Marijuana withdrawal

Using marijuana (way, way back when and never,ever inhaling!) made me as fumble-mouthed as an evening news anchor and rather forgetful, so I gave it up before college. I've been surprised to learn, however, in my role as privileged exam room confidante that quite a few people continue to smoke up daily. Before they even go to work! Very few express any desire to quit, and no wonder considering new evidence from Johns Hopkins University researchers.

In a small series, the Baltimore psychiatrists found that subjects withdrawing from regular marijuana use suffered from withdrawal symptoms equivalent to those which occur on giving up cigarettes. The symptoms included irritability, anxiety, difficulty in focusing, and insomnia.

The problem I've come up against in helping those few who'd like to walk away from the marijuana habit is a lack of available medical adjuncts to shore up their will power. We have alternative nicotine delivery systems such as patches, lozenges*, and gum for those giving up cigarettes. A newish drug called Chantix* acts as a weak nicotine analogue in the brain, working on nicotine receptors to release a little bit of the feel-good neurotransmitter called dopamine but not so very much as to perpetuate the addiction. Naltrexone helps alcoholics give up drinking, as, theoretically, does Campral although efficacy data on the latter is not so very convincing.

But, alas, there are no legal marijuana analogues on the market FDA-approved for withdrawal purposes. Marinol (generic ronabinol) is a synthetic version of the active compound in marijuana called delta-9-tetrahydrocannabinol or THC. It is indicated for suppression of nausea associated with cancer chemotherapy or as an appetite stimulant for persons with AIDS. Its use could perhaps supply THC to marijuana addicts in much the same way that Nicoderm provides nicotine to withdrawing cigarette smokers.

Acomplia*** or rimonabant is an endocannabinoid receptor blocker which was developed to help persons with a prediabetic condition called the metabolic syndrome get a grip on their elevated blood fat levels and weight. It would probably take the fun out of smoking marijuana as the THC could not meet up with its receptors if Acomplia was already sitting in place, but it is not available in the US.

The bottom line is that quitting addictions is a lot of unpleasant work. I quit smoking 30 years ago this month, and I'd never care to have to motor my way through another withdrawal experience.
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*A patient recently told me about a nicotine lozenge called Ariva. Sold behind the Walgreen's cigarette counter, 20 lozenges for about the same price as a pack of cigarettes, Ariva was very helpful in her quest to quit. I gave a pack to a near and dear one who wished to cut back on his habit, and the product set off powerful and painful gagging. Great, gagging or smoking, which would you pick?

**A pesky little post-release problem with Chantix has the FDA re-examining safety data. Apparently partially blocking nicotine receptors sets off suicidal depressions in some people.

***Acomplia is also linked with suicidal depression. Apparently, you can't block the body's feel good receptors without making some people feel bad.