most commonly reported was diarrhea (44%). In Part 2, Arm 2, 9 (75%) volunteers reported all-causality AEs; the most commonly reported was headache (58%). Nine volunteers withdrew because of AEs in Part 1; 1 withdrew in Part 2, Arm 2, because of an AE that began in Part 1. Four severe AEs were reported in Part 1; the remainder were mild or moderate. No serious AEs were reported. CONCLUSION In healthy volunteers, no evidence of withdrawal syndrome was found with abrupt discontinuation of short-term treatment with CBD.
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Affiliation(s)
- Lesley Taylor
- GW Research Ltd., Sovereign House, Vision Park, Histon, Cambridge CB24 9BZ, UK.
| | - Julie Crockett
- GW Research Ltd., Sovereign House, Vision Park, Histon, Cambridge CB24 9BZ, UK.
| | - Bola Tayo
- GW Research Ltd., Sovereign House, Vision Park, Histon, Cambridge CB24 9BZ, UK.
| | - Daniel Checketts
- GW Research Ltd., Sovereign House, Vision Park, Histon, Cambridge CB24 9BZ, UK.
| | - Kenneth Sommerville
- Greenwich Biosciences, Inc., 5750 Fleet Street, Suite 200, Carlsbad, CA 92008, USA.
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27
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Tavhare SD, Acharya R, Reddy RG, Dhiman KS. Management of chronic pain with Jalaprakshalana (water-wash) Shodhita (processed) Bhanga ( Cannabis sativa L.) in cancer patients with deprived quality of life: An open-label single arm clinical trial. Ayu 2019; 40:34-43. [PMID: 31831967 PMCID: PMC6891996 DOI: 10.4103/ayu.ayu_43_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Pain is a common and complex symptom of cancer having physical, social, spiritual and psychological aspects. Approximately 70%-80% of cancer patients experiences pain, as reported in India. Ayurveda recommends use of Shodhita (Processed) Bhanga (Cannabis) for the management of pain but no research yet carried out on its clinical effectiveness. Objective To assess the analgesic potential of Jala-Prakshalana (Water-wash) processed Cannabis sativa L. leaves powder in cancer patients with deprived quality of life (QOL) through openlabel single arm clinical trial. Materials and Methods Waterwash processed Cannabis leaves powder filled in capsule, was administered in 24 cancer patients with deprived QOL presenting complaints of pain, anxiety or depression; for a period of 4 weeks; in a dose of 250 mg thrice a day; along with 50 ml of cow's milk and 4 g of crystal sugar. Primary outcome i.e. pain was measured by Wong-Bakers FACES Pain Scale (FACES), Objective Pain Assessment (OPA) scale and Neuropathic Pain Scale (NPS). Secondary outcome namely anxiety was quantified by Hospital Anxiety and Depression Scale (HADS), QOL by FACT-G scale, performance score by Eastern Cooperative Oncology Group (ECOG) and Karnofsky score. Results Significant reduction in pain was found on FACES Pain Scale (P < 0.05), OPA (P < 0.05), NPS (P < 0.001), HADS (P < 0.001), FACT-G scale (P < 0.001), performance status score like ECOG (P < 0.05) and Karnofsky score (P < 0.01). Conclusion Jalaprakshalana Shodhita Bhanga powder in a dose of 250 mg thrice per day; relieves cancerinduced pain, anxiety and depression significantly and does not cause any major adverse effect and withdrawal symptoms during trial period.
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Affiliation(s)
- Swagata Dilip Tavhare
- Department of Dravyaguna, GJ Patel Institute of Ayurvedic Studies and Research, New Vallabhvidyanagar, Anand, Jamnagar, Gujarat, India
| | - Rabinarayan Acharya
- Department of Dravyaguna, Institute for Post Graduate Teaching and Research in Ayurved, Gujarat Ayurved University, Jamnagar, Gujarat, India
| | - R Govind Reddy
- Regional Ayurveda Research Institute for Mother and Child Health, CCRAS, Nagpur, Maharashtra, India
| | - Kartar Singh Dhiman
- Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Government of India, New Delhi, India
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28
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Kells M, Burke PJ, Parker S, Jonestrask C, Shrier LA. Engaging Youth (Adolescents and Young Adults) to Change Frequent Marijuana Use: Motivational Enhancement Therapy (MET) in Primary Care. J Pediatr Nurs 2019; 49:24-30. [PMID: 31473464 DOI: 10.1016/j.pedn.2019.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/04/2019] [Accepted: 08/13/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To characterize information elicited from adolescent/young adults with frequent cannabis use in Motivational Enhancement Therapy (MET), and determine whether differences exist across stages of change (SOC) for reducing use. DESIGN AND METHODS Primary care patients 15-24 years old using cannabis ≥3 times/week enrolled in a pilot randomized intervention trial. All youth were offered two 1-hour MET sessions. Content analysis was used to code and categorize main reasons for use, alternative behaviors, goals, values, pros and cons of change, and compared results between youth in Pre-Contemplation vs. Contemplation SOC. RESULTS Fifty-six youth completed MET session 1, 46 completed session 2. Most reported their main reason for use was related to emotional coping, negative feelings were a top-3 trigger, and distraction was an alternative way to meet their needs. Youth most frequently described progress in education or career/job as 1-year goals. More than half identified family as a very important value. They most frequently reported pros of using less related to achieving goals, self-improving, and saving money, and a con related to stress/coping. Compared to youth in Pre-Contemplation SOC, those in Contemplation were more likely to identify relationships as both a pro and con of using less cannabis. CONCLUSIONS MET can reveal developmentally appropriate goals, healthy values, and ambivalence about cannabis use that can be used to facilitate movement along the stages of behavior change toward reduction/cessation. PRACTICE IMPLICATIONS Brief motivational therapy can be used in primary care to gather information important in helping youth to reduce cannabis use.
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Affiliation(s)
- Meredith Kells
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, United States of America.
| | - Pamela J Burke
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, United States of America; Northeastern University Bouve College of Health Sciences, School of Nursing, United States of America
| | - Sarah Parker
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, United States of America; Northeastern University Bouve College of Health Sciences, School of Nursing, United States of America
| | - Cassandra Jonestrask
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, United States of America
| | - Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, United States of America; Department of Pediatrics, Harvard Medical School, United States of America
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Haney M, Cooper ZD, Bedi G, Herrmann E, Comer SD, Reed SC, Foltin RW, Levin FR. Guanfacine decreases symptoms of cannabis withdrawal in daily cannabis smokers. Addict Biol 2019; 24:707-716. [PMID: 29659126 DOI: 10.1111/adb.12621] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 12/22/2017] [Accepted: 02/12/2018] [Indexed: 01/27/2023]
Abstract
The α2a-adrenergic agonist, lofexidine, reduced cannabis withdrawal-related sleep disruption in the laboratory, but side effects (e.g. fatigue, hypotension) limit its utility as a treatment for cannabis use disorder. This study tested the potential efficacy and tolerability of a daily bedtime administration of the FDA-approved α2a-adrenergic agonist, guanfacine, in a human laboratory model of cannabis use disorder. Daily, nontreatment-seeking cannabis smokers (13M, 2F) completed a within-subject study comprising two 9-day inpatient study phases. Each phase tested the effects of daily placebo or immediate-release guanfacine (2 mg) on cannabis intoxication (5.6 percent THC; 2 days), withdrawal (4 days of abstinence) and subsequent 'relapse' (3 days of cannabis self-administration). Ratings of mood, sleep, cardiovascular effects, food intake, psychomotor performance and cannabis self-administration were assessed. An outpatient phase preceded each inpatient phase for medication clearance or dose induction. Under placebo medication conditions, cannabis abstinence produced significant withdrawal, including irritability, sleep disruption and anorexia. Guanfacine reduced ratings of irritability and improved objective measures of sleep during cannabis withdrawal relative to placebo but did not reduce cannabis self-administration. Guanfacine was well tolerated with little evidence of fatigue and only small decreases in blood pressure: no dose was held due to hypotension. Thus, a single daily administration of guanfacine at bedtime improved sleep and mood during cannabis withdrawal relative to placebo. This positive signal supports further studies varying the guanfacine dose, formulation or frequency of administration, or combining it with other medications to increase the likelihood of having an impact on cannabis use.
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Affiliation(s)
- Margaret Haney
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of PsychiatryColumbia University Medical Center New York NY USA
| | - Ziva D. Cooper
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of PsychiatryColumbia University Medical Center New York NY USA
| | - Gillinder Bedi
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of PsychiatryColumbia University Medical Center New York NY USA
| | - Evan Herrmann
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of PsychiatryColumbia University Medical Center New York NY USA
| | - Sandra D. Comer
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of PsychiatryColumbia University Medical Center New York NY USA
| | - Stephanie Collins Reed
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of PsychiatryColumbia University Medical Center New York NY USA
| | - Richard W. Foltin
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of PsychiatryColumbia University Medical Center New York NY USA
| | - Frances R. Levin
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of PsychiatryColumbia University Medical Center New York NY USA
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Herrmann ES, Cooper ZD, Bedi G, Ramesh D, Reed SC, Comer SD, Foltin RW, Haney M. Varenicline and nabilone in tobacco and cannabis co-users: effects on tobacco abstinence, withdrawal and a laboratory model of cannabis relapse. Addict Biol 2019; 24:765-776. [PMID: 30378231 DOI: 10.1111/adb.12664] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/18/2018] [Accepted: 06/27/2018] [Indexed: 01/19/2023]
Abstract
Tobacco and cannabis co-users (T+CUs) have poor cannabis cessation outcomes, but the mechanisms underlying this are not well understood. This laboratory study examined the effects of (1) the partial nicotinic agonist, varenicline, on tobacco cessation among T+CUs, and (2) varenicline, alone, and when combined with the cannabinoid agonist nabilone, on cannabis withdrawal and a laboratory model of cannabis relapse. Non-treatment-seeking T+CUs were randomized to active-varenicline or placebo-varenicline, and completed a 15-day outpatient phase; varenicline was titrated to 1 mg BID during days 1-8, and participants were instructed to abstain from tobacco during days 9-15. Participants then moved inpatient for 16 days, where they continued their outpatient medication and tobacco abstinence. Inpatient testing included two, 8-day medication periods, where active-nabilone and placebo-nabilone were administered in counterbalanced order, and measures of acute cannabis effects (days 1-2), withdrawal (days 4-5) and 'relapse' (days 6-8) were collected. Participants in the active-varenicline group were more likely to achieve cotinine-verified tobacco abstinence during the outpatient period versus placebo-varenicline group (46 percent versus 24 percent, respectively), and also reported less mood disturbance and cigarette craving while inpatient. Active-nabilone attenuated cannabis withdrawal in both groups but did not affect cannabis relapse. Regression analyses revealed that two tobacco-related variables, i.e. age of first cigarette use, and cigarette craving while inpatient, were independent predictors of cannabis relapse outcomes. Thus, varenicline holds promise in this population, as a tool to examine the effects of tobacco abstinence on cannabis use outcomes, and as a component of smoking cessation treatments targeting T+CUs.
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Affiliation(s)
- Evan S. Herrmann
- Division on Substance Use Disorders, New York State Psychiatric Institute, Department of PsychiatryCollege of Physicians and Surgeons of Columbia University New York NY USA
| | - Ziva D. Cooper
- Division on Substance Use Disorders, New York State Psychiatric Institute, Department of PsychiatryCollege of Physicians and Surgeons of Columbia University New York NY USA
| | - Gillinder Bedi
- Division on Substance Use Disorders, New York State Psychiatric Institute, Department of PsychiatryCollege of Physicians and Surgeons of Columbia University New York NY USA
| | - Divya Ramesh
- Division on Substance Use Disorders, New York State Psychiatric Institute, Department of PsychiatryCollege of Physicians and Surgeons of Columbia University New York NY USA
| | - Stephanie Collins Reed
- Division on Substance Use Disorders, New York State Psychiatric Institute, Department of PsychiatryCollege of Physicians and Surgeons of Columbia University New York NY USA
| | - Sandra D. Comer
- Division on Substance Use Disorders, New York State Psychiatric Institute, Department of PsychiatryCollege of Physicians and Surgeons of Columbia University New York NY USA
| | - Richard W. Foltin
- Division on Substance Use Disorders, New York State Psychiatric Institute, Department of PsychiatryCollege of Physicians and Surgeons of Columbia University New York NY USA
| | - Margaret Haney
- Division on Substance Use Disorders, New York State Psychiatric Institute, Department of PsychiatryCollege of Physicians and Surgeons of Columbia University New York NY USA
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31
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Montgomery L, McClure EA, Tomko RL, Sonne SC, Winhusen T, Terry GE, Grossman JT, Gray KM. Blunts versus joints: Cannabis use characteristics and consequences among treatment-seeking adults. Drug Alcohol Depend 2019; 198:105-111. [PMID: 30901744 PMCID: PMC6467739 DOI: 10.1016/j.drugalcdep.2019.01.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/03/2019] [Accepted: 01/27/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite the high prevalence of blunt smoking among cannabis users, very few studies examine the clinical profile of blunt smokers relative to those using more common methods of cannabis use, such as joints. METHODS The current study uses baseline data from the ACCENT (Achieving Cannabis Cessation-Evaluating N-acetylcysteine Treatment) study, a multi-site randomized pharmacotherapy clinical trial within the National Drug Abuse Treatment Clinical Trials Network, to predict the association between blunt and joint use frequency and cannabis use characteristics (e.g., grams of cannabis used) and consequences (e.g., withdrawal) among past-month cannabis users (N = 377) who were screened for study participation. RESULTS After controlling for race, age, gender, other forms of cannabis use (including joint use) and nicotine dependence, multivariable linear regression models indicated that the number of days of blunt use in the past month was a significant predictor of the average amount of cannabis per using day (t = 3.04, p < .01), the estimated average cost of cannabis (t = 2.28, p < .05) and Cannabis Withdrawal Scale scores (t = 1.94, p < .05). Frequency of joint use did not significantly predict any of the cannabis use characteristics or consequences. CONCLUSIONS Blunt smokers may present to treatment with greater amounts of cannabis smoked and more intense withdrawal symptoms, which may adversely impact their likelihood of successful abstinence. Cannabis-dependent blunt smokers may be more likely to benefit from treatment that targets physiological and mood-related withdrawal symptoms.
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Affiliation(s)
- LaTrice Montgomery
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Suite 104, Cincinnati, OH, 45229, USA.
| | - Erin A. McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC861, Charleston, SC 29425, USA
| | - Rachel L. Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC861, Charleston, SC 29425, USA
| | - Susan C. Sonne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC861, Charleston, SC 29425, USA
| | - Theresa Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Suite 104, Cincinnati, OH 45229, USA
| | - Garth E. Terry
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1660 S Columbian Way, Seattle, WA 98108, USA
| | - Jason T. Grossman
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles; Integrated Substance Abuse Programs, 11075 Santa Monica Blvd Ste 200, Los Angeles, CA 90025, USA
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC861, Charleston, SC 29425, USA
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Livne O, Shmulewitz D, Lev-Ran S, Hasin DS. DSM-5 cannabis withdrawal syndrome: Demographic and clinical correlates in U.S. adults. Drug Alcohol Depend 2019; 195:170-177. [PMID: 30361043 PMCID: PMC6359953 DOI: 10.1016/j.drugalcdep.2018.09.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Cannabis withdrawal syndrome (CWS) was newly added to the Diagnostic and Statistical Manual of Mental Disorders in its most recent edition, DSM-5. With cannabis use increasing among U.S. adults, information is needed about the prevalence and correlates of DSM-5 CWS in the general population. This study presents nationally representative findings on the prevalence, sociodemographic and clinical correlates of DSM-5 CWS among U.S. adults. METHOD Participants ≥18 years were interviewed in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) in 2012-2013. Among the sub-sample of frequent cannabis users in the prior 12 months (≥3 times a week; N = 1527), the prevalence and demographic and clinical correlates of DSM-5 CWS were examined. RESULTS In frequent cannabis users, the prevalence of CWS was 12.1%. The most common withdrawal symptoms among those with CWS were nervousness/anxiety (76.3%), hostility (71.9%), sleep difficulty (68.2%) and depressed mood (58.9%). CWS was associated with significant disability (p < 0.001), and with mood disorders (adjusted odds ratios [aOR] = 1.9-2.6), anxiety disorders (aOR = 2.4-2.5), personality disorders (aOR = 1.7-2.2) and family history of depression (aOR = 2.5) but not personal history of other substance use disorders or family history of substance use problems. CONCLUSIONS CWS is highly comorbid and disabling. Its shared symptoms with depressive and anxiety disorders call for clinician awareness of CWS and the factors associated with it to promote more effective treatment among frequent cannabis users.
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Affiliation(s)
- Ofir Livne
- Lev Hasharon Medical Center, P.O. Box 90000, Netanya 42100, Israel
| | - Dvora Shmulewitz
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA,Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - Shaul Lev-Ran
- Lev Hasharon Medical Center, P.O. Box 90000, Netanya 42100, Israel,Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Ramat Aviv, Tel Aviv 69978, Israel
| | - Deborah S. Hasin
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA,Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
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Lee DC, Schlienz NJ, Peters EN, Dworkin RH, Turk DC, Strain EC, Vandrey R. Systematic review of outcome domains and measures used in psychosocial and pharmacological treatment trials for cannabis use disorder. Drug Alcohol Depend 2019; 194:500-517. [PMID: 30530238 PMCID: PMC7038155 DOI: 10.1016/j.drugalcdep.2018.10.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/09/2018] [Accepted: 10/13/2018] [Indexed: 01/21/2023]
Abstract
Cannabis use disorder (CUD) is prevalent and demand for treatment is increasing, yet few individuals engage in formal treatment and the efficacy of established interventions for CUD is modest. Existing clinical trials evaluating psychosocial and pharmacological treatments for CUD have incorporated a wide variety of measures for assessing cannabis use outcomes, including abstinence, self-reported frequency and quantity used, withdrawal, use/dependence severity, and other psychosocial outcomes. The heterogeneity of measures and outcomes has limited quantitative analyses of the comparative effectiveness of existing interventions. The purpose of this systematic review is to: 1) identify and characterize approaches for measuring cannabis use in existing CUD intervention trials, including abstinence, frequency and quantity of use, and 2) summarize measures used to assess treatment efficacy in other outcome domains (e.g., cannabis use severity, psychosocial functioning, cannabis withdrawal), and provide a platform for future research to evaluate which outcome measures are most likely to reflect treatment efficacy and clinically significant improvement in other outcome domains.
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Affiliation(s)
- Dustin C Lee
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Nicolas J Schlienz
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Erica N Peters
- Battelle Public Health Center for Tobacco Research, Battelle Memorial Institute, Baltimore, MD, USA
| | - Robert H Dworkin
- Department of Anesthesiology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Dennis C Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Eric C Strain
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ryan Vandrey
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Abstract
BACKGROUND Based on the prevalence and health implications of tobacco and cannabis use, aiming to reduce their use, especially among youth, is a sound objective at both the individual and public health level. A proper understanding of the relationships between tobacco and cannabis use may help to achieve this goal. OBJECTIVES To review the relationships between tobacco and cannabis use. METHODS A selective review of the literature. RESULTS We present an overview of the motivations for tobacco and cannabis use, and their perceived harmfulness. The article then reviews the gateway theory, reverse gateway theory, route of administration theory, and common liability theory. We describe the link between co-use and dependence symptoms, and the substitution phenomenon between tobacco and cannabis use. Three forms of simultaneous use-mulling, blunt smoking, and chasing-and their impacts are explained. We summarize the impact of tobacco use on cannabis (and vice versa) treatment outcomes, and, finally, review new treatments that simultaneously target tobacco and cannabis dependence. Most of the literature reviewed here relates to substance use among adolescents and young adults. CONCLUSIONS The use of tobacco and cannabis-two of the most widely used substances around the world-are strongly intertwined in several respects. Both health professionals and researchers should have well-informed views on this issue to better evaluate, understand, inform, and provide care to their patients.
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Affiliation(s)
- Alexandre Lemyre
- a School of Psychology , Université Laval , Québec , QC , Canada.,b Population Health and Optimal Health Practices Branch , CHU de Québec Research Centre , Québec , QC , Canada
| | - Natalia Poliakova
- b Population Health and Optimal Health Practices Branch , CHU de Québec Research Centre , Québec , QC , Canada
| | - Richard E Bélanger
- b Population Health and Optimal Health Practices Branch , CHU de Québec Research Centre , Québec , QC , Canada.,c Department of Paediatrics , Centre mère-enfant Soleil, CHU de Québec, Université Laval , Québec , QC , Canada
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Perron BE, Holt KR, Yeagley E, Ilgen M. Mental health functioning and severity of cannabis withdrawal among medical cannabis users with chronic pain. Drug Alcohol Depend 2019; 194:401-409. [PMID: 30500688 DOI: 10.1016/j.drugalcdep.2018.09.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 09/24/2018] [Accepted: 09/29/2018] [Indexed: 01/25/2023]
Abstract
PURPOSE To describe patterns of cannabis withdrawal among a large sample of those who use medical cannabis and test the association between withdrawal symptomology and functioning. PROCEDURES Adults ages 21 and older (N = 801) who were seeking medical cannabis certification (either for the first time or as a renewal) for chronic pain at medical cannabis clinics in southern Michigan completed baseline measures of cannabis use, withdrawal symptomology, functioning and other related constructs. Patients were included in the current study if they endorsed using cannabis at least weekly over the past three months. Of the persons in the baseline sample (N = 801), 83% endorsed using cannabis at this level of frequency and duration (N = 665). FINDINGS Approximately two-thirds of the sample (67.8%) reported at least one moderate or severe withdrawal symptom. The most commonly observed symptom was sleep difficulties (50.3%), followed by anxiety (27.8%), irritability (26.7%), and appetite disturbance (25.2%). Patients with low mental functioning had significantly higher rates of withdrawal symptom endorsement than patients with high mental functioning. However, no association was observed between physical functioning and withdrawal symptom endorsement. These patterns of association were consistent in multivariate analyses that controlled for other potentially confounding variables. CONCLUSIONS Cannabis withdrawal symptomology is highly prevalent among patients who use medical cannabis at least three times a week. Helping patients recognize the association between poorer functioning and withdrawal may be an effective way to highlight potentially negative consequences of regular and moderate heavy use.
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Affiliation(s)
- Brian E Perron
- School of Social Work, University of Michigan, Ann Arbor, MI, United States.
| | - Katlyn R Holt
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Emily Yeagley
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States; Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Mark Ilgen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States; Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
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Abstract
Introduction: The opioid epidemic has become an immense problem in North America, and despite decades of research on the most effective means to treat opioid use disorder (OUD), overdose deaths are at an all-time high, and relapse remains pervasive. Discussion: Although there are a number of FDA-approved opioid replacement therapies and maintenance medications to help ease the severity of opioid withdrawal symptoms and aid in relapse prevention, these medications are not risk free nor are they successful for all patients. Furthermore, there are legal and logistical bottlenecks to obtaining traditional opioid replacement therapies such as methadone or buprenorphine, and the demand for these services far outweighs the supply and access. To fill the gap between efficacious OUD treatments and the widespread prevalence of misuse, relapse, and overdose, the development of novel, alternative, or adjunct OUD treatment therapies is highly warranted. In this article, we review emerging evidence that suggests that cannabis may play a role in ameliorating the impact of OUD. Herein, we highlight knowledge gaps and discuss cannabis' potential to prevent opioid misuse (as an analgesic alternative), alleviate opioid withdrawal symptoms, and decrease the likelihood of relapse. Conclusion: The compelling nature of these data and the relative safety profile of cannabis warrant further exploration of cannabis as an adjunct or alternative treatment for OUD.
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Affiliation(s)
- Beth Wiese
- Department of Psychology, University of Missouri–St. Louis, St. Louis, Missouri
- Department of Anesthesiology, Pain Center, Washington University School of Medicine, St. Louis, Missouri
| | - Adrianne R. Wilson-Poe
- Department of Anesthesiology, Pain Center, Washington University School of Medicine, St. Louis, Missouri
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Mikulskaya E, Martin FH. Contrast sensitivity and motion discrimination in cannabis users. Psychopharmacology (Berl) 2018; 235:2459-2469. [PMID: 29909427 DOI: 10.1007/s00213-018-4944-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 06/05/2018] [Indexed: 01/09/2023]
Abstract
RATIONALE Cannabis use impairs visual attention; however, it is unclear whether cannabis use also impairs low level visual processing or whether low level visual deficits can be related to lower dopaminergic functioning found in cannabis users. OBJECTIVES To investigate whether spatiotemporal contrast sensitivity and motion discrimination under normal and low luminance conditions differ in cannabis users and non-users. METHODS Control (n = 20) and cannabis (n = 21) participants completed a visual acuity test, a saliva test and self-report measures. Spatial and temporal contrast thresholds, motion coherence thresholds for translational and radial motion and the spontaneous eye blink rate were then collected. RESULTS Cannabis users showed decreased spatial contrast sensitivity under low luminance conditions and increased motion coherence thresholds under all luminance levels tested compared to non-users. No differences in temporal contrast sensitivity were found between the groups. Frequency of cannabis use correlated significantly and negatively with contrast sensitivity, both spatial and temporal, in the cannabis group and higher motion coherence thresholds for radial motion were also associated with more frequent cannabis use in this group. The eye blink rate was significantly lower in cannabis users compared to non-users. CONCLUSIONS The present study shows that cannabis use is associated with deficits in low level visual processing. Such deficits are suggested to relate to lower dopamine, in a similar manner as in clinical populations. The implications for driving safety under reduced visibility (e.g. night) in abstaining cannabis users are discussed.
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Affiliation(s)
- Elena Mikulskaya
- School of Psychology, University of Newcastle, Ourimbah, NSW, 2258, Australia.,TIEI, Russian Federation, Tula University, Tula, Russia
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Trigo JM, Soliman A, Quilty LC, Fischer B, Rehm J, Selby P, Barnes AJ, Huestis MA, George TP, Streiner DL, Staios G, Le Foll B. Nabiximols combined with motivational enhancement/cognitive behavioral therapy for the treatment of cannabis dependence: A pilot randomized clinical trial. PLoS One 2018; 13:e0190768. [PMID: 29385147 PMCID: PMC5791962 DOI: 10.1371/journal.pone.0190768] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 12/12/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The current lack of pharmacological treatments for cannabis use disorder (CUD) warrants novel approaches and further investigation of promising pharmacotherapy. We previously showed that nabiximols (27 mg/ml Δ9-tetrahydrocannabinol (THC)/ 25 mg/ml cannabidiol (CBD), Sativex®) can decrease cannabis withdrawal symptoms. Here, we assessed in a pilot study the tolerability and safety of self-titrated nabiximols vs. placebo among 40 treatment-seeking cannabis-dependent participants. METHODS Subjects participated in a double blind randomized clinical trial, with as-needed nabiximols up to 113.4 mg THC/105 mg CBD or placebo daily for 12 weeks, concurrently with Motivational Enhancement Therapy and Cognitive Behavioral Therapy (MET/CBT). Primary outcome measures were tolerability and abstinence, secondary outcome measures were days and amount of cannabis use, withdrawal, and craving scores. Participants received up to CDN$ 855 in compensation for their time. RESULTS Medication was well tolerated and no serious adverse events (SAEs) were observed. Rates of adverse events did not differ between treatment arms (F1,39 = 0.205, NS). There was no significant change in abstinence rates at trial end. Participants were not able to differentiate between subjective effects associated with nabiximols or placebo treatments (F1,40 = 0.585, NS). Cannabis use was reduced in the nabiximols (70.5%) and placebo groups (42.6%). Nabiximols reduced cannabis craving but no significant differences between the nabiximols and placebo groups were observed on withdrawal scores. CONCLUSIONS Nabiximols in combination with MET/CBT was well tolerated and allowed for reduction of cannabis use. Future clinical trials should explore the potential of high doses of nabiximols for cannabis dependence.
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Affiliation(s)
- Jose M. Trigo
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Alexandra Soliman
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Lena C. Quilty
- Campbell Family Mental Health Research Institute, CAMH, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Benedikt Fischer
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada
- Institute for Mental Health Policy Research, CAMH, Toronto, Canada
- Centre for Applied Research in Mental Health & Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Jürgen Rehm
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada
- Institute for Mental Health Policy Research, CAMH, Toronto, Canada
- Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany
| | - Peter Selby
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Addictions Division, CAMH, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Allan J. Barnes
- Chemistry and Drug Metabolism, National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), Baltimore, United States of America
| | - Marilyn A. Huestis
- Chemistry and Drug Metabolism, National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), Baltimore, United States of America
| | - Tony P. George
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Addictions Division, CAMH, Toronto, Canada
- Division of Brain and Therapeutics, CAMH, Toronto, Canada
| | - David L. Streiner
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Gregory Staios
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Addictions Division, CAMH, Toronto, Canada
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Cousijn J, van Duijvenvoorde ACK. Cognitive and Mental Health Predictors of Withdrawal Severity During an Active Attempt to Cut Down Cannabis Use. Front Psychiatry 2018; 9:301. [PMID: 30050473 PMCID: PMC6050370 DOI: 10.3389/fpsyt.2018.00301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/18/2018] [Indexed: 01/30/2023] Open
Abstract
A milestone in cannabis research is the establishment of a clinically relevant cannabis withdrawal syndrome, yet little is known about the underlying mechanisms. We investigated the predictive role of mental health and cognitive factors in withdrawal severity during an active attempt to cut down, relative to uninterrupted cannabis use. Ninety heavy cannabis users were randomly assigned to an experimental or control group. The experimental group was asked to cut down substance use for 1 week. Past week substance use, substance use-related problems, depressive symptoms, cravings, and cognitive control were assessed at baseline. Past week substance use and withdrawal severity were assessed at follow-up. The experimental group reduced their cannabis use more and experienced more withdrawal than the control group. Hierarchical regression analysis per predictor indicated that cannabis use-related problems, depressive symptoms, and cannabis craving, but not cognitive control, predicted stronger withdrawal. Craving uniquely predicted withdrawal in the experimental group. A combined hierarchical regression indicated that only depressive symptoms and cannabis use-related problems uniquely predicted withdrawal across groups. These results suggest that depressive symptoms and cannabis use-related problems are generally indicative of cannabis withdrawal severity, whereas craving specifically predicts cannabis withdrawal during an active attempt to cut-down cannabis use.
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Affiliation(s)
- Janna Cousijn
- Addiction Development and Psychopathology Lab, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - A C K van Duijvenvoorde
- Brain and Development Lab, Department of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden, Netherlands
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40
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Hasin DS. US Epidemiology of Cannabis Use and Associated Problems. Neuropsychopharmacology 2018; 43:195-212. [PMID: 28853439 PMCID: PMC5719106 DOI: 10.1038/npp.2017.198] [Citation(s) in RCA: 370] [Impact Index Per Article: 61.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/17/2017] [Accepted: 08/18/2017] [Indexed: 12/12/2022]
Abstract
This review provides an overview of the changing US epidemiology of cannabis use and associated problems. Adults and adolescents increasingly view cannabis as harmless, and some can use cannabis without harm. However, potential problems include harms from prenatal exposure and unintentional childhood exposure; decline in educational or occupational functioning after early adolescent use, and in adulthood, impaired driving and vehicle crashes; cannabis use disorders (CUD), cannabis withdrawal, and psychiatric comorbidity. Evidence suggests national increases in cannabis potency, prenatal and unintentional childhood exposure; and in adults, increased use, CUD, cannabis-related emergency room visits, and fatal vehicle crashes. Twenty-nine states have medical marijuana laws (MMLs) and of these, 8 have recreational marijuana laws (RMLs). Many studies indicate that MMLs or their specific provisions did not increase adolescent cannabis use. However, the more limited literature suggests that MMLs have led to increased cannabis potency, unintentional childhood exposures, adult cannabis use, and adult CUD. Ecological-level studies suggest that MMLs have led to substitution of cannabis for opioids, and also possibly for psychiatric medications. Much remains to be determined about cannabis trends and the role of MMLs and RMLs in these trends. The public, health professionals, and policy makers would benefit from education about the risks of cannabis use, the increases in such risks, and the role of marijuana laws in these increases.
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Affiliation(s)
- Deborah S Hasin
- Columbia University and New York State Psychiatric Institute, New York, NY, USA
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41
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The Current State of Pharmacological Treatments for Cannabis Use Disorder and Withdrawal. Neuropsychopharmacology 2018; 43:173-194. [PMID: 28875989 PMCID: PMC5719115 DOI: 10.1038/npp.2017.212] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/31/2017] [Accepted: 08/31/2017] [Indexed: 02/07/2023]
Abstract
Cannabis use disorder (CUD) commonly occurs and carries a notable economic and functional burden at both individual and societal levels. While there are no clearly efficacious medication treatments for CUD, 20 years of committed and high-quality research in the human laboratory and clinical settings have resulted in medications with demonstrated effectiveness in the treatment of cannabis withdrawal, the ability to reduce cannabis use, and results that point to promising future work. The current state of pharmacology research for CUD highlights the need to consider particular characteristics of patients, such as gender, impulsivity, and severity of cannabis use, when selecting a medication in the off-label treatment of CUD or cannabis withdrawal. As a field, the body of work also exposes some areas in need of improvement in study design, selection of outcome measures, interpretation of results, and the overall process of evaluating candidate medications. Coming to a consensus as a field and addressing these gaps in future research will likely lend itself to further advances in improving the lives of patients with CUD.
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42
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The consequences of chronic cannabis smoking in vulnerable adolescents. Paediatr Respir Rev 2017; 24:44-53. [PMID: 27986504 DOI: 10.1016/j.prrv.2016.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/02/2016] [Indexed: 01/18/2023]
Abstract
Cannabis, like the mythic shape-shifter, presents in various guises, morphing with the perspective and context of the observer. Arguments about cannabis are confused by a myriad of debates-medical, social, ethical and political-as if a single conceptual umbrella can capture the variety and granularity of marijuana-related issues. This paper responds to marijuana use as it is commonly practised by youth in Australia. It has little to say about synthetic cannabinoids, specific medicinal cannabinoids, or medicinal properties of marijuana. We address those adolescents genetically and environmentally vulnerable to mental illness, with specific emphasis on indigenous and neurodevelopmentally impaired young people who show patterns of usage and response very different to adults and more resilient members of the population. Specifically, the practice of mixing tobacco with marijuana by aboriginal youth, and the resultant coalition of dependencies, will likely presage a rise in pulmonary and central nervous system pathology over the coming decades. Aboriginal youth begin using earlier, persist longer, and take greater quantities of cannabis than non-indigenous youth. This paper recommends practical interventions to reduce the multiple health consequences of chronic cannabis use in young people, especially indigenous young people.
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Pokorski I, Clement N, Phung N, Weltman M, Fu S, Copeland J. Cannabidiol in the management of in-patient cannabis withdrawal: clinical case series. FUTURE NEUROLOGY 2017. [DOI: 10.2217/fnl-2016-0035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: To assess the feasibility of the use of cannabidiol (CBD) for the management of cannabis withdrawal. Patients & methods: Eight participants were admitted to an in-patient detoxification facility for a 7-day open-label trial of CBD. Five participants received 600 mg of CBD and three participants received 1200 mg of CBD. Participants returned for a 28-day follow-up interview. Results & conclusion: CBD was well tolerated by all participants. Five completed the full treatment period and abstinence was maintained by four participants at day 28 follow-up. All those receiving the higher dose completed treatment and achieved abstinence at follow-up. This pilot study suggests that further exploration of CBD as a pharmacological adjunctive therapy for cannabis withdrawal and dependence is warranted. Registration ACTRN1261400024866.
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Affiliation(s)
- Izabella Pokorski
- National Cannabis Prevention & Information Centre, University of New South Wales, Medicine, Sydney, New South Wales 2052, Australia
| | - Nicole Clement
- National Cannabis Prevention & Information Centre, University of New South Wales, Medicine, Sydney, New South Wales 2052, Australia
| | - Nghi Phung
- Western Sydney Local Health District, New South Wales Health Department, New South Wales 5041, Australia
| | - Marin Weltman
- Western Sydney Local Health District, New South Wales Health Department, New South Wales 5041, Australia
| | - Shanlin Fu
- University of Technology, Sydney 2007, Australia
| | - Jan Copeland
- National Cannabis Prevention & Information Centre, University of New South Wales, Medicine, Sydney, New South Wales 2052, Australia
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Schlienz NJ, Budney AJ, Lee DC, Vandrey R. Cannabis Withdrawal: A Review of Neurobiological Mechanisms and Sex Differences. CURRENT ADDICTION REPORTS 2017; 4:75-81. [PMID: 29057200 PMCID: PMC5648025 DOI: 10.1007/s40429-017-0143-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW This report provides an updated overview of pre-clinical and clinical research on the etiology and biological substrates of the cannabis withdrawal syndrome. RECENT FINDINGS Long-term cannabis use is associated with downregulation of type-1 cannabinoid receptors (CB1). Reduced CB1 receptor density is related to increased withdrawal during early abstinence, and the reduction in CB1 receptor density reverses with extended abstinence. Females have been shown to have increased rate and severity of a subset of cannabis withdrawal symptoms compared with men. SUMMARY Recent studies have extended knowledge of the biological processes and individual difference variables that influence cannabis withdrawal. However, caveats include small sample sizes in clinical studies, participant samples that are predominantly male, and limited examinations of endocannabinoids, enzymes that degrade endocannabinoids, negative allosteric modulators, and other neurobiological systems that may directly impact cannabis withdrawal symptom expression.
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Affiliation(s)
- Nicolas J. Schlienz
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224
| | - Alan J. Budney
- Department of Psychiatry, Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH 03766
| | - Dustin C. Lee
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224
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45
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Sloan ME, Gowin JL, Ramchandani VA, Hurd YL, Le Foll B. The endocannabinoid system as a target for addiction treatment: Trials and tribulations. Neuropharmacology 2017; 124:73-83. [PMID: 28564576 DOI: 10.1016/j.neuropharm.2017.05.031] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 12/19/2022]
Abstract
Addiction remains a major public health concern, and while pharmacotherapies can be effective, clinicians are limited by the paucity of existing interventions. Endocannabinoid signaling is involved in reward and addiction, which raises the possibility that drugs targeting this system could be used to treat substance use disorders. This review discusses findings from randomized controlled trials evaluating cannabinergic medications for addiction. Current evidence suggests that pharmacotherapies containing delta-9-tetrahydrocannabinol, such as dronabinol and nabiximols, are effective for cannabis withdrawal. Dronabinol may also reduce symptoms of opioid withdrawal. The cannabinoid receptor 1 (CB1) inverse agonist rimonabant showed promising effects for smoking cessation but also caused psychiatric side effects and currently lacks regulatory approval. Few trials have investigated cannabinergic medications for alcohol use disorder. Overall, the endocannabinoid system remains a promising target for addiction treatment. Development of novel medications such as fatty acid amide hydrolase inhibitors and neutral CB1 antagonists promises to extend the range of available interventions. This article is part of the Special Issue entitled "A New Dawn in Cannabinoid Neurobiology".
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Affiliation(s)
- Matthew E Sloan
- Section on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, 10 Center Drive (10CRC, 2-2352), Bethesda, MD, 20892-1540, USA
| | - Joshua L Gowin
- Section on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, 10 Center Drive (10CRC, 2-2352), Bethesda, MD, 20892-1540, USA
| | - Vijay A Ramchandani
- Section on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, 10 Center Drive (10CRC, 2-2352), Bethesda, MD, 20892-1540, USA
| | - Yasmin L Hurd
- Departments of Psychiatry, Neuroscience, Pharmacology, and Systems Therapeutics, Icahn School of Medicine at Mount Sinai, Hess CSM Building, Floor 10, Rm 105, Office 1470, Madison Avenue, New York, NY, 10029, USA
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S 2S1, Canada; Addiction Medicine Service, Ambulatory Care and Structured Treatments, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Departments of Family and Community Medicine, Pharmacology and Toxicology, and Psychiatry, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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46
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Overview of Current State-of-the-Art Treatments for Cannabis Use Disorders, and Future Directions. CURRENT ADDICTION REPORTS 2017. [DOI: 10.1007/s40429-017-0151-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Parrott AC, Hayley AC, Downey LA. Recreational stimulants, herbal, and spice cannabis: The core psychobiological processes that underlie their damaging effects. Hum Psychopharmacol 2017; 32. [PMID: 28557129 DOI: 10.1002/hup.2594] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/13/2017] [Accepted: 03/18/2017] [Indexed: 12/19/2022]
Abstract
AIMS Recreational drugs are taken for their positive mood effects, yet their regular usage damages well-being. The psychobiological mechanisms underlying these damaging effects will be debated. METHODS The empirical literature on recreational cannabinoids and stimulant drugs is reviewed. A theoretical explanation for how they cause similar types of damage is outlined. RESULTS All psychoactive drugs cause moods and psychological states to fluctuate. The acute mood gains underlie their recreational usage, while the mood deficits on withdrawal explain their addictiveness. Cyclical mood changes are found with every central nervous system stimulant and also occur with cannabis. These mood state changes provide a surface index for more profound psychobiological fluctuations. Homeostatic balance is altered, with repetitive disturbances of the hypothalamic-pituitary-adrenal axis, and disrupted cortisol-neurohormonal secretions. Hence, these drugs cause increased stress, disturbed sleep, neurocognitive impairments, altered brain activity, and psychiatric vulnerability. Equivalent deficits occur with novel psychoactive stimulants such as mephedrone and artificial "spice" cannabinoids. These psychobiological fluctuations underlie drug dependency and make cessation difficult. Psychobiological stability and homeostatic balance are optimally restored by quitting psychoactive drugs. CONCLUSIONS Recreational stimulants such as cocaine or MDMA (3.4-methylenedioxymethamphetamine) and sedative drugs such as cannabis damage human homeostasis and well-being through similar core psychobiological mechanisms.
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Affiliation(s)
- Andrew C Parrott
- Department of Psychology, Swansea University, Swansea, UK.,Centre for Human Psychopharmacology, Swinburne University, Melbourne, Australia
| | - Amie C Hayley
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, Australia
| | - Luke A Downey
- Department of Psychology, Swansea University, Swansea, UK.,Centre for Human Psychopharmacology, Swinburne University, Melbourne, Australia
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Abstract
Introduction: Cannabis has been used for medical purposes across the world for centuries. As states and countries implement medical and recreational cannabis policies, increasing numbers of people are using cannabis pharmacotherapy for pain. There is a theoretical rationale for cannabis' efficacy for pain management, although the subjective pain relief from cannabis may not match objective measurements of analgesia. As more patients turn to cannabis for pain relief, there is a need for additional scientific evidence to evaluate this increase. Materials and Methods: Research for this review was performed in the PubMed/National Library of Medicine database. Discussion: Preclinical studies demonstrate a narrow therapeutic window for cannabis as pharmacotherapy for pain; the body of clinical evidence for this indication is not as extensive. A recent meta-analysis of clinical trials of cannabis and cannabinoids for pain found modest evidence supporting the use of cannabinoid pharmacotherapy for pain. Recent epidemiological studies have provided initial evidence for a possible reduction in opioid pharmacotherapy for pain as a result of increased implementation of medical cannabis regimens. Conclusion: With increased use of medical cannabis as pharmacotherapy for pain comes a need for comprehensive risk-benefit discussions that take into account cannabis' significant possible side effects. As cannabis use increases in the context of medical and recreational cannabis policies, additional research to support or refute the current evidence base is essential to attempt to answer the questions that so many healthcare professionals and patients are asking.
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Affiliation(s)
- Kevin P. Hill
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | - Brian Johnson
- State University of New York Upstate Medical University, Syracuse, New York
| | - Joseph W. Ditre
- Department of Psychology, Syracuse University, Syracuse, New York
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49
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Abstract
The cannabis withdrawal syndrome (CWS) is a criterion of cannabis use disorders (CUDs) (Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition) and cannabis dependence (International Classification of Diseases [ICD]-10). Several lines of evidence from animal and human studies indicate that cessation from long-term and regular cannabis use precipitates a specific withdrawal syndrome with mainly mood and behavioral symptoms of light to moderate intensity, which can usually be treated in an outpatient setting. Regular cannabis intake is related to a desensitization and downregulation of human brain cannabinoid 1 (CB1) receptors. This starts to reverse within the first 2 days of abstinence and the receptors return to normal functioning within 4 weeks of abstinence, which could constitute a neurobiological time frame for the duration of CWS, not taking into account cellular and synaptic long-term neuroplasticity elicited by long-term cannabis use before cessation, for example, being possibly responsible for cannabis craving. The CWS severity is dependent on the amount of cannabis used pre-cessation, gender, and heritable and several environmental factors. Therefore, naturalistic severity of CWS highly varies. Women reported a stronger CWS than men including physical symptoms, such as nausea and stomach pain. Comorbidity with mental or somatic disorders, severe CUD, and low social functioning may require an inpatient treatment (preferably qualified detox) and post-acute rehabilitation. There are promising results with gabapentin and delta-9-tetrahydrocannabinol analogs in the treatment of CWS. Mirtazapine can be beneficial to treat CWS insomnia. According to small studies, venlafaxine can worsen the CWS, whereas other antidepressants, atomoxetine, lithium, buspirone, and divalproex had no relevant effect. Certainly, further research is required with respect to the impact of the CWS treatment setting on long-term CUD prognosis and with respect to psychopharmacological or behavioral approaches, such as aerobic exercise therapy or psychoeducation, in the treatment of CWS. The up-to-date ICD-11 Beta Draft is recommended to be expanded by physical CWS symptoms, the specification of CWS intensity and duration as well as gender effects.
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Affiliation(s)
- Udo Bonnet
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Castrop-Rauxel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen
| | - Ulrich W Preuss
- Vitos-Klinik Psychiatrie und Psychotherapie Herborn, Herborn
- Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Etges T, Karolia K, Grint T, Taylor A, Lauder H, Daka B, Wright S. An observational postmarketing safety registry of patients in the UK, Germany, and Switzerland who have been prescribed Sativex ® (THC:CBD, nabiximols) oromucosal spray. Ther Clin Risk Manag 2016; 12:1667-1675. [PMID: 27956834 PMCID: PMC5113923 DOI: 10.2147/tcrm.s115014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The global exposure of Sativex® (Δ9-tetrahydrocannabinol [THC]:cannabidiol [CBD], nabiximols) is estimated to be above 45,000 patient-years since it was given marketing approval for treating treatment-resistant spasticity in multiple sclerosis (MS). An observational registry to collect safety data from patients receiving THC:CBD was set up following its approval in the UK, Germany, and Switzerland, with the aim of determining its long-term safety in clinical practice. Twice a year, the Registry was opened to prescribing physicians to voluntarily report data on patients' use of THC:CBD, clinically significant adverse events (AEs), and special interest events. The Registry contains data from 941 patients with 2,213.98 patient-years of exposure. Within this cohort, 60% were reported as continuing treatment, while 83% were reported as benefiting from the treatment. Thirty-two percent of patients stopped treatment, with approximately one third citing lack of effectiveness and one quarter citing AEs. Psychiatric AEs of clinical significance were reported in 6% of the patients, 6% reported falls requiring medical attention, and suicidality was reported in 2%. Driving ability was reported to have worsened in 2% of patients, but improved in 7%. AEs were more common during the first month of treatment. The most common treatment-related AEs included dizziness (2.3%) and fatigue (1.7%). There were no signals to indicate abuse, diversion, or dependence. The long-term risk profile from the Registry is consistent with the known (labeled) safety profile of THC:CBD, and therefore supports it being a well-tolerated and beneficial medication for the treatment of MS spasticity. No evidence of new long-term safety concerns has emerged.
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