Elsevier

Drug and Alcohol Dependence

Volume 144, 1 November 2014, Pages 153-159
Drug and Alcohol Dependence

Long-term cannabis abuse and early-onset cannabis use increase the severity of cocaine withdrawal during detoxification and rehospitalization rates due to cocaine dependence

https://doi.org/10.1016/j.drugalcdep.2014.09.003Get rights and content

Highlights

Abstract

Background

Long-term and early-onset cannabis consumption are implicated in subsequent substance- related problems. The aim of this follow-up study was to investigate whether these patterns of cannabis use could impact cocaine withdrawal severity and cocaine craving intensity during detoxification. In addition, we investigated their impact in the rehospitalization rates due to cocaine dependence 2.5 years after detoxification assessment.

Methods

The sample was composed of 93 female cocaine-dependent inpatients who were enrolled in an inpatient detoxification unit. Cocaine withdrawal symptoms were measured at the 4th, 9th and 14th days of detoxification using the cocaine selective severity assessment (CSSA). Data on the age of first years of drug use – alcohol, cannabis and cocaine – and the years of substance abuse were obtained using the Addiction Severity Index (ASI-6). Other relevant clinical variables were also investigated, including a 2.5 years follow-up assessment of number of rehospitalization due to cocaine dependence.

Results

Early-onset cannabis use and long-term cannabis abuse were associated with an increase instead of a reduction in the severity of cocaine withdrawal symptoms and craving intensity during detoxification. In addition, long-term cannabis abuse predicted higher number of rehospitalization due to cocaine dependence after 2.5 years of the first detoxification assessment.

Conclusions

Early-onset cannabis use and long-term cannabis abuse are associated with a worse detoxification treatment response. Our findings may help to identify patients who will struggle more severely to control cocaine withdrawal syndrome during early drug abstinence, and indicate that cannabis use prior to cocaine withdrawal should be considered an adverse factor.

Introduction

Early-onset drug use is considered a significant predictor of the subsequent development of drug abuse and dependence (Sintov et al., 2009, Trenz et al., 2012). Around 34% of adolescents in the U.S. reported early-onset use of tobacco, alcohol and illicit substances (Moss et al., 2014), but during this period cannabis is the most popular illicit drug (Chadwick et al., 2013). Therefore, previous studies have shown that a significant percentage of teens (5.6%) who initiate cannabis use before the age of 15 report daily substance use and further drug abuse (Johnston et al., 2004), suggesting that early-onset cannabis use is a risk factor for further drug-related problems (Lynskey et al., 2003). However, the debate regarding the harmful consequences of cannabis consumption is still ongoing and the main reasons for this include the poor quality of current evidence and the small number of studies on this topic (Calabria et al., 2010).

Early-onset cannabis use and abuse are also associated with potential progression to the use of other illicit substances such as cocaine. Estimations regarding the prevalence of cannabis use among primary cocaine users range between 50 and 70% (Hall and Lynskey, 2005, Lynskey et al., 2003, Wagner and Anthony, 2002). Moreover, the treatment of cocaine dependence conventionally involves detoxification programs for the management and reduction of drug craving and abstinence symptoms. However, the severity of withdrawal symptoms can vary among drug users (Francke et al., 2013), and multiple factors, including the history of other substance consumption, could impact treatment response (Ahmadi et al., 2008). In this sense, recent evidence indicated that concomitant cocaine and long-term cannabis use might increase craving for cocaine during drug abstinence (Fox et al., 2013). Therefore, a potential role of patterns of cannabis consumption in cocaine dependence-related problems is suggested.

Despite that, research has yet to address the consequences of cannabis use on specific clinical manifestations during the initial period of cocaine detoxification. This topic is of particular interest given that the severity of cocaine withdrawal symptoms at the first two weeks of treatment is a robust predictor of the ensuing treatment response (Kampman et al., 2001, Kampman et al., 2004). Therefore, the aim of this follow-up study was to investigate whether long-term cannabis abuse and early-onset cannabis use could impact cocaine withdrawal severity and cocaine craving intensity during the first two weeks of detoxification treatment. In addition, we investigated the impact of cannabis consumption patterns in the rehospitalization rates due to cocaine dependence after 2.5 years of assessment.

Section snippets

Participants

One hundred and twenty-two female cocaine-dependent inpatients of a detoxification treatment public hospital unit in Southern Brazil took part in this study. Inclusion criteria were as follows: (1) age 18 to 45; (2) diagnosis of physiological dependence on cocaine (smoked or snorted) according to the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV). Participants were excluded from this study if (1) for any reason they did not report or did not provide reliable

Descriptive statistics

All participants reported having smoked cocaine and 89% reported having snorted cocaine as well. Overall, 66% of the sample reported early-onset cannabis use and 52% reported long-term cannabis abuse.

Participants with early-onset cannabis use presented a higher severity of cocaine withdrawal symptoms and specific cocaine craving symptoms at the 14° day of detoxification compared with those with late-onset cannabis use (see Table 1). In addition, a trend association was found between early-onset

Discussion

The current study shows that long-term cannabis abuse and early-onset cannabis use are associated with a worse detoxification treatment response in a cohort of female inpatients with cocaine dependence. More specifically, patients who exhibit more severe cocaine withdrawal symptoms at the end of two weeks of detoxification also reported early-onset cannabis use or a prolonged history of cannabis abuse. Such histories of cannabis consumption were associated with an increase, instead of a

Role of funding source

This study was supported by MCT/CT-Saúde—DECIT/SCTIE/MS, Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) (Grant number 402723/2010-4) and Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS) (Grant number 11/1302-7). The funding source had no involvement in study design, in the collection, analysis and interpretation of data, in the writing of the report, and in the decision to submit the paper for publication.

Contributors

Authors Viola T.W., J.C. Pezzi and Grassi-Oliveira R. designed the study and wrote the protocol. Authors Viola T.W., Tractenberg S.G., Wearick-Silva, L.E. and Rosa, C.S.O., managed the literature searches and summaries of previous related work. Authors Viola T.W., Wearick-Silva, L.E. and Grassi-Oliveira R. undertook the statistical analysis, and authors Viola T.W. and Tractenberg S.G. wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.

Conflict of interest

All authors declare that they have no conflicts of interest.

Acknowledgements

The authors would like to thank all members of GNCD and Sistema de Saúde Mãe de Deus.

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