jasbird

<http://www.medpagetoday.com/2005MeetingCoverage/2005APAMeeting/tb/3404>

APA: Cannabis Withdrawal Syndrome No Pot Dream

By Michael Smith, MedPage Today Staff Writer
Reviewed by Rubeen K. Israni, M.D., Fellow, Renal-Electrolyte and
Hypertension Division, University of Pennsylvania School of Medicine
May 26, 2006

TORONTO, May 26 - The so-called "cannabis withdrawal syndrome" is real
and should be added to diagnostic manuals.

So asserted Deborah Hasin, Ph.D., of Columbia's Mailman School of Public
Health at the American Psychiatric Association meeting here.

Dr. Hasin based her conclusion on data gleaned from the landmark
National Epidemiologic Survey on Alcohol and Related Conditions
(NESARC), a national longitudinal study of more than 43,000 Americans
with respect to their alcohol and drug use, conducted in 2001 and 2002.

"Cannabis withdrawal at this point really should be added to the DSM-V
and the ICD-11," she said. The Diagnostic and Statistical Manual of
Mental Disorders, now in its fourth edition, is being revised. The
International Classification of Diseases (ICD) is established by the
World Health Organization.

Among the questions asked in structured interviews were a number about
after-effects of drug use, and Dr. Hasin and colleagues examined the
answers from 2,6113 participants who identified themselves as having
used marijuana three or more times a week during their period of
heaviest drug use.

The most common side-effects after stopping marijuana use were feeling
weak or tired, yawning, hypersomnia, psychomotor retardation, and
anxiety and depression, Dr. Hasin said.

Many of those participants also used other drugs, Dr. Hasin said, so to
avoid confounding, the researchers restricted their ****ysis to 1,119
people who used marijuana heavily - more than three times a week - but
didn't indulge in binge drinking or use other drugs heavily.

The sub-population included some very heavy users - two-thirds smoked
the drug between five and seven days a week, and a similar proportion
smoked at least one joint a day, she said.

The same set of symptoms appeared, Dr. Hasin said, indicating that other
drugs were not causing them.

Using factor ****ysis, the researchers classed the major symptoms into
two clusters - slowness, which included sleeping more, feeling weak or
tired, and yawning, and depression/anxiety, which included
sweating/heart beating, anxiety, restlessness, insomnia, depression,
muscle aches, and shaking.

Two key questions, she said are whether the symptoms cause distress or
impairment and whether the participants turned to other drugs or
returned to marijuana to avoid the distress. A negative binomial
regression ****ysis showed that:
* Both symptom clusters were associated with distress or impairment. The
association was significant at P<0.01.
* And both were associated with using drugs to avoid the distress, again
at P<0.01.

Both symptom clusters were associated with heavy use, at P<0.05, but not
with the age at which participants started using the drug, Dr. Hasin
said. The duration of the period of heaviest use was associated with the
anxiety cluster but not with slowness, the researchers found.

Dr. Hasin said the epidemiological approach allowed the researchers to
overcome problems that had dogged earlier studies of the issue,
including such things as small numbers, unrepresentative samples, and
confounding by other drug use.

But that may not be enough to claim that the symptoms seen are true
withdrawal, said Nicholas Seivewright, M.D., a consultant psychiatrist
with the Community Health Sheffield NHS Trust in Great Britain and
author of Community Treatment of Drug Misuse.

Citing the case of benzodiazepines, Dr. Seivewright noted that the
central argument for a withdrawal syndrome with those drugs was the
emergence of novel symptoms that patients had not previously had but
incurred after stopping. In the case of marijuana, he said, "I'm a bit
concerned about how you can call these withdrawal symptoms" without
knowing that they aren't a rebound effect or part of a pre-existing
condition.

Dr. Hasin may be "jumping the gun" in labeling her symptom clusters
cannabis withdrawal, he said in an interview.

budburner

I guess some folks might be prone to symptoms resembling
withdrawal but my guess would be that most people don't have trouble
with that. I have stopped for several weeks at a time and had no real
problems other than increased dream activity when I sleep. I'm going on
close to a month now with no herb smoked and although I am surrounded
by lots of good herb I'm having no trouble leaving it alone and am
asymptomatic.
I do, however, really *really* desire to smoke up as soon as
I'm employed again and the danger of a test is over. In fact, I plan on
smoking myself silly just as soon as I can.
BudBurner

name

Most people who smoke heavily or most people who smoke occasionally?

I've been alternating periods of 1 or more months of daily usage with
periods of abstinence over the past few years and I've found that
psychologically
it doesn't take me very much effort to abstain and there is only a
slight desire (or craving if you like) to toke up again while I'm
sober. Physiologically however, I find that it takes a while for my
body to adjust to the new situation and the transition from usage to
abstinence is upsetting my digestive processes. I tend to step down
usage gradually over the course of a week or so to minimize those
effects.
I guess I must be a pretty heavy user given the criteria in the study
mentioned, since I tend to toke up 3 to 5 times a day during the
periods of heaviest usage.
I also notice the intensity of dreams increasing immediately after
abstinence.
If there was a well-defined withdrawal symptom from cannabis use,
surely it should be possible to establish this based on extensive
experiments on animals in the lab?
Just like they managed to do for other substances with a potential for
psychological and physiological dependency.

sla#s

<SNIP>

Yes, in fact any study that fails to mention what we all know i.e. "
increased dream activity " can hardly be considered valid.

Slatts

phil stovell

As I've said before, that's how it affects me. I also get "the sweats".
Both symptoms disappear after at most 3 days. Compared with nicotine
withdrawal it's nothing (I'm ****ing on a NRT gum as I type this, 4.5
years after I stopped smoking).

--
Phil Stovell, South Hampshire, UK

"They said I should not take him to the police, but rather
let him pay a dowry for my goat because he used it as his wife"

jasbird

The ACMD reckon that nicotine would be a class C/B drug had it ever been
criminalized (Alcohol class B/A). I reckon they are kidding.

jez

Who'd want to withdraw ?


--
Jez, MBA.,
Country Dancing and Advanced Astrology, UBS.

'Realism is seductive because once you have accepted the reasonable notion
that you should base your actions on reality, you are too often led to
accept, without much questioning, someone else's version of what that
reality is. It is a crucial act of independent thinking to be skeptical of
someone else's description of reality.'-
Howard Zinn

sla#s

<snip>


I'd put it the other way round. Ask any junkie it's easier to give up heroin
than tobacco!
Almost all tobacco users are addicts and you have to top up nicotine every
so many hours.
As for alcohol most users are not addicts and don't have to top up.
Tobacco kills pa 140,000 out of 23% of the population. Alcohol kills 30,000
a year out of most of the UK population.

Slatts

name

But how many people cause accidents while driving vehicles or operating
machines while being so intoxicated on nicotine that it impairs their
ability to behave responsibly?
I think alcohol causes much more collateral damage in case of abuse.
If someone abuses tobacco at home, that's not likely to be related to
violent or irresponsible behavior that affects others in the way
alcohol often is.

jasbird

I agree. Class A on the basis of harm caused to health and
addictiveness. Same with booze.