From the Guidelines
Cannabis withdrawal symptoms typically include irritability, anxiety, sleep disturbances, decreased appetite, restlessness, depressed mood, and physical discomfort like headaches, sweating, chills, and stomach pain, usually beginning within 24-72 hours after stopping cannabis use and lasting 1-2 weeks. These symptoms are a result of the body adapting to regular cannabis use, particularly THC, which affects brain neurotransmitters, and when cannabis use stops, the brain must readjust to functioning without THC, causing temporary imbalances that manifest as withdrawal symptoms 1.
Key Symptoms
- 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 The severity of withdrawal typically correlates with the frequency, amount, and duration of previous cannabis use 1.
Management
Management often involves supportive care rather than specific medications, though doctors may prescribe medications for specific symptoms: hydroxyzine or buspirone for anxiety, trazodone or melatonin for sleep disturbances, and NSAIDs for physical discomfort 1. Staying hydrated, maintaining a healthy diet, exercising regularly, and seeking social support can help manage symptoms. It is essential for clinicians to be aware of these symptoms and provide appropriate care, especially in the postoperative period, where cannabis withdrawal could potentially contribute to morbidity 1.
From the Research
Symptoms of Cannabis Withdrawal
The symptoms of cannabis withdrawal can be categorized into common and less common features.
- Common features include:
- Anxiety
- Irritability
- Anger or aggression
- Disturbed sleep/dreaming
- Depressed mood
- Loss of appetite
- Less common physical symptoms include:
- Chills
- Headaches
- Physical tension
- Sweating
- Stomach pain
- Nausea 2
Onset and Duration of Symptoms
Symptom onset typically occurs 24-48 hours after cessation, with most symptoms peaking at days 2-6 3. However, some symptoms can last up to 3 weeks or more in heavy cannabis users 3. In some cases, symptoms can peak at a significantly delayed time, greater than 40 days after cessation 4.
Treatment of Cannabis Withdrawal
There are no medications currently approved specifically for medically assisted withdrawal (MAW) of cannabis 3. However, some medications have been used to manage short-term symptoms, such as anxiety, sleep, and nausea 3. Gabapentin, Lofexidine, Mirtazapine, Quetiapine, and Zolpidem have shown some benefits for treating sleep difficulties associated with cannabis withdrawal 5. Dexmedetomidine has also been used to treat delayed peak symptoms of cannabis withdrawal syndrome 4.
Factors Influencing Withdrawal Severity
The severity of cannabis withdrawal syndrome (CWS) is dependent on the amount of cannabis used pre-cessation, gender, and heritable and environmental factors 2. Women may report stronger CWS than men, including physical symptoms such as nausea and stomach pain 2. Comorbidity with mental or somatic disorders, severe CUD, and low social functioning may require inpatient treatment 2.