4 This was related with a mounting number of patients seeking treatment due to various cannabis-related disorders, including cognitive deficits, psychosis, and dependence.
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4 A hallmark of cannabis dependence ( Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition or International Classification of Diseases - 10) as well as cannabis use disorder (CUD) ( Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition ) is the cannabis withdrawal syndrome (CWS) that characteristically occurs after quitting a regular cannabis use abruptly.Īlthough there was early evidence from animal experiments 7 and despite observations in humans in every decade, 8, 9 CWS entity was doubted before the 1990s, when a new cannabis wave started to roll in worldwide, particularly in affluent regions. 4 There is a significant positive correlation between the region’s economic situation and the prevalence of cannabis dependence. 6 Most of the other regions of the world providing data report a prevalence of cannabis dependence of <0.2%. 4 In Germany, ~0.5% of the adult population have a cannabis dependence diagnosis. 4, 5 The prevalence of cannabis dependence ( Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition – Text Revision ) is highest in Australasia (0.68%), followed by North America (0.60%), Western Europe (0.34%), Asia Central (0.28%), and southern Latin America (0.26%). Approximately 1% of European adolescents and young adults use cannabis daily or almost daily (defined as use on ≥20 days in the last month), 2 a consumption pattern which is more likely to produce cannabis-related disabling disorders. 3 Although such prevalence rates are useful to indicate consumption trends, it is doubted whether these rates are relevant to reflect a health risk. They decline in Spain, UK, and Germany (currently 12%), and there is an increase in the number of treatment demands for cannabis-related problems across Europe 2 and the USA. 1 In Europe, prevalence rates of annual cannabis use rise in Nordic countries (7%–18%) and France (22%). 1 Its use continues to be high in West and Central Africa, Western and Central Europe, Australasia, and North America, where recently an increase in the prevalence of past year cannabis use was recorded in the USA (12.6%). 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.Ĭannabis is a psychotropic substance with widespread recreational use worldwide, surpassed only by nicotine and alcohol.
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. According to small studies, venlafaxine can worsen the CWS, whereas other antidepressants, atomoxetine, lithium, buspirone, and divalproex had no relevant effect. Mirtazapine can be beneficial to treat CWS insomnia. There are promising results with gabapentin and delta-9-tetrahydrocannabinol analogs in the treatment of CWS. Comorbidity with mental or somatic disorders, severe CUD, and low social functioning may require an inpatient treatment (preferably qualified detox) and post-acute rehabilitation. Women reported a stronger CWS than men including physical symptoms, such as nausea and stomach pain. Therefore, naturalistic severity of CWS highly varies. The CWS severity is dependent on the amount of cannabis used pre-cessation, gender, and heritable and several environmental factors.
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.
Regular cannabis intake is related to a desensitization and downregulation of human brain cannabinoid 1 (CB1) receptors. 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. 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 -10).
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