Treatment for Cannabis Withdrawal
Cannabis withdrawal should be managed in a supportive environment with symptomatic medication for relief of symptoms such as agitation and sleep disturbance, while cannabis cessation remains the primary treatment focus. 1, 2
Cannabis Withdrawal Syndrome Characteristics
- Cannabis withdrawal symptoms typically occur within 24-48 hours after cessation, peak at days 2-6, and can last up to 3 weeks in heavy cannabis users 2
- Common withdrawal symptoms include irritability, restlessness, anxiety, sleep disturbances, appetite changes, and abdominal pain 1
- Less common physical symptoms include chills, headaches, physical tension, sweating, and stomach pain 2
- Withdrawal symptoms usually occur within 3 days after cessation and may last up to 14 days 1
Treatment Approach
First-Line Management
- Withdrawal is best undertaken in a supportive environment with no specific FDA-approved medication currently recommended for cannabis withdrawal 1, 3
- Supportive counseling and psychoeducation are the first-line approaches despite limited empirical evidence 2
- Short duration psychosocial support modeled on motivational principles should be offered for the treatment of cannabis use disorders in non-specialized settings 1, 3
Symptomatic Treatment
- Relief of symptoms such as agitation and sleep disturbance may be achieved with symptomatic medication during the withdrawal period 1, 3
- Mirtazapine can be beneficial specifically for treating cannabis withdrawal-related insomnia 3
- There are promising results with gabapentin and delta-9-tetrahydrocannabinol analogs in the treatment of cannabis withdrawal syndrome 3
Monitoring and Follow-up
- Monitor for less common but serious withdrawal effects such as depression or psychosis; if these occur, close monitoring and specialist consultation are needed 1, 3
- Individuals who do not respond to short-duration psychological support should be referred for treatment in a specialist setting 1, 3
Special Considerations
Medication Cautions
- Venlafaxine may worsen cannabis withdrawal symptoms and should be avoided 3
- Other antidepressants, atomoxetine, lithium, buspirone, and divalproex have shown no relevant effect on cannabis withdrawal 3
- Dexamphetamine should not be offered for the treatment of cannabis use disorders 1
Treatment Setting
- Most cannabis withdrawal can be managed in an outpatient setting 2
- Inpatient treatment (preferably qualified detoxification) may be required for patients with:
- Comorbid mental or somatic disorders
- Severe cannabis use disorder
- Low social functioning 4
Pharmacotherapy Evidence
- Current evidence for pharmacotherapies for cannabis withdrawal is limited, with most treatments still considered experimental 5
- A Cochrane review found incomplete evidence for all clinically important pharmacotherapies investigated for cannabis use disorder 5
- N-acetylcysteine and cannabidiol have shown some promise but evidence remains of low to moderate certainty 5, 6
Common Pitfalls to Avoid
- Failing to recognize the clinical significance of cannabis withdrawal symptoms, which may precipitate relapse to cannabis use 2
- Not monitoring for complicated withdrawal, which may occur in people with concurrent mental health issues and polysubstance use 2
- Relying solely on short-term interventions for severe cases without appropriate referral to specialized treatment 3
- Using medications that may worsen withdrawal symptoms, such as venlafaxine 3