What symptoms occur when individuals stop smoking marijuana regularly?

Cannabis Withdrawal Symptoms After Cessation of Regular Use

Regular cannabis users who stop smoking marijuana will typically experience withdrawal symptoms including irritability, anxiety, sleep disturbances, decreased appetite, restlessness, altered mood, and physical discomfort such as abdominal pain, tremors, sweating, fever, chills, or headaches. 1

Diagnostic Criteria and Prevalence

• Cannabis withdrawal syndrome (CWS) is recognized in the DSM-5 and occurs when there is abrupt cessation of prolonged or heavy cannabis use accompanied by three or more characteristic symptoms 1
• Withdrawal symptoms occur in approximately half of regular and dependent cannabis users after stopping use 2
• The incidence of withdrawal can be even higher (50-95%) among highly dependent or in-treatment users 3

Time Course of Withdrawal Symptoms

• Symptom onset typically occurs within 24-48 hours after cessation 2, 4
• Most symptoms peak between days 2-6 of abstinence 2, 5
• Withdrawal symptoms generally last 1-2 weeks, though some symptoms may persist for up to 3 weeks or longer in heavy users 1, 2
• CB1 receptors (downregulated during regular cannabis use) begin to reverse within the first 2 days of abstinence and return to normal functioning within approximately 4 weeks 1, 4

Common Withdrawal Symptoms

Psychological Symptoms

• Irritability or anger 1, 5
• Anxiety 1, 2
• Depressed mood 2
• Restlessness 1
• Altered mood 1

Sleep-Related Symptoms

• Insomnia 1, 2
• Disturbed dreaming 2
• Sleep problems 5

Appetite and Gastrointestinal Symptoms

• Decreased appetite 1, 5
• Stomach pain or abdominal discomfort 1, 5

Physical Symptoms

• Tremors 1
• Sweating 1, 2
• Fever or chills 1, 2
• Headaches 2
• Physical tension 2
• Shakiness 5

Factors Affecting Withdrawal Severity

• The severity of withdrawal symptoms correlates with the amount of cannabis used before cessation 1
• Withdrawal is more likely to occur in those consuming more than:
  • 1.5 g/day of inhaled cannabis 1
  • 300 mg/day of CBD-dominant oil 1
  • 20 mg/day of THC-dominant cannabis oil 1
• Users consuming cannabis products with unknown CBD/THC content more than 2-3 times daily may also develop withdrawal symptoms 1
• Gender differences exist, with women reporting stronger withdrawal symptoms than men, including more physical symptoms such as nausea and stomach pain 4
• Symptoms are unlikely to occur in patients consuming 300 mg/day or less of smoked CBD-dominant cannabis (approximately one cigarette) 1

Clinical Significance

• Withdrawal symptoms can precipitate relapse to cannabis use 2
• The discomfort from withdrawal may contribute to continued use and difficulty quitting 5
• Withdrawal symptoms may theoretically contribute to increased distress and decreased tolerance of pain 1
• The magnitude and time course of cannabis withdrawal appears comparable to tobacco and other withdrawal syndromes 5, 6

Special Considerations

• Complicated withdrawal may occur in people with concurrent mental health conditions and polysubstance use 2
• Cannabis users with opioid dependence are less likely to experience CWS 1
• Cannabis withdrawal may exacerbate psychiatric disorders in vulnerable individuals 1, 7
• Withdrawal from an analgesic or anxiolytic cannabis regimen might contribute to increased pain perception 1

Cannabis withdrawal is a clinically significant syndrome that should be recognized and addressed when individuals stop regular marijuana use, as it can impact quality of life and contribute to relapse if not properly managed.