Cannabis withdrawal syndrome

An initial examination of the extent to which lithium may prevent cannabis withdrawal in rats was conducted by Cui et al. (2001), who reported that, at clinically relevant serum levels, lithium prevented the appearance of the cannabis withdrawal syndrome. The authors also noted that these effects were accompanied by a release of oxytocin, which they conclude is responsible for suppression of the withdrawal signs. 

Budney, A.J., Hughes, J.R., Moore, B.A. and Vandrey, R. (2004) Review of the validity and significance of cannabis withdrawal syndrome. American Journal of Psychiatry,161,1967-1977. 

Duffy A and Millin R (1996). Case study Withdrawal syndrome in adolescent chronic cannabis users. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1618-1621. 

Cessation of chronic cannabis use is known to produce a withdrawal syndrome consisting of restlessness, irritability, insomnia, nausea, and muscle cramping (table 10.9) (O Brien 1996). However, this syndrome is only seen in people who use high daily amounts and then suddenly stop (O Brien 1996). These symptoms are not usually seen in clinical populations, and frequent users of cannabis are not driven by a fear to avoid a withdrawal syndrome as seen in opioid addiction. 

In mice, somatic signs of withdrawal include wet dog shakes, front paw tremor, ataxia, hunched posture, tremor, ptosis, piloerection, mastication and decreased locomotor activity (Hutcheson et al. 1998). The CBl antagonist (SR141716A) has been used to precipitate a withdrawal state in THC-tolerant animals, and higher doses of THC produced a greater withdrawal syndrome (Aceto et al. 1995 Cook et al. 1998). Withdrawal from chronic cannabis use reduces mesolimbic dopaminer-... 

Tolerance develops to many of A -THC s effects in heavy marijuana users. Although chronic cannabis use does not result in severe withdrawal symptoms, numerous case reports attest to development of dependence in subjects taking high doses of THC for several weeks. The most prominent symptoms were irritability and restlessness others included insomnia, anorexia, increased sweating, and mild nausea. Cessation of mild or moderate use of marijuana, however, does not produce a withdrawal syndrome. 

Green L Gossop M (1988). Effects of information on the opiate withdrawal syndrome. British Journal of Addiction, 83, 305-9 Green B, Young R Kavanagh D (2005). Cannabis use and misuse prevalence among people with psychosis. British Journal of Psychiatry, 187, 306-13... 

Tolerance to the effects of marijuana clearly exist even though chronic users have described a reversed tolerance and claim that smaller doses of the drug are necessary to produce the desired effects. This effect is probably related to the manner of use and the expectations of the user. Chronic, high-dose cannabis users may experience an abstinence or withdrawal syndrome on abrupt discontinuation of use. Signs and symptoms include irritability, restlessness, nervousness, weight loss, insomnia, and rapid eye movement (REM) rebound. Onset of this syndrome is several hours after the last dose, and it lasts 4 to 5 d. Because withdrawal is not life-threatening, treatment involves little more than supportive therapy with short-term, low doses of benzodiazepines. 

Tolerance, with continued heavy use, and a withdrawal syndrome occur (depression, anxiety, sleep disturbance, tremor and other symptoms). Many users find it very difficult to abandon cannabis. In studies of self-administration by monkeys, spontaneous use did not occur but, once use was initiated, drug-seeking behaviour developed. Subjects who have become tolerant to LSD or opioids as a result of repeated dosage respond normally to cannabis but... 

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