Coding note: The |CD-9-CM code is 292.0. The |CD-10-CM code for cannabis withdrawal is F12.288. Note that the |CD-10-CM code indicates the comorbid presence of a moderate or severe cannabis use disorder, reflecting the fact that cannabis withdrawal can only oc- cur in the presence of a moderate or severe cannabis use disorder. It is not permissible to code a comorbid mild cannabis use disorder with cannabis withdrawal.
The essential feature of cannabis withdrawal is the presence of a characteristic withdrawal syndrome that develops after the cessation of or substantial reduction in heavy and pro- longed cannabis use. In addition to the symptoms in Criterion B, the following may also be observed postabstinence: fatigue, yawning, difficulty concentrating, and rebound periods of increased appetite and hypersomnia that follow initial periods of loss of appetite and in- somnia. For the diagnosis, withdrawal symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion
C). Many cannabis users report smoking cannabis or taking other substances to help re- lieve withdrawal symptoms, and many report that withdrawal symptoms make quitting difficult or have contributed to relapse. The symptoms typically are not of sufficient se- verity to require medical attention, but medication or behavioral strategies may help alle— viate symptoms and improve prognosis in those trying to quit using cannabis.
Cannabis withdrawal is commonly observed in individuals seeking treatment for can- nabis use as well as in heavy cannabis users who are not seeking treatment. Among indi- viduals who have used cannabis regularly during some period of their lifetime, up to one- third report having experienced cannabis withdrawal. Among adults and adolescents en— rolled in treatment or heavy cannabis users, 50%—95% report cannabis withdrawal. These findings indicate that cannabis withdrawal occurs among a substantial subset of regular cannabis users who try to quit.
The amount, duration, and frequency of cannabis smoking that is required to produce an associated withdrawal disorder during a quit attempt are unknown. Most symptoms have their onset within the first 24—72 hours of cessation, peak within the first week, and last approximately 1—2 weeks. Sleep difficulties may last more than 30 days. Cannabis with- drawal has been documented among adolescents and adults. Withdrawal tends to be more common and severe among adults, most likely related to the more persistent and greater frequency and quantity of use among adults.
Environmental. \Most likely, the prevalence and severity of cannabis withdrawal are greater among heavier cannabis users, and particularly among those seeking treatment for cannabis use disorders. Withdrawal severity also appears to be positively related to the se- verity of comorbid symptoms of mental disorders.
Functional Consequences of Cannabis Withdrawal
Cannabis users report using cannabis to relieve withdrawal symptoms, suggesting that withdrawal might contribute to ongoing expression of cannabis use disorder. Worse out- comes may be associated with greater withdrawal. A substantial proportion of adults and adolescents in treatment for moderate to severe cannabis use disorder acknowledge mod- erate to severe withdrawal symptoms, and many complain that these symptoms make ces- sation more difficult. Cannabis users report having relapsed to cannabis use or initiating use of other drugs (e.g., tranquilizers) to provide relief from cannabis withdrawal symp— toms. Last, individuals living with cannabis users observe significant withdrawal effects, suggesting that such symptoms are disruptive to daily living.
Because many of the symptoms of cannabis withdrawal are also symptoms of other sub- stance withdrawal syndromes or of depressive or bipolar disorders, careful evaluation should focus on ensuring that the symptoms are not better explained by cessation from an- other substance (e.g., tobacco or alcohol withdrawal), another mental disorder (general— ized anxiety disorder, major depressive disorder), or another medical condition.