From the Guidelines
Cannabis withdrawal symptoms typically occur within 24-72 hours after last use, peak within the first week, and generally last 1-2 weeks, with symptoms including irritability, anxiety, sleep disturbances, decreased appetite, restlessness, depressed mood, physical discomfort, and cravings for cannabis 1.
Symptoms of Cannabis Withdrawal
- Irritability or anger
- Anxiety
- Insomnia
- Decreased appetite
- Restlessness
- Altered mood
- Physical symptoms causing significant discomfort, such as abdominal pain, tremors, sweating, fever, chill, or headache These symptoms are a result of the body adapting to regular cannabis use, particularly THC, and needing time to readjust to functioning without it, as noted in a study published in the Journal of Clinical Oncology 1.
Managing Cannabis Withdrawal
For managing withdrawal, a combination of supportive care and medications can help, as suggested by a study in the British Journal of Anaesthesia 2.
- Over-the-counter medications like acetaminophen or ibuprofen can address headaches and physical discomfort
- Sleep aids such as melatonin (3-5mg before bedtime) may help with insomnia
- For severe symptoms, a healthcare provider might prescribe short-term medications like buspirone for anxiety, mirtazapine for sleep and appetite issues, or gabapentin for multiple symptoms
- Staying hydrated, maintaining regular meals despite appetite changes, engaging in light exercise, and practicing relaxation techniques are also beneficial It is essential to note that the severity of withdrawal correlates with the frequency, amount, and duration of previous cannabis use, as highlighted in a study published in 2021 2.
Importance of Vigilance and Education
Vigilance for cannabis withdrawal symptoms should be included in relevant perioperative care plans, especially if a patient’s daily cannabis intake is not replaced or continued in the postoperative period, as recommended by a consensus report in the British Journal of Anaesthesia 2. Suspected cannabis withdrawal should provoke referral to a psychiatry service, and tools like the Cannabis Withdrawal Scale can be used for assessment. Admission for elective surgery may also provide an opportune time for cannabis education, and patients could be involved in self-monitoring for cannabis withdrawal symptoms. Healthcare providers should prioritize educating patients about the risks and symptoms of cannabis withdrawal, as well as the importance of seeking medical attention if symptoms persist or worsen 1.
From the Research
Cannabis Withdrawal Symptoms
- Cannabis withdrawal is a well-characterized phenomenon that occurs in approximately half of regular and dependent cannabis users after abrupt cessation or significant reductions in cannabis products that contain Δ9 -tetrahydrocannabinol (THC) 3
- Symptom onset typically occurs 24-48 hours after cessation and most symptoms generally peak at days 2-6, with some symptoms lasting up to 3 weeks or more in heavy cannabis users 3
- The most common features of cannabis withdrawal are: + Anxiety + Irritability + Anger or aggression + Disturbed sleep/dreaming + Depressed mood + Loss of appetite 3
- Less common physical symptoms include: + Chills + Headaches + Physical tension + Sweating + Stomach pain 3
Management of Cannabis Withdrawal
- Despite limited empirical evidence, supportive counselling and psychoeducation are the first-line approaches in the management of cannabis withdrawal 3
- There are no medications currently approved specifically for medically assisted withdrawal (MAW) 3, 4
- Medications have been used to manage short-term symptoms (e.g. anxiety, sleep, nausea) 3
- A number of promising pharmacological agents have been examined in controlled trials, but these have been underpowered and positive findings not reliably replicated 3, 4
- Some medications (e.g. cannabis agonists) are used 'off-label' in clinical practice 3
Treatment Outcomes
- Abstinence at end of treatment was no more likely with Δ9-tetrahydrocannabinol (THC) preparations than with placebo 4
- There was qualitative evidence of reduced intensity of withdrawal symptoms with THC preparations compared to placebo 4
- Adverse effects were no more likely with THC preparations or N-acetylcysteine compared to placebo 4
- Cognitive and behavioral therapies and motivational enhancement therapies have proven their efficacy in several randomized controlled trials 5
- Brief therapies have also been associated with good compliance and efficacy 5