An overview of current pharmacologic interventions for management of cannabis withdrawal syndrome and the evidence for their use

Cannabis withdrawal syndrome (CWS) represents one of the most common and debilitating consequences of frequent cannabis use. Thought to be related to the downregulation of cannabinoid type 1 (CB1) receptors resulting from daily or near daily cannabis use, CWS involves an assortment of symptoms—including but not limited to aggression, insomnia, loss of appetite, anxiety, depression, and tremulousness—that have been shown to perpetuate cannabis use. Management of CWS therefore represents an important clinical target for those with cannabis use disorder (CUD) who are either attempting to quit or must otherwise abruptly abstain from daily cannabis use. Several classes of medications have been explored for their potential to treat CWS. Small randomized studies have identified several medications that have significantly reduced CWS symptoms; such agents include the cannabinoid agonists, dronabinol and nabilone, the anticonvulsant gabapentin, and the fatty acid amino hydrolyze inhibitor PF-04457845. Other medications, including the alpha-agonist guanfacine and antipsychotic quetiapine, showed benefits for specific CWS symptoms such as irritability and insomnia. While no one option is backed by such a robust amount of evidence to define it as a standard treatment for CWS, early results for several of these options suggest that such a treatment could be attained with further study.