From the Guidelines
Marijuana withdrawal symptoms typically include irritability, anxiety, sleep disturbances, decreased appetite, restlessness, depressed mood, physical discomfort, and cravings, and can be managed with a combination of supportive care and medications, as well as non-medication approaches like cognitive behavioral therapy and lifestyle changes. According to the most recent study 1, long-term daily cannabis users may experience non–life-threatening withdrawal symptoms after cessation of cannabis, including irritability, restlessness, anxiety, sleep disturbances, appetite changes, and abdominal pain, which usually occur within 3 days after cessation and may last up to 14 days.
Symptoms of Marijuana 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
Treatment Options
- Supportive care: regular exercise, maintaining a consistent sleep schedule, staying hydrated, eating nutritious meals
- Medications:
- Sleep disturbances: trazodone (50-100mg at bedtime) or low-dose mirtazapine (7.5-15mg at bedtime)
- Anxiety: buspirone (5-10mg twice daily) or hydroxyzine (25-50mg every 6 hours as needed)
- Severe symptoms: gabapentin (300mg three times daily)
- Non-medication approaches: cognitive behavioral therapy (CBT) to develop coping strategies for cravings and emotional symptoms, and seeking psychological support through therapy or support groups
The intensity of withdrawal varies based on factors like duration of use, amount used, and individual physiology, with heavier, long-term users typically experiencing more pronounced symptoms, as noted in the study 1. It is essential to be aware of these symptoms and to provide appropriate care and support to individuals experiencing marijuana withdrawal.
From the Research
Symptoms of Marijuana Withdrawal
- The most common features of cannabis withdrawal are anxiety, irritability, anger or aggression, disturbed sleep/dreaming, depressed mood, and loss of appetite 2, 3.
- Less common physical symptoms include chills, headaches, physical tension, sweating, and stomach pain 2.
- Women reported a stronger cannabis withdrawal syndrome than men, including physical symptoms such as nausea and stomach pain 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 2.
Treatment Options for Marijuana Withdrawal
- Supportive counselling and psychoeducation are the first-line approaches in the management of cannabis withdrawal 2.
- Medications have been used to manage short-term symptoms, such as anxiety, sleep, and nausea 2.
- Gabapentin, delta-9-tetrahydrocannabinol analogs, and mirtazapine have shown promising results in the treatment of cannabis withdrawal syndrome 3, 4, 5.
- Nabilone therapy has been used to treat protracted nausea and vomiting secondary to cannabis withdrawal 6.
- Inpatient admission for medically assisted withdrawal may be clinically indicated for patients who have significant comorbid mental health disorders and polysubstance use 2, 3.
- Cognitive behavior therapy (CBT) combined with other techniques, systemic multidimensional family therapy (MDFT), and motivational talk therapy have been found to be effective in the treatment of cannabis dependence 4.