Page 52 - CASA Bulletin of Anesthiology 2021, Vol 8, No. 6 (1)

CASA Bulletin of Anesthesiology

Cannabis Withdrawal

Yinan Chen MD PhD, Christina Le-Short MD
Department of Pain Medicine,
Division of Anesthesiology and Critical Care,
The University of Texas MD Anderson Cancer Center, Houston, TX

Introduction

Cannabis is the most commonly used illicit substance
worldwide. Although commonly considered a “soft drug”,
cannabis use is associated with mental and physical health
problems. As use of cannabis increases over the past 2 decades,
more research efforts have advanced our understanding of not
1
only cannabis use disorder, but also cannabis withdrawal.
Abrupt cessation of prolonged cannabis use can lead to a
withdrawal syndrome, a new diagnosis included in the
Diagnostic and Statistical Manual of Mental Disorders – Fifth
Edition (DSM-5) and as a criterion for cannabis use disorder.
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Symptoms of CWS occur reliably following a specific time
course with cessation of cannabis use, are transient, can be ameliorated by re-administration of
cannabis, and are clinically significant.

Symptoms and Prevalence
Cannabis withdrawal syndrome (CWS) is diagnosed when within a week after cessation of
heavy, prolonged use, ≥3 of 7 symptoms occur, including six behavioral or emotional symptoms
and one or more of a list of physical symptoms (Table 1). It should be noted that if the symptoms
are attributable to another medical condition or better explained by another mental disorder,
including intoxication with or withdrawal from another substance, diagnosis of CWS is
excluded. This makes the diagnosis of CWS even more challenging since the coexistence of
mental disorder and other substance use disorder among cannabis users is not uncommon.
3-5
Onset of symptoms typically occurred between days 1-3, peak effects between days 2-6, and
most effects lasted 4-14 days, similar to tobacco and other withdrawal syndromes.
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Table 1. Cannabis withdrawal symptoms

Irritability or aggression
Insomnia or unpleasant dreams
Depressed mood
Decreased appetite or weight loss
restlessness
Physical symptoms
Abdominal pain
Shakiness or tremors
Sweating
Fever
Chills
Headache

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