Historique
Article de Périodique
Clinical management of cannabis withdrawal (2022)
Auteur(s) :
CONNOR, J. P. ;
STJEPANOVIC, D. ;
BUDNEY, A. J. ;
LE FOLL, B. ;
HALL, W. D.
Année
2022
Page(s) :
2075-2095
Sous-type de document :
Revue de la littérature / Literature review
Langue(s) :
Anglais
Refs biblio. :
92
Domaine :
Drogues illicites / Illicit drugs
Thésaurus mots-clés
CANNABIS
;
PRISE EN CHARGE
;
SEVRAGE
;
SYNDROME DE SEVRAGE
;
PHARMACOTHERAPIE
;
SYMPTOME
;
DIAGNOSTIC
;
COMORBIDITE
;
ABSTINENCE
Résumé :
BACKGROUND AND AIMS: Cannabis withdrawal is a well-characterized phenomenon that occurs in approximately half of regular and dependent cannabis users after abrupt cessation or significant reductions in cannabis products that contain Delta9-tetrahydrocannabinol (THC). This review describes the diagnosis, prevalence, course and management of cannabis withdrawal and highlights opportunities for future clinical research.
METHODS: Narrative review of literature.
RESULTS: Symptom onset typically occurs 24-48 hours after cessation and most symptoms generally peak at days 2-6, with some symptoms lasting up to 3 weeks or more in heavy cannabis users. The most common features of cannabis withdrawal are anxiety, irritability, anger or aggression, disturbed sleep/dreaming, depressed mood and loss of appetite. Less common physical symptoms include chills, headaches, physical tension, sweating and stomach pain. Despite limited empirical evidence, supportive counselling and psychoeducation are the first-line approaches in the management of cannabis withdrawal. There are no medications currently approved specifically for medically assisted withdrawal (MAW). Medications have been used to manage short-term symptoms (e.g. anxiety, sleep, nausea). A number of promising pharmacological agents have been examined in controlled trials, but these have been underpowered and positive findings not reliably replicated. Some (e.g. cannabis agonists) are used 'off-label' in clinical practice. Inpatient admission for MAW may be clinically indicated for patients who have significant comorbid mental health disorders and polysubstance use to avoid severe complications.
CONCLUSIONS: The clinical significance of cannabis withdrawal is that its symptoms may precipitate relapse to cannabis use. Complicated withdrawal may occur in people with concurrent mental health and polysubstance use.
METHODS: Narrative review of literature.
RESULTS: Symptom onset typically occurs 24-48 hours after cessation and most symptoms generally peak at days 2-6, with some symptoms lasting up to 3 weeks or more in heavy cannabis users. The most common features of cannabis withdrawal are anxiety, irritability, anger or aggression, disturbed sleep/dreaming, depressed mood and loss of appetite. Less common physical symptoms include chills, headaches, physical tension, sweating and stomach pain. Despite limited empirical evidence, supportive counselling and psychoeducation are the first-line approaches in the management of cannabis withdrawal. There are no medications currently approved specifically for medically assisted withdrawal (MAW). Medications have been used to manage short-term symptoms (e.g. anxiety, sleep, nausea). A number of promising pharmacological agents have been examined in controlled trials, but these have been underpowered and positive findings not reliably replicated. Some (e.g. cannabis agonists) are used 'off-label' in clinical practice. Inpatient admission for MAW may be clinically indicated for patients who have significant comorbid mental health disorders and polysubstance use to avoid severe complications.
CONCLUSIONS: The clinical significance of cannabis withdrawal is that its symptoms may precipitate relapse to cannabis use. Complicated withdrawal may occur in people with concurrent mental health and polysubstance use.
Affiliation :
National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, QLD, Australia
Cote :
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