Gender differences among treatment-seeking adults with cannabis use disorder

• Cannabis remains the most commonly used illicit drug in the U.S. with an estimated 22.2 million people aged 12 or older reporting past month usage in 2014.
• Of those who ever use cannabis, approximately 9% will meet lifetime criteria for cannabis use disorder (CUD), increasing to 16.6% for those who first use in adolescence.
• Men and women demonstrate differing behavioral, clinical, and neural correlates of cannabis use; for example, men are more likely to initiate cannabis use and be diagnosed with CUD, and women typically demonstrate greater abuse-related potential and sensitivity to withdrawal.

Recent evidence also suggests that women may fare worse than men in cannabis trials with pharmacologic interventions. Identifying baseline clinical profiles of treatment-seeking cannabis-dependent adults could inform gender-specific treatment planning and development. This study compared baseline demographic, cannabis use, and psychiatric factors between women (n=86) and men (n=216) entering the Achieving Cannabis Cessation-Evaluating N-acetylcysteine Treatment (ACCENT) study, a multi-site, randomized controlled trial conducted within the NIDA Clinical Trials Network.
Results found that, compared to men in treatment for CUD, women in treatment for CUD:

• reported greater withdrawal intensity and negative impact of withdrawal, especially regarding physiological, sleep, and mood symptoms (headaches, nausea, nightmares, irritability, e.g.);
• were more likely to have lifetime panic disorder and current agoraphobia, and report more days of poor physical health and cannabis-related medical problems;
• Additionally, women reported more days of poor physical health, and those reporting chronic pain had greater mean pain scores than men with chronic pain. Men and women did not differ on any measures of baseline cannabis use.
• Conclusions: Cannabis-dependent women may present for treatment with more severe and impairing withdrawal symptoms and psychiatric conditions compared to cannabis-dependent men. This might help explain recent evidence suggesting that women fare worse than men in cannabis treatment trials of pharmacologic interventions. Baseline clinical profiles of treatment-seeking adults can inform gender-specific treatment planning and development. Cannabis-dependent women may benefit from integrated treatment focusing on co-occurring psychiatric disorders and targeted treatment of cannabis withdrawal syndrome.

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