What are the symptoms of cannabis withdrawal?

From the Guidelines

Cannabis withdrawal symptoms typically include irritability, anxiety, sleep disturbances, decreased appetite, restlessness, depressed mood, and physical discomfort like headaches, sweating, and stomach pain, usually beginning within 24-72 hours after stopping cannabis use and lasting 1-2 weeks. These symptoms occur because the body has adapted to regular cannabis exposure, particularly THC, and needs time to readjust to functioning without it, as noted in a study published in the Journal of Clinical Oncology 1. The endocannabinoid system requires time to return to normal functioning after dependence has developed. Some key points to consider in managing cannabis withdrawal include:

• The severity of withdrawal depends on factors like frequency of use, potency of cannabis consumed, and individual physiology, as discussed in a study published in the British Journal of Anaesthesia 1.
• Management often involves supportive care rather than specific medications, though doctors may prescribe short-term medications for specific symptoms, such as hydroxyzine or buspirone for anxiety, trazodone or melatonin for sleep disturbances, and NSAIDs for headaches or physical discomfort.
• Staying hydrated, maintaining regular sleep patterns, exercising, and seeking social support can help manage symptoms, as suggested in a study published in the Annals of Internal Medicine 1.
• The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM V) criteria for the diagnosis of cannabis withdrawal syndrome include the abrupt cessation of prolonged or heavy cannabis use accompanied by three or more symptoms, such as irritability, anxiety, insomnia, and physical symptoms, as noted in a study published in the British Journal of Anaesthesia 1. It is essential to be aware of the potential for cannabis withdrawal symptoms, especially in individuals with a history of heavy or prolonged cannabis use, and to provide appropriate support and management to mitigate these symptoms, as emphasized in a study published in Gastroenterology 1.

From the Research

Symptoms of Cannabis Withdrawal

The symptoms of cannabis withdrawal can be categorized into several areas, including:

• Mood symptoms:
  • Anxiety 2, 3, 4
  • Irritability 2, 5, 3, 6
  • Anger or aggression 2, 3, 6
  • Depressed mood 2, 3, 6, 4
  • Mood swings 6
• Sleep symptoms:
  • Disturbed sleep/dreaming 2
  • Insomnia 3, 6, 4
  • Sleep-related withdrawal symptoms 4
• Physical symptoms:
  • Chills 2
  • Headaches 2
  • Physical tension 2
  • Sweating 2
  • Stomach pain 2, 3
  • Nausea 3
• Other symptoms:
  • Loss of appetite 2
  • Cravings 2, 6
  • Restlessness 6

Timeline of Symptoms

The onset of symptoms typically occurs 24-48 hours after cessation of cannabis use, with most symptoms peaking at days 2-6 2. However, some symptoms can last up to 3 weeks or more in heavy cannabis users 2. In some cases, symptoms can peak at a later time, such as greater than 40 days after cessation 5.

Factors Influencing Symptom Severity

The severity of cannabis withdrawal symptoms can be influenced by several factors, including:

• Amount of cannabis used pre-cessation 3
• Gender, with women reporting stronger symptoms than men 3
• Heritable and environmental factors 3
• Comorbidity with mental or somatic disorders 3, 6
• Severity of cannabis use disorder 3, 6
• Social functioning 3