Unequal Burden: Sex Differences in Cannabis Withdrawal Symptom Severity in People With Multiple Sclerosis-A Short Report

People with multiple sclerosis (MS) frequently use cannabis to manage symptoms such as pain, spasticity, and sleep disturbance. During abstinence, withdrawal symptoms may overlap with MS-related complaints, complicating cessation. This study examined whether cannabis withdrawal trajectories differ by sex during monitored abstinence in people with MS.

Nineteen frequent cannabis users with MS (11 women) completed 28 days of monitored abstinence. Withdrawal symptoms were assessed using the Cannabis Withdrawal Questionnaire (CWQ) at baseline and weekly through day 28. Abstinence was verified using creatinine-adjusted urinary THC-COOH ratios. Mood was assessed using the Hospital Anxiety and Depression Scale (HADS) at baseline and day 28. A repeated-measures analysis of covariance examined time × sex effects, adjusting for demographic, disability, and cannabis-use covariates.

At baseline (preabstinence), women reported higher CWQ scores than men. On day 28, women again showed higher scores. A significant time × sex interaction (Pillai trace = .784; P = .018; partial η² = .784) indicated distinct symptom trajectories across abstinence. Women reported greater irritability, sleep disturbance, physical tension, nausea, and headaches. HADS scores remained stable and within normal limits for both sexes.

Women with MS demonstrated a more pronounced and sustained increase in CWQ symptom burden over the abstinence period than men. These findings likely reflect both withdrawal-related effects and the unmasking of underlying MS-related symptoms. Cannabis cessation appears psychologically tolerable in people with MS, though women may require closer monitoring and targeted support during abstinence.