Cannabis withdrawal is becoming an ever-increasing problem because according to the Centers for Disease Control and Prevention (CDC), cannabis or marijuana is the most widely used illicit drug in the United States,

There are doubts about whether people can become addicted to cannabis. The fact is that it is possible to not only become dependent on it but the potential for addiction is very strong with regular use.

What is cannabis withdrawal?

Cannabis withdrawal syndrome consists of a group of abnormal and uncomfortable physical or psychological symptoms that follow the abrupt discontinuation of cannabis after developing physical dependence or addiction to it.

Cannabis addiction is widespread. Over 300,000 people start to take treatment for cannabis addiction in the U.S. each year.

Research from 2012 indicates that 30.6 percent of those who use cannabis had cannabis use disorder in 2012–2013.

People develop an addiction when they use marijuana frequently and regularly and when they attempt to quit, withdrawal symptoms may surface. Studies found 47% of people who regularly used cannabis experienced withdrawal syndrome when they stopped consuming the substance.

The cannabis withdrawal syndrome makes it more difficult to stop using marijuana, but with a sustained effort, it is possible.

Unpleasant physical and psychological symptoms can develop when a long-term, regular user of cannabis suddenly quits.

The way to avoid withdrawal symptoms is by curbing intake or lowering the dose of the substance gradually. Though the effects are usually short-lived, they can be highly uncomfortable.

Who is at a higher risk to experience cannabis withdrawal?

Marijuana withdrawal can develop in people who use it for recreational purposes, as well as in those who use it for medicinal purposes.

It is dose-dependent and heavy, long-term users are most at risk. Again, individuals who have begun using it young before age 18 are 4 to 7 times more prone to develop a marijuana use disorder, and subsequently withdrawal.

Researchers found that there are more women than men seeking help for withdrawal and the symptoms were more severe in women.

Symptoms like irritability, restlessness, increased anger, violent outbursts, and gastrointestinal symptoms like nausea and stomach pain were more severe in women than in men.

Symptoms

Occasional use of cannabis will not cause withdrawal symptoms. With regular and heavy use, your body develops a dependence on the substance and gets addicted. When you abruptly stop using it, your body protests in the form of symptoms. These are called withdrawal symptoms.

Withdrawal symptoms of cannabis peak within the first week of stopping its use, and they can last for 2 weeks. Symptoms of withdrawal can include

  • irritability
  • headaches
  • loss of focus
  • sleeplessness
  • loss of appetite
  • restlessness
  • cravings for cannabis
  • nausea
  • abdominal pain

Diagnostic criteria

The diagnostic criteria to label a patient as having cannabis withdrawal are (DSM-5, 2013):

  • Cessation of heavy or prolonged cannabis use
  • Presentation of at least three of the following withdrawal signs and symptoms within about seven days after stopping cannabis use (the usual onset is within the first 24 to 72 hours of cessation):
    • Irritability or aggression
    • Anxiety or nervousness
    • Difficulties in sleeping such as insomnia and disturbing dreams (may last for more than 30 days)
    • Abdominal pain, fever, chills, headache, sweating, or tremors (at least one of these symptoms causing significant discomfort)
  • There is significant distress or decrease in important areas of functioning.
  • There is no other medical condition or mental disorder producing those symptoms.

Why does marijuana cause withdrawal symptoms when discontinued?

Marijuana withdrawal symptoms are caused by your body adjusting to not getting the usual supply of  Delta-9-tetrahydrocannabinol (THC) from cannabis, which it was getting regularly and for a long time. THC is the main psychoactive ingredient in cannabis that produces the pleasurable intoxicating effect or the “high”. Another component, cannabidiol (CBD) is not as psychoactive as THC and it has other uses.

In individuals who regularly use cannabis, their bodies develop a tolerance for THC. When they stop using cannabis, their bodies react to the new condition by exhibiting certain physical and psychological symptoms

The cannabis plant contains delta-9-tetrahydrocannabinol (THC), with THC contributing to the primary intoxicating effects of marijuana use.

Different types of THC are present in cannabis plants, the most abundant form being delta-9. When people refer to the effects of THC, they’re usually talking about the delta-9 effects.

While THC contributes to the psychoactive effects, Terpenes present in cannabis give the substance its aroma and flavor. The more the concentration of THC in cannabis, the greater its effect on the brain.

Using weed regularly makes the brain and body get used to the regular effect of THC. When you abruptly stop this supply, the body has depended on this supply and takes some time to adjust to not having it. It then protests and you then experience uncomfortable physical and psychological withdrawal symptoms.

The physical symptoms will stop once the brain and body have adjusted to not having THC, but psychological cravings will persist for some time.

Over the years, it has been found the concentration of THC in cannabis being supplied has steadily increased from around 3.8 percent in the 1990s to 12.2 percent in 2014. This is evident from the confiscated cannabis samples.

This simply means that the addictive effects and the withdrawal symptoms of cannabis are more severe as compared to the effect of previous decades. Higher concentrations make you more prone to becoming addicted and similarly more prone to withdrawal after cessation of cannabis.

Marijuana withdrawal timeline

How long withdrawal symptoms will vary and depend on the frequency of use, the quantity used, and an individual’s overall physical and mental health.

The physical withdrawal effects will cease after the drug has vanished from the person’s system. However, the psychological symptoms can last longer.

According to research, the brain receptors called cannabinoid 1 receptors begin to adjust and return to their normal state after 2 days of stopping cannabis, and they start to function normally within 4 weeks of stopping the use of the substance.

How long do cannabis withdrawal symptoms last?

The cannabis withdrawal timeline varies in individuals, but generally, their timeline is along the following lines:

  • First three days: Symptoms of weed withdrawal begin immediately. They are most severe around day three of cannabis abstinence. There may be vomiting accompanied by abdominal pain. You may feel restless and sweat excessively during this stage. Difficulty in sleeping is a very strong problem and there will be a strong urge to use marijuana again. Relapses are not uncommon during this time. You should seek professional help if you feel the need for treatment to tide over the strong urge.
  • 4 to 10 days: Cannabis withdrawal symptoms will peak during this phase. By day four of cannabis abstinence, most of the physical symptoms will start to decrease, but the mental withdrawal effects become stronger in most individuals. Depression is very common during this phase, which may stay throughout the first week after withdrawal.
  • 10-20 days: Withdrawal symptoms begin to lessen during this period. At the end of the second week, you begin to feel stable. You should continue your ongoing treatment in spite of feeling strong.

Usually, within 30 days cannabis is completely excreted from the body. The effects may not last that long though. In most cases, the withdrawal symptoms last at the most for three weeks, and sometimes for less.

Fatigue and difficulty in falling asleep may still be present throughout the first month. Though there is substantial improvement in the symptoms, some people especially those with prolonged and heavy consumption may experience psychological symptoms for several weeks or months.

Anxiety and depression may remain for several months in such individuals and traces of cannabis may be found in their bodies even three months after quitting.

Treatment

People with cannabis withdrawal rarely require medical intervention. The symptoms are usually not as dangerous as those experienced with alcohol or opioid withdrawal.

However, inpatient detoxification may be useful for those individuals for whom withdrawal symptoms can be dangerous, or even fatal. Such individuals include those

  • suffering from co-existing marijuana abuse and mental health disorders
  • diagnosed with severe cannabis use disorder
  • who are victims of abuse of additional substances such as opioids and alcohol along with marijuana.
  • Medication regimes

Medications

No particular medications have yet been found to effectively treat cannabis withdrawal. Treatment of cannabis withdrawal consists of short-term medications to give symptomatic relief to the person.

Such medicines may include:

  • Diazepam 5 to 10mg QID or as needed for a maximum of seven to 10 days. If diazepam does not relieve agitation, olanzapine 2.5 to 5mg BD or as needed may be prescribed for seven to 10 days
  • Metoclopramide 10 to 20mg TDS or as needed for nausea
  • Analgesics (for example paracetamol).

Psychotic symptoms such as delusions (false beliefs) and hallucinations are managed with antipsychotic medication such as olanzapine or risperidone for up to two weeks.

Psychiatric treatment will help if the symptoms are severe or persistent.

Sleep disturbance, which can persist for weeks, should be managed with assurances and as far as possible without medications. Insomnia (sleeplessness) can be managed using certain guidelines:

Tips to manage withdrawal