The medical marijuana movement has been blowing up all around the world. Both ancient and modern studies have cited it as a cure for all sorts of ailments ranging from chronic pain to even leprosy (in the ancient Indian science of ayurveda too, of all places).
But recent research shines a light on the darker side of the use of marijuana for medicinal purposes. Conducted by psychologists from University of Michigan Medical School and the VA Ann Arbor Healthcare System, the new study has found that more than half its participants who used medical marijuana products to ease pain also experienced clusters of multiple withdrawal symptoms when they were between uses. And a tenth of the participants even experienced worsening changes to their sleep, mood, mental state, energy, and appetite over the next two years as they continued to use cannabis.
Published in the journal Addiction, the research was conducted over a period of two years, and reports findings from detailed surveys of 527 residents of Michigan in the U.S., all of whom qualified under the state’s system to permit medical use of marijuana to people with certain conditions and non-cancer related pain.
While they may attribute these symptoms to their underlying condition, many of them may not realise that they stem from their brain and body’s reaction to the absence of substances in the cannabis products they’re consuming, said Lara Coughlin, the University of Michigan Addiction Center psychologist who led the study.
In addition to a general craving to use cannabis, withdrawal symptoms can include anxiety, sleep difficulties, decreased appetite, restlessness, depressed mood, aggression, irritability, nausea, sweating, headache, stomach pain, strange dreams, increased anger and shakiness.
Regularly experiencing more than a few of these worrying symptoms can lead to a condition called the cannabis withdrawal syndrome, which might further worsen into more serious issues such as cannabis use disorder.
“Some people report experiencing significant benefits from medical cannabis, but our findings suggest a real need to increase awareness about the signs of withdrawal symptoms developing to decrease the potential downsides of cannabis use, especially among those who experience severe or worsening symptoms over time,” says Coughlin.
At the beginning, the participants were asked to self-report if they had experienced any of the 15 different symptoms—ranging from trouble sleeping and nausea to irritability and aggression—when they had gone a significant time without using cannabis. They were then grouped into those who had no symptoms or mild symptoms at the start of the study, those who had moderate symptoms (meaning they experienced multiple withdrawal symptoms), and those who had severe withdrawal issues that included most or all of the symptoms. Then their symptoms were observed at the one year and two year marks to study how they had changed over time.
At baseline, 41 percent of the study participants fell into the mild symptoms group, 34 percent in the moderate group, and 25 percent classified as severe. While those who started off with mild symptoms were likely to stay that way, some did progress into experiencing moderate symptoms, raising alarm amongst the researchers.
However, people in the moderate withdrawal group were more likely to go down in symptoms than up, and by the end of the study, the number of the people in the severe category had dropped to 1 percent. In all, 13 percent of the patients had gone up to the next level of symptoms by the end of the first year, and eight percent had experienced worse symptoms by the end of two years.
Sleep problems were the most common symptom across all three groups, and many in the mild group also reported major cravings for cannabis. In the moderate group, the most common withdrawal symptoms were sleep problems, depressed mood, decreased appetite, craving, restlessness, anxiety and irritability.
The severe withdrawal symptom group was much more likely to report all the symptoms, except sweatiness. Nearly all the participants in this group reported irritability, anxiety, and sleep problems. They were also more likely to be long time and frequent users of cannabis.
If you’re young and a regular user of medical cannabis, the findings might paint a cautionary picture. Not only were those in the severe withdrawal club younger, but they also experienced worse mental health. At the same time, older people were less likely to go up in withdrawal symptom severity. You might also want to give that vape a rest because those who vaped cannabis were less likely to go lower in symptoms.
While it focused on withdrawal symptoms from medical cannabis usage, the study also delved into the misconceptions people harbour about the healing magic of marijuana.
Many people who turn to medical cannabis for pain do so because other pain relievers haven’t worked, says Coughlin, an Assistant Professor in the Department of Psychiatry who sees patients as part of U-M Addiction Treatment Services.
Over time, cannabis has developed an image of being “harmless”, which she says is not correct. It contains substances called cannabinoids that act on the brain—and that over time can lead the brain to react when those substances are absent. She also suggested talking to your doctor about other forms of pain treatment including cognitive behavioural therapy, if marijuana use leads you to experience any worrying symptoms.
In the past, studies have shown that the greater symptoms a person has, the less likely they are to be able to reduce their use of cannabis, quit it, or stay away once they quit. They may even make the mistake of thinking these symptoms are caused by their underlying medical condition, and in turn, double up on their usage to mitigate these effects—launching them into a toxic cycle of increasing use and increasing withdrawal.
The study also noted that those who frequently feel the urge to use cannabis after a period without use, such as soon after waking up, could be experiencing withdrawal syndrome.
In the absence of legal and medical standards for medical cannabis dosing for different conditions, patients are often faced with a wide array of cannabis products that vary in strength. Some products could pose more risk for development of withdrawal symptoms than others, Coughlin says. In India, where even the medical use of marijuana is still prohibited, the lack of awareness and options can further problematise the use of cannabis. But we are now seeing things change, even the launch of the first medical cannabis clinic, which is prescribing cannabis pills and oils to relieve pain and cure illnesses among patients.