Author: Alex Thompson
Clinical management of cannabis withdrawal PMC
All medications have side‐effects and these need to be balanced against potential benefits from their unknown efficacy in this population. The first days and weeks after quitting marijuana can be a rollercoaster of thoughts, physical symptoms, and emotions. Though we provide a general timeline of typical withdrawal symptoms, everyone is different. Your experience with withdrawal is influenced by how much and how long you’ve used as well as a host of biological and psychosocial factors that make your experience wholly unique. So, use this as a general outline to mentally prepare yourself for what’s to come, but don’t be alarmed if your experience is a little different. Generally, symptoms of withdrawal begin within the first 24 hours of abstinence, peak by day three and can last for up to two to three weeks or longer.
Skills training in CBT such as relaxation approaches, pleasant activity scheduling, managing stress/mood/anger and goal‐setting may be of clinical benefit. This review describes the diagnosis, prevalence, course and management of cannabis withdrawal and highlights opportunities for future clinical research. According to the CDC, research has linked cannabis use with numerous negative health consequences. These include memory problems, an increased risk of stroke and heart disease, lung problems from smoke, and mental health symptoms such as those related to anxiety and paranoia.
Why are alternative forms of cannabinoids effective cessation tools?
By the end of your first week, most of the physical symptoms of withdrawal will have begun to show signs of improvement—for some, these will go away completely. Even so, people may continue to struggle with sleep, lack of energy, or loss of appetite. In some people, decreased appetite may even result in significant weight loss.
For regular, long-term cannabis consumers who want to take a tolerance break or need to abstain completely, cannabis withdrawal syndrome can be a mild but very real challenge. It’s nowhere near the severity of withdrawal induced by tobacco, alcohol, or other drugs, but it may be irritating and mildly discomforting for a few days. In fact, it may most resemble the withdrawal a daily coffee drinker might feel upon going cold turkey. In some cases, marijuana users have experienced several weeks or months of withdrawal symptoms.
“Cannabis metabolites accumulate in body fat and can take weeks to leach out of the body, so some effects of withdrawal may last a long time,” says Umhau. When withdrawing from marijuana, you might feel extra edgy and irritable, have trouble sleeping and eating, and may even get a stomachache or headache. Whatever name you give it—cannabis, weed, pot, etc—marijuana is the most commonly used illicit drug and you probably know someone who partakes. It feels dated to even call it an illicit drug but despite some form of legalization in 24 states, it is still outlawed at a federal level. No pharmacological approaches have been approved to prevent risk of relapse to CUD during or after MAW [77]. The two most effective stand‐alone behavioural interventions are cognitive–behavioural therapy (CBT) and motivational enhancement therapy (MET).
Cannabis is commonly used with tobacco [70], and in treatment‐seeking cannabis users approximately two‐thirds also use tobacco [71]. Tobacco withdrawal symptoms overlap with cannabis withdrawal and may have a similar intensity and time‐course [72, 73]. Table 4 outlines the withdrawal features observed in this complex case and possible management.
Benefits of Living a Sober Life
Typically, early symptoms of withdrawal include irritability and feeling edgy. If depression doesn’t lift after a week or two, is impacting functioning, or seems overwhelming, seek help from a healthcare provider or substance abuse counselor. As with other mood changes, depression can be substance-induced or pre-existing to cannabis use. Although regular marijuana smokers may not believe that they’re addicted to the drug, experiencing cravings is a hallmark of addiction.
“For many people who smoke marijuana, withdrawal is a non-issue,” says Roger Roffman, a University of Washington researcher who studied cannabis use for more than 25 years. People who consume cannabis occasionally, or use a higher amount for a short period of time, generally don’t experience any withdrawal symptoms. “But the person who smokes a lot of dope for quite a long period of time is likely to have an experience of withdrawal,” Roffman says. Individuals who are addicted to marijuana and plan to get sober should attend a professional addiction treatment program.
- Over the years, based on samples of confiscated cannabis, potency has steadily increased.
- All medications have side‐effects and these need to be balanced against potential benefits from their unknown efficacy in this population.
- The time span and severity of symptoms will differ from person to person, Roffman adds.
- The severity of CWS among humans “is dependent on the amount of cannabis used pre-cessation, gender, and heritable and several environmental factors,” the German researchers noted.
There is considerable overlap of features between DSM‐5 and MWC and CWS, but not complete concordance. An adaption of the MWC, the 14‐item composite withdrawal scale (WDS [26]), corresponds more closely with cannabis withdrawal symptoms described in the DSM‐5. By comparison with other substance withdrawal scales (e.g. alcohol withdrawal scale), there has been limited psychometric validation of the various cannabis withdrawal scales.
Other Physical Symptoms
Others report feelings of aggression, nervousness, restlessness, and a loss of concentration. Once the brain and body have adjusted to not having THC, the physical withdrawal symptoms will stop. According to the Centers for Disease Control and Prevention (CDC), marijuana is the most commonly used federally illegal substance in the U.S. In 2020, over 49 million people 12 years old or older reported using marijuana within the past year. With more and more states legalizing marijuana, use is increasing — and more information is coming to light about marijuana addiction and cannabis withdrawal.
However, based on a 2018 survey from Washington State, legalization does not seem to have significantly increased use. The patient is currently on sick leave but has a history of stable employment.
Treating Marijuana Withdrawal and Addiction
Physical weed withdrawal symptoms tend to be less intense, peak sooner, and fade more quickly than psychological symptoms. The management of substance withdrawal typically includes pharmacological agents which reduce clinically significant withdrawal symptoms. Cannabis does not have any approved medications for MAW, despite a well‐recognized and clinically significant withdrawal profile. A number of novel agents have been examined with some promising results (Table 2). This is an important avenue of future research, with some agents showing early efficacy. For this reason, cannabis agonists have been cautiously used ‘off‐label’ for cannabis withdrawal.
Researchers have linked marijuana use to a higher risk of serious health conditions, including memory issues, heart disease, stroke, lung disease, and mental health disorders such as anxiety, depression, and paranoia. When individuals attend inpatient and outpatient treatment programs, they receive an array of behavioral therapies to help them recover from the psychological aspects of addiction. Oftentimes, this includes individual therapy, group counseling, family therapy, and relapse prevention planning.
days to 1 Week After Quitting
Most pharmacological studies of withdrawal include some form of concurrent behavioural intervention, but the differential efficacy of these behavioural approaches has not been assessed (Table 2). Over the years, based on samples of confiscated cannabis, potency has steadily increased. The THC content has risen from around 3.8 percent in the 1990s to 12.2 percent in 2014. In recent years, more states have legalized the recreational and medicinal use of weed.