Cannabis Withdrawal Study Records Dependence among Adolescents

A study seems to prove that dependence is a realistic side-effect of Cannabis use – at least for teens being treated for substance abuse.

The study, published under the title of Cannabis withdrawal symptoms common among adolescents treated for substance use disorder, was conducted by Massachusetts General Hospital (MGH) and supported by the National Institute of Alcohol Abuse and Alcoholism grant R01AA015526. Already available online, the Journal of Addiction Medicine will officially publish the research.

Adolescents between the ages of fourteen and nineteen who were, at the time, in the care of an outpatient substance use disorder clinic were enrolled in the study. In total, 127 participants were examined, ninety of whom had self-identified as frequent Cannabis users - more specifically, that Cannabis was the drug they indicated as the one they used with the highest frequency.

That latter point is a convenient reminder that much more detailed research should be conducted regarding the topic of teens abusing multiple drugs simultaneously, on a regular basis, and the pharmacological impact of compounding one drug's effect by layering another - or many more - on top of that. Even adults in the United States are developing dangerous dependencies involving multiple prescription pharmaceuticals, or experiencing negative consequences when mixing alcohol with prescribed and/or illicit drugs.

In fact, the timing of these findings could not have been better for those protesting the potential legalization of recreational Cannabis in an ever-increasing list of American states - not to mention the recent implementation of the country's first legal pot laws in Colorado and Washington state. One of the most wildly promoted issues of the anti-weed agenda is that the unleashing of this 'dangerous' plant onto hapless communities would immediately result in the corruption of every minor in sight, in spite of compulsory minimum age requirements in pot shops.

From the Center for Addiction Medicine in the MGH Department of Psychiatry, senior author of the study John Kelly, PhD, seems to agree: "Our results are timely, given the changing attitudes and perceptions of risk related to Cannabis use in the [United States].

"As more people are able to obtain and consume Cannabis legally for medical and, in some states, recreational use, people are less likely to perceive it as addictive or harmful. But research shows that Cannabis use can have significant consequences, and we know that among adolescents it is second only to alcohol in rates of misuse."

After the main study was concluded, participants were comprehensively assessed at regular intervals of three, six and twelve months. While a few other attempts at following up on similar research projects have been made, the MGH approach is rare, in that they made a concerted effort to take the entire time line of drug abuse and treatment into consideration, especially concerning "the incidence of Cannabis withdrawal in adolescents and its relationship to treatment outcomes."

Regardless of whether or not the participants considered themselves to be addicts or drug abusers, the scientists analyzed factors relating to substance use and abuse, such as various psychiatric symptoms or diagnoses, physical issues, such as withdrawal and social factors, including identifying negative consequences of drug use within their lives and relationships.

However Claire Greene, MPH, a contributing author of the report, notes that, "We hypothesize that participants who experience withdrawal symptoms but do not recognize having a substance use problem may not attribute those symptoms to Cannabis withdrawal."

Based upon such observations, participants were divided into two categories: those who reported no Cannabis withdrawal and those who experienced withdrawal symptoms, such as sleeplessness, anxiety, depression, irritability and others. While this may sound unsettling, it should be remembered that the human brain does not finish developing until late adolescence to early adulthood; in order to ensure healthy social and physical development, adolescents should refrain from any drug use - but this is obviously difficult to control. Instead, our society should be focusing upon effective treatment options.

Research that was conducted roughly one year before the Massachusetts General Hospital study, entitled Cannabis withdrawal symptoms might have clinical importance, notes that the tracking of the appearance and severity of symptoms such as physical tension and mood swings, in addition to those experienced by the MGH participants, could potentially assist in targeting therapeutic approaches to the needs of individual patients. Ultimately, the information may "improve counseling and treatment strategies for those looking for support."

The crux of the MGH study can be summarized thus:

"Of the ninety Cannabis-using participants, seventy-six (eighty-four percent) met criteria for Cannabis dependence - which include increased tolerance and use of Cannabis, unsuccessful efforts to reduce or stop using and persistent use in spite of medical and psychological problems made worse by Cannabis. Withdrawal symptoms were reported by thirty-six participants (forty percent of the overall group), all of whom also met criteria for dependence. At the study's outset, substance use was likely to be more severe and consequences - such as missing work or school, financial and relationship problems - tended to be greater in participants reporting withdrawal symptoms, who also were more likely to have mood disorders.

"While the presence of withdrawal symptoms is a strong indicator of Cannabis dependence, the authors note, it did not significantly impact the ability of participants to reduce their use of Cannabis during the twelve-month follow-up period. The factor that did appear to make a difference was whether or not an individual recognized having a problem with substance use upon entering the study. Participants who both reported withdrawal symptoms and recognized having a problem had a small but steady improvement in abstinence through the entire study period. Those who reported withdrawal symptoms but did not recognize a substance use problem had a slight increase in abstinence in the first three months, but then had some increase in Cannabis use during the subsequent nine months, a pattern that was also seen in participants not experiencing withdrawal."

The two September studies simply highlight previously anecdotal evidence with which many heavy Cannabis users are familiar: the more you smoke, the higher your tolerance becomes, leading to higher usage rates; those in the category of regular or heavy users will experience more withdrawal symptoms than lighter or occasional users, while some people experience none at all; and finally, those heavy users who do abstain for an observable, controlled period of time - for whatever reason - will afterward likely consume more than they did before the abstinence period.

People who smoked before legalization continue to smoke in pretty much every zip code that has enacted pro-pot legislation. However, it is extremely unlikely that legalization will prompt any outrageous, long-term spikes in consumption statistics. Consider the Netherlands, where small sales and the personal purchasing, possession and consumption of five grams of Cannabis per day, per person have been tolerated for decades. Once the stigma has been removed, i.e., taking away the clandestine aspects of getting high, society pretty much remains unaffected in their personal preferences as to whether or not they wish to be a regular Cannabis user. The Netherlands is regularly listed far below the United States on global drug consumption surveys.

It should be mentioned that reported Cannabis use in Dutch teens tends to show slightly higher numbers than adults of legal age (eighteen and over), but it is also fair to include the fact that many of these same teens choose to quit using Cannabis as they get older, or only ever occasionally take part, such as once per year on a birthday, at a holiday party or perhaps when attending a large, outdoor weekend musical festival. Again, once the conclusion that smoking weed is no longer something sneaky and exciting has been reached, statistics for consumption tend to drop. Additionally, Dutch adults generally seem to view Cannabis use as something that 'young people' do, and then grow out of, whereas many American adults smoke, eat or vaporize weed for both recreational and medical reasons.

This is relevant, especially in light of the MGH study. If this relatively small sample number truly poses an accurate depiction of Cannabis dependence trends in teens, so be it. They should wait until they are of legal age. No one should be promoting teenage consumption of any drug - and it bears repeating that some pharmaceuticals should be treated as being much more harmful to society than beneficial. Teenagers and children should not be so easily medicated, nor to such extent, and underlying mental health issues that can trigger substance abuse issues should also be considered when choosing between differing avenues of therapy.

An observation by Science Daily supports this theory: "Study participants reporting withdrawal were more likely to meet criteria for severe substance use and for mood disorders, although the presence or absence of withdrawal did not appear to change long-term treatment outcomes."

The conclusion of the MGH study was as follows:
"Although Cannabis... is broadly believed to be non-addictive, a study has found that forty percent of Cannabis-using adolescents receiving outpatient treatment for substance use disorder reported experiencing symptoms of withdrawal, which are considered a hallmark of drug dependence."