Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.
JAMA Netw Open. 2020 Apr 1;3(4):e202370. doi: 10.1001/jamanetworkopen.2020.2370.
Cannabis withdrawal syndrome (CWS)-a diagnostic indicator of cannabis use disorder-commonly occurs on cessation of heavy and prolonged cannabis use. To date, the prevalence of CWS syndrome has not been well described, nor have the factors potentially associated with CWS.
To estimate the prevalence of CWS among individuals with regular or dependent use of cannabinoids and identify factors associated with CWS.
A search of literature from database inception to June 19, 2019, was performed using MEDLINE, Embase, PsycINFO, Web of Science, the Cumulative Index to Nursing and Allied Health Literature, ProQuest, Allied and Complementary Medicine, and Psychiatry online, supplemented by manual searches of reference lists of included articles.
Articles were included if they (1) were published in English, (2) reported on individuals with regular use of cannabinoids or cannabis use disorder as a primary study group, (3) reported on the prevalence of CWS or CWS symptoms using a validated instrument, (4) reported the prevalence of CWS, and (5) used an observational study design (eg, cohort or cross-sectional).
All abstracts, full-text articles, and other sources were reviewed, with data extracted in duplicate. Cannabis withdrawal syndrome prevalence was estimated using a random-effects meta-analysis model, alongside stratification and meta-regression to characterize heterogeneity.
Cannabis withdrawal syndrome prevalence was reported as a percentage with 95% CIs.
Of 3848 unique abstracts, 86 were selected for full-text review, and 47 studies, representing 23 518 participants, met all inclusion criteria. Of 23 518 participants included in the analysis, 16 839 were white (72%) and 14 387 were men (69%); median (SD) age was 29.9 (9.0) years. The overall pooled prevalence of CWS was 47% (6469 of 23 518) (95% CI, 41%-52%), with significant heterogeneity between estimates (I2 = 99.2%). When stratified by source, the prevalence of CWS was 17% (95% CI, 13%-21%) in population-based samples, 54% in outpatient samples (95% CI, 48%-59%), and 87% in inpatient samples (95% CI, 79%-94%), which were significantly different (P < .001). Concurrent cannabis (β = 0.005, P < .001), tobacco (β = 0.002, P = .02), and other substance use disorders (β = 0.003, P = .05) were associated with a higher CWS prevalence, as was daily cannabis use (β = 0.004, P < .001).
These findings suggest that cannabis withdrawal syndrome appears to be prevalent among regular users of cannabis. Clinicians should be aware of the prevalence of CWS in order to counsel patients and support individuals who are reducing their use of cannabis.
大麻戒断综合征（CWS）是大麻使用障碍的诊断指标，通常在停止大量和长期使用大麻后出现。迄今为止，CWS 综合征的患病率尚未得到很好的描述，也没有描述与 CWS 相关的潜在因素。
评估经常使用或依赖大麻的个体中 CWS 的患病率，并确定与 CWS 相关的因素。
从数据库成立到 2019 年 6 月 19 日，使用 MEDLINE、Embase、PsycINFO、Web of Science、护理和联合健康文献累积索引、ProQuest、联合和补充医学以及精神病学在线进行文献检索，辅以纳入文章的参考文献手动搜索。
如果文章（1）以英文发表，（2）报告了经常使用大麻素或大麻使用障碍的个体作为主要研究组，（3）使用经过验证的工具报告 CWS 或 CWS 症状的患病率，（4）报告 CWS 的患病率，并且（5）使用观察性研究设计（例如，队列或横断面），则将其纳入。
对所有摘要、全文文章和其他来源进行了审查，并进行了重复数据提取。使用随机效应荟萃分析模型估计 CWS 患病率，并进行分层和荟萃回归以描述异质性。
以百分比（95%CI）报告 CWS 患病率。
在 3848 篇独特的摘要中，有 86 篇被选为全文审查，47 项研究代表 23518 名参与者，符合所有纳入标准。在纳入分析的 23518 名参与者中，16839 名是白人（72%），14387 名是男性（69%）；中位（SD）年龄为 29.9（9.0）岁。CWS 的总体 pooled 患病率为 47%（23518 名中的 6469 名）（95%CI，41%-52%），估计值之间存在显著异质性（I2=99.2%）。按来源分层，基于人群的样本中 CWS 的患病率为 17%（95%CI，13%-21%），门诊样本为 54%（95%CI，48%-59%），住院样本为 87%（95%CI，79%-94%），差异显著（P<0.001）。同时存在大麻（β=0.005，P<0.001）、烟草（β=0.002，P=0.02）和其他物质使用障碍（β=0.003，P=0.05）与更高的 CWS 患病率相关，每日使用大麻（β=0.004，P<0.001）也是如此。
这些发现表明，大麻戒断综合征似乎在经常使用大麻的人群中很常见。临床医生应该意识到 CWS 的患病率，以便为患者提供咨询并支持那些正在减少大麻使用的患者。
Zotero 插件