Women Entering Cannabis Treatment Had More Severe Withdrawal, More Psychiatric Conditions, and More Pain Than Men | Research

The takeaway

Among 302 treatment-seeking cannabis-dependent adults, women reported significantly greater withdrawal intensity, more psychiatric disorders, and more pain despite similar levels of cannabis use as men.

Women experiencing cannabis dependence or considering treatment.

Women reported greater withdrawal intensity (p = 0.001) despite identical cannabis use levels

What the researchers found

Comparing 86 women and 216 men entering a multi-site cannabis cessation trial, women presented with a more clinically complex picture despite using cannabis at similar rates and quantities.

Women reported significantly greater withdrawal intensity (p = 0.001) and negative impact of withdrawal (p = 0.001), driven primarily by physiological and mood symptoms. Women were more likely to have lifetime panic disorder (p = 0.038) and current agoraphobia (p = 0.022). They reported more days of poor physical health (p = 0.006) and more cannabis-related medical problems (p = 0.023).

Among those with chronic pain, women reported significantly higher pain scores than men (p = 0.006). Importantly, men and women did not differ on any baseline measures of cannabis use itself, meaning the clinical differences were not explained by women using more cannabis.

Why it matters

Women have fared worse than men in cannabis pharmacotherapy trials, and this study helps explain why: they enter treatment with more severe withdrawal, more psychiatric comorbidity, and more pain. This suggests that one-size-fits-all cannabis treatment approaches may disadvantage women, and that gender-specific treatment planning could improve outcomes.

The numbers in context

86 women, 216 men. Women had greater withdrawal intensity (p = 0.001) and negative impact (p = 0.001). Lifetime panic disorder: women more likely (p = 0.038). Current agoraphobia: women more likely (p = 0.022). More days poor physical health (p = 0.006). Higher pain scores among those with chronic pain (p = 0.006). No differences in cannabis use measures.

How the study worked

Baseline comparison of women (n = 86) and men (n = 216) entering the ACCENT study, a multi-site randomized controlled trial of N-acetylcysteine for cannabis cessation within the National Drug Abuse Treatment Clinical Trials Network.

What this study cannot tell us

Treatment-seeking population may not represent all cannabis-dependent individuals. Women were underrepresented (28% of sample), limiting statistical power for some comparisons. Cross-sectional baseline data cannot determine whether the sex differences are causes or consequences of cannabis dependence. The study examined baseline profiles but did not report treatment outcomes by gender.

How to read the evidence

Moderate evidence from baseline data of a multi-site RCT with adequate sample size.

When this study was published

Published in 2017. Gender-specific cannabis treatment approaches continue to develop.

The bigger picture

Sex and gender differences in substance use disorders are increasingly recognized across all substances, not just cannabis. This study contributes to the pattern: women tend to present with more psychiatric comorbidity and withdrawal severity across multiple substances. For cannabis specifically, these findings may partly explain the "telescoping" effect, where women progress from first use to dependence faster than men.

Questions still open

Would cannabis treatment programs that address co-occurring psychiatric disorders improve outcomes for women? Are the sex differences in withdrawal biological (hormonal) or psychosocial? Should clinical trials for cannabis use disorder stratify by sex to ensure adequate female representation?

Common questions

Is cannabis withdrawal worse for women?

This study found that women entering cannabis treatment reported significantly more intense withdrawal symptoms, particularly physiological and mood symptoms, compared to men who used cannabis at the same rates. This aligns with other research suggesting sex-based differences in withdrawal severity.

Why do women have worse outcomes in cannabis treatment trials?

This study suggests one explanation: women enter treatment with more severe withdrawal, more psychiatric comorbidity (panic disorder, agoraphobia), and more pain. These additional burdens may make treatment harder, not because the treatment itself is less effective for women, but because women face more challenges going in.

Read the original research

Gender differences among treatment-seeking adults with cannabis use disorder: Clinical profiles of women and men enrolled in the achieving cannabis cessation-evaluating N-acetylcysteine treatment (ACCENT) study.

The American journal on addictions, 26(2), 136-144

View on PubMed ↗Publisher’s paper ↗

Citation

Sherman, Brian J; McRae-Clark, Aimee L; Baker, Nathaniel L; Sonne, Susan C; Killeen, Therese K; Cloud, Kasie; Gray, Kevin M. (2017). Gender differences among treatment-seeking adults with cannabis use disorder: Clinical profiles of women and men enrolled in the achieving cannabis cessation-evaluating N-acetylcysteine treatment (ACCENT) study.. The American journal on addictions, 26(2), 136-144. https://doi.org/10.1111/ajad.12503