From the Guidelines
Managing marijuana withdrawal symptoms involves a combination of supportive strategies and possibly medications, with a focus on staying hydrated, maintaining regular sleep patterns, and practicing relaxation techniques. For mild to moderate withdrawal, over-the-counter medications can help with specific symptoms: acetaminophen or ibuprofen for headaches and pain, and melatonin (3-5mg before bedtime) for sleep disturbances 1. According to the ASCO guideline, long-term daily cannabis users may experience non–life-threatening withdrawal symptoms after cessation of cannabis, including irritability, restlessness, anxiety, sleep disturbances, appetite changes, and abdominal pain, which usually occur within 3 days after cessation and may last up to 14 days 1. The management of withdrawal from cannabis is best undertaken in a supportive environment, with relief of symptoms achieved with symptomatic medication for the period of the withdrawal syndrome 1. Key considerations for managing marijuana withdrawal symptoms include:
- Creating a supportive environment
- Avoiding triggers
- Considering therapy or support groups
- Staying hydrated
- Maintaining regular sleep patterns
- Practicing relaxation techniques like deep breathing or meditation
- Using over-the-counter medications for specific symptoms, such as acetaminophen or ibuprofen for headaches and pain, and melatonin for sleep disturbances. It is essential to note that the intensity of symptoms relates to how heavily and how long you've used marijuana, as your body has adapted to the presence of cannabinoids and needs time to readjust to functioning without them 1. In cases where symptoms are more severe, consulting a healthcare provider is crucial, as they may prescribe medications like mirtazapine, buspirone, or gabapentin to help manage sleep, anxiety, and irritability issues 1. Overall, a comprehensive approach to managing marijuana withdrawal symptoms, prioritizing supportive strategies and possibly medications, can significantly improve the chances of successfully managing withdrawal and maintaining abstinence.
From the Research
Management of Marijuana Withdrawal Symptoms
- The management of marijuana withdrawal symptoms typically involves supportive counselling and psychoeducation as the first-line approaches 2.
- There are no medications currently approved specifically for medically assisted withdrawal (MAW) of marijuana, but medications have been used to manage short-term symptoms such as anxiety, sleep, and nausea 2.
- Some pharmacological agents, such as gabapentin, have shown promise in reducing cannabis use and withdrawal symptoms, but more research is needed to confirm these findings 3, 4.
Pharmacological Options for Treatment
- A systematic review of pharmacological management of sleep disturbance associated with cannabis withdrawal found that gabapentin, lofexidine, mirtazapine, quetiapine, and zolpidem showed some primary benefits, but the evidence was limited by small sample sizes and methodological limitations 3.
- A proof-of-concept study found that gabapentin significantly reduced cannabis use and withdrawal symptoms, and improved executive function deficits in cannabis-dependent adults 4.
Characteristics of Marijuana Withdrawal
- Marijuana withdrawal symptoms typically occur 24-48 hours after cessation and peak at days 2-6, with some symptoms lasting up to 3 weeks or more in heavy users 2.
- The most common symptoms of marijuana withdrawal include anxiety, irritability, anger or aggression, disturbed sleep, depressed mood, and loss of appetite 2, 5.
- A study of individuals using medical cannabis for chronic pain found that withdrawal symptoms tend to be stable over a 2-year period, but younger age is predictive of worse symptoms and an escalating withdrawal trajectory 6.
Treatment Considerations
- Inpatient admission for MAW may be clinically indicated for patients with significant comorbid mental health disorders and polysubstance use to avoid severe complications 2.
- Treatment studies have shown that rates of continuous abstinence are low, and more treatment options are needed for marijuana use disorders 5.