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Cannabis withdrawal: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis

Author
David A Gorelick, MD, PhD
Section Editor
Andrew J Saxon, MD
Deputy Editor
Richard Hermann, MD

INTRODUCTION

Cannabis (also called marijuana) is the most commonly used illegal psychoactive substance worldwide [1]. Its psychoactive properties are primarily due to one cannabinoid: delta-9-tetrahydrocannabinol (THC); THC concentration is commonly used as a measure of cannabis potency [2].

Cannabis withdrawal is manifested by a constellation of signs and symptoms occurring within one week after abrupt reduction or cessation of heavy and prolonged cannabis use, including irritability, anger, anxiety, depression, and disturbed sleep [3].

The epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis, and management of cannabis withdrawal are reviewed here. The treatment of cannabis withdrawal is reviewed separately. The clinical manifestations, course, assessment, and diagnosis of cannabis use disorder are also reviewed separately. The epidemiology and health consequences of cannabis use and cannabis use disorder are also reviewed separately. The pathogenesis, pharmacology, and treatment of cannabis use disorder in adults are also reviewed separately. Acute intoxication from cannabis and synthetic cannabinoids are also reviewed separately. (See "Cannabis use and disorder: Epidemiology, comorbidity, health consequences, and medico-legal status" and "Cannabis use and disorder: Pathogenesis and pharmacology" and "Treatment of cannabis use disorder" and "Cannabis (marijuana): Acute intoxication" and "Synthetic cannabinoids: Acute intoxication".)

EPIDEMIOLOGY

Prevalence — There are no definitive data on the prevalence of cannabis withdrawal, in part because of the lack of large-scale, representative studies that attempt to correlate participants’ intensity of cannabis use with their withdrawal experience. A limitation of studies that have been published is that their data were collected a decade or more ago, when the potency (delta-9-tetrahydrocannabinol [THC] concentration) of cannabis used in the United States was about one-third that of currently available cannabis [4].

Comparison across the studies below suggests that intensity (amount multiplied by duration) of cannabis use is positively correlated with prevalence of cannabis withdrawal, similar to the well-established relationship for other psychoactive substances such as alcohol and opiates. In general, individuals using cannabis daily or almost daily have a greater than 50 percent prevalence of withdrawal, while those using cannabis less than weekly experience little or no withdrawal. The prevalence of withdrawal among individuals with intermediate intensities of cannabis use is not well established and may depend on the presence or absence of other factors. (See 'Risk factors' below.)

             
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Literature review current through: Nov 2017. | This topic last updated: Aug 24, 2017.
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