Identifying risk and protective factors for cannabis hangovers

Abstract

Objective: An understudied topic in the cannabis field is the cannabis hangover. Cannabis hangovers are defined as unwanted consequences of cannabis use occurring either the next-day or same day after the acute effects have worn off. Cannabis hangovers have been described by people who use cannabis in self-report social media posts; however, there are inconsistent findings in the current literature. The inconsistency in the current literature may be largely due to low validity and the limited range of symptoms investigated. The present study sought to identify the prevalence and severity of cannabis hangover symptoms, explore facets of cannabis use (e.g., quantity, frequency, route of administration, tolerance) as predictors, and exploring the associations between protective behavioral strategies (PBS) and cannabis hangover occurrence and severity. Method: 1211 adult college students who reported using cannabis at least once in their lifetime were recruited from the psychology research pool at Colorado State University over 2 semesters. Participants completed a survey on their cannabis use patterns, cannabis hangover experiences, and protective behavioral strategies (PBS) for cannabis use, along with general information questionnaires (e.g., demographics). Results: Overall, the study results provide evidence for heterogeneity in both the endorsement of cannabis hangover symptoms and the severity ratings. 91.4% of the sample reported at least one cannabis hangover symptom with a mean total number of symptoms of 7.5 (SD=6.07). The average mean severity across symptoms was 4.73 (SD=1.69). Each predictor was significantly associated with the likelihood of at least one cannabis hangover symptom. Tolerance and average PBS frequency were the most robust predictors of cannabis hangover symptom occurrence such that tolerance significantly predicted a higher likelihood of endorsing 29 symptoms and average PBS frequency significantly predicted a greater likelihood of not endorsing 19 symptoms. Only flower use, tolerance and average PBS frequency significantly predicted the rate of total number of cannabis hangover symptoms, whereby flower use and tolerance predicted a higher rate of total number of cannabis hangover symptoms and average PBS frequency predicted a lower rate. None of the predictors were significantly associated with cannabis hangover severity ratings. Conclusion: This study describes a high prevalence rate and moderate severity of cannabis hangovers, with tolerance and protective behavioral strategies emerging as key predictors of symptom occurrence and total symptom count. The results suggest that interventions aimed at lowering tolerance and promoting PBS use may be more effective in reducing the occurrence of cannabis hangovers than simply focusing on changing patterns of use. Future research should use longitudinal designs to investigate causal relationships and explore potential confounding variables, such as contextual factors, to better understand cannabis hangover symptom occurrence and severity.