Exploratory Growth Mixture Modeling of Cannabis-Withdrawal Syndrome Trajectories of Adult Pure Cannabis Dependents During Detoxification: Two Subtypes?

ABSTRACT

As clinical studies about subtypes of the cannabis withdrawal syndrome (CWS) are scant, we performed a re-analysis of longitudinal data with German adult cannabis-users seeking inpatient cannabis detoxification-treatment. Sixty-seven cannabis-dependents without active comorbidity were included for growth-mixture-analysis (GMM) of their CWS-severity-trajectories during a scheduled 24-day detox-treatment. As of treatment-day 12, thirty-six (53.7%) of 67 patients were discharged after successful detoxification. This led to artificial imputations for I-GMM. Therefore, we preferred the results of the GMM including raw data-only (R-GMM). By both, I-GMM and R-GMM, we found two classes of CWS severity time-courses. Class one (n = 44, R-GMM) showed a continuously decreasing CWS-severity; class two (n = 23, R-GMM) exhibited a sharp peak (generally between days 2–6 post-cessation). A short inpatient treatment-period and low urinary 11-nor-9-carboxy-Δ⁹ -tetrahydrocannabinol-level upon admission predicted the peaking trajectory of R-GMM-class-two-CWS. Withdrawal syndrome medication (PRN), comorbidity, cannabis-history data and gender balance were not significantly different between the CWS-classes. Although possibly confounded by PRN-medication, this exploratory study supports the presence of two CWS-variants in adult cannabis-dependents, characterized by a slowly decreasing (“protracted”) slope (class one) or a clear crescendo-decrescendo trajectory (class two). The latter was associated with a significantly shorter inpatient detoxification period and lower urinary THC-COOH-levels at admission.

KEYWORDS:

• Cannabis withdrawal syndrome subtypes
• subtype predictors
• Urinary 11-nor-9-carboxy-Delta9-tetrahydrocannabinol
• post-acute withdrawal syndrome

Acknowledgments

The authors thank Dr Raga Qasem (MD) as well as the staff of the detoxification ward ‘Station S1’ (LVR-Klinikum Essen, Germany) for their help with conducting the study. We are grateful to all participants for study support.

Disclosure statement

No potential conflict of interest was reported by the authors.

Contributors

Conception, design, data collection and drafting the article: U. Bonnet; analysis of the data: B.B. Claus; interpretation of data: all authors; revising the manuscript critically for important intellectual content: all authors.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/02791072.2023.2229830.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.