How is THC (Tetrahydrocannabinol) addiction treated?

Treatment of THC (Cannabis) Addiction

THC addiction should be treated with a combination of behavioral therapies and supportive care, with medication-assisted treatments considered for managing withdrawal symptoms in heavy users. 1, 2

Assessment of Cannabis Use

• Determine frequency, quantity, THC content, duration, and method of use:

  • Heavy use: >1.5 g/day of inhaled cannabis, >300 mg/day CBD oil, or >20 mg/day THC oil
  • Moderate use: Daily or almost daily use with some functional impairment
  • Light use: Occasional use without evidence of dysfunction

• Screen for cannabis use disorder (CUD) using validated tools such as the revised Cannabis Use Disorder Identification Test 1

• Assess for withdrawal symptoms:

  • Psychological: irritability, anxiety, restlessness, mood changes, sleep disturbances, decreased appetite
  • Physical: headaches, abdominal pain, tremors, sweating, fever, chills 2

Treatment Approach

1. Behavioral Therapies (First-Line)

• Cognitive-behavioral therapy (CBT): Helps identify triggers and develop coping strategies 1, 2

• Motivational enhancement therapy: Increases motivation to change cannabis use patterns 2

• Contingency management: Provides incentives for abstinence 1

• Relapse prevention: Focuses on identifying high-risk situations and developing coping strategies 1

• Multidimensional family therapy: Comprehensive family-centered treatment, especially effective for adolescents 1

2. Management of Cannabis Withdrawal Syndrome

For patients with heavy cannabis use (>1.5 g/day of high-THC cannabis or >20 mg/day of THC oil) experiencing withdrawal:

• Dronabinol (synthetic THC): Start at lowest available dose and titrate slowly based on symptom response; typical treatment duration 1-2 weeks 2

• Supportive care:

  • Quiet, supportive environment
  • Adequate hydration
  • Acetaminophen or NSAIDs for headaches and pain
  • Benzodiazepines for severe anxiety and agitation (short-term use only) 2

• For severe symptoms: Consider psychiatric consultation and specialist-guided substitution with nabilone or nabiximols 1, 2

3. Medication Options for Cannabis Use Disorder

Currently, no medications are FDA-approved specifically for cannabis use disorder, but evidence suggests:

• N-acetylcysteine: May help reduce cravings and promote abstinence, especially in adolescents (experimental) 3

• Gabapentin: May help with sleep disturbances, anxiety, and cravings (experimental) 3

• Cannabidiol (CBD): May help manage withdrawal symptoms without psychoactive effects (experimental) 2, 3

Special Considerations

Cannabinoid Hyperemesis Syndrome (CHS)

For patients presenting with cyclical vomiting:

• Complete cannabis cessation
• IV fluid rehydration
• Dopamine receptor antagonists (e.g., haloperidol 0.5-2 mg IV/PO every 4-6 hours)
• Hot showers/baths or topical capsaicin cream 2

High-Risk Populations

• Adolescents and young adults: Higher risk of adverse neurodevelopmental effects; prioritize abstinence 2, 4

• Patients with psychiatric disorders: Cannabis use may exacerbate symptoms; integrated treatment addressing both conditions is essential 2

• Patients with cardiovascular disease: Use caution with medications that may increase heart rate or blood pressure 2

Follow-Up and Monitoring

• Schedule follow-up within 1-2 weeks of initiating treatment

• Monitor for:

  • Continued cannabis use
  • Withdrawal symptoms
  • Treatment adherence
  • Emergence of psychiatric symptoms

• Consider referral to addiction specialist if:

  • Patient fails to reduce use despite primary care interventions
  • Severe withdrawal symptoms persist
  • Comorbid substance use or psychiatric disorders present 1, 4

Harm Reduction

For patients unwilling or unable to achieve abstinence:

• Encourage reduction in frequency and amount of use
• Suggest switching from smoking to less harmful methods of administration
• Advise against driving or operating machinery while under the influence
• Recommend avoiding high-potency THC products 1, 2

Common Pitfalls to Avoid

• Underestimating withdrawal: Cannabis withdrawal is real and can be severe enough to cause relapse

• Focusing only on cannabis: Screen for and address polysubstance use and co-occurring mental health conditions

• Inadequate follow-up: Cannabis use disorder is a chronic condition requiring ongoing support and monitoring

• Stigmatization: Approaching cannabis addiction as a moral failing rather than a treatable medical condition 5

Remember that successful outcomes for substance use disorders are as likely as for chronic diseases such as diabetes, hypertension, and asthma when evidence-based approaches are used 1.