Clinical withdrawal symptom profile of synthetic cannabinoid receptor agonists and comparison of effects with high potency cannabis

Synthetic cannabinoid receptor agonists (SCRAs) may be used as an alternative to natural cannabis; however, they may carry a greater risk of problematic use and withdrawal. This study aimed to characterise the withdrawal symptom profile of SCRAs and compare their profile of effect with high-potency herbal cannabis. Global Drug Survey data (2015 and 2016) were used to access a clinically relevant sample of people reporting use of SCRAs >10 times in the past 12-months, a previous SCRA quit attempt, and lifetime use of high-potency herbal cannabis. Participants completed an 11-item SCRA withdrawal symptom checklist and compared SCRAs and high-potency herbal cannabis on their onset and duration of effects, speed of the development of tolerance, severity of withdrawal, and difficulty with dose titration. Participants (n = 284) reported experiencing a mean of 4.4 (95% CI: 4.1, 4.8) withdrawal symptoms after not using SCRAs for >1 day; most frequently reported were sleep issues (59.2%), irritability (55.6%), and low mood (54.2%). Withdrawal symptoms were significantly associated with frequency (>51 vs. 11–50 times per year: IRR = 1.43, 95% CI: 1.16, 1.77, p = 0.005) and quantity (grams per session: IRR = 1.13, 95% CI: 1.05, 1.22, p = 0.001) of SCRA use. Compared to high-potency herbal cannabis, SCRAs were rated as having a faster onset and shorter duration of effects, faster development of tolerance, and more severe withdrawal (p’s < 0.001). In conclusion, SCRA withdrawal symptoms are more likely to occur after greater SCRA exposure. The effects of SCRA indicate a more severe withdrawal syndrome and a greater risk of problematic use than natural cannabis.

Withdrawal Symptoms Among American Collegiate Internet Gamers

We examined the gaming patterns and withdrawal symptomology of 144 American collegiate internet gamers. Our findings indicated that Internet Gaming Disorder Scale (IGDS) scores positively correlated with withdrawal symptomology. The 10 most endorsed withdrawal symptoms were craving to game, impatience, increased sleeping, increased eating, lack of pleasure, irritable/angry, anxious/tense, restless, difficulty concentrating, and increased dreaming. Only 27.1% of gamers did not endorse any withdrawal symptoms. A MANOVA revealed significant differences in IGDS and withdrawal symptom scores among gamers who preferred to game alone, with others in person, with others online, or with others in person and online (8.1% variance explained). Specifically, IGDS scores were higher among gamers who preferred to game with others online compared with other modalities. Withdrawal symptoms did not significantly discriminate between groups. Finally, many gamers indicated that if internet gaming were not available, they would be more likely to engage in other potentially addictive behaviors.