Patients admitted for inpatient cannabis detoxification : withdrawal symptoms and impacts of common comorbidities

There is clinical impetus to accurately monitor cannabis withdrawal symptoms. In doing this the impact of other drug and mental health comorbidities should be considered. The aim of this study was to report patient demographics, psychiatric and substance use comorbidities and symptoms of cannabis withdrawal in the first 5 days of hospital admission for detoxification. Daily self-reported symptom severity ratings were analysed as functions of gender, secondary drug use and recent mental health history. 193 consecutive patients admitted for routine inpatient cannabis withdrawal management over a 9-month period at a specialised inpatient hospital unit for withdrawal management (detoxification) at a University of Sydney teaching hospital, Sydney, Australia were screened via daily self-reported subjective ratings of cannabis withdrawal. Average cannabis used per day was 2.6 g. Most patients smoked tobacco daily (91%) and half of the sample (53%) reported other drug use. Alcohol was the main secondary drug used (29%). Half of the patients (51%) reported recent contact or interventions for mental health concerns. We were able to delineate principal withdrawal features to include "anxiety" (physical tension, hypermentation, palpitations and excessive worry), dysphoria (+ anergia, anhedonia, lethargy and somnolence) and irritability/agitation. Additional features identified included mood swings and cravings for cannabis. These features all significantly declined over a 5-day admission. Recent mental health concerns, but not gender or secondary drug use, correspond to greater global symptom severity over the course of admission. This study underscores a need to be alert to the impacts of comorbidities that are common in this treatment-seeking population, especially secondary drug use and the potential for mental health issues which add dimensions of complexity.