Can cannabis use cause diarrhea in a healthy adult?

Can Cannabis Cause Diarrhea?

Yes, cannabis can cause diarrhea, but primarily as a withdrawal symptom when stopping chronic use rather than during active use. 1

Diarrhea During Cannabis Withdrawal

The most direct connection between cannabis and diarrhea occurs when long-term daily users stop using cannabis:

• Withdrawal symptoms develop within 24-72 hours of cessation and include abdominal pain, appetite changes, and diarrhea 1
• Symptoms peak between days 2-6 and typically last 1-2 weeks 1
• Approximately 47% of regular cannabis users experience cannabinoid withdrawal syndrome after cessation of heavy and prolonged use 2
• Standard antidiarrheal agents such as loperamide are recommended for managing withdrawal-related diarrhea 1

Effects During Active Cannabis Use

During active cannabis use, the gastrointestinal effects are typically opposite to diarrhea:

• Cannabis generally reduces gastrointestinal motility through activation of CB1 receptors in the enteric nervous system 3
• Cannabinoids have historically been used to treat diarrhea, not cause it 4, 3
• CB1 receptor activation reduces excitatory enteric transmission and slows intestinal transit 3

Cannabinoid Hyperemesis Syndrome: A Different Presentation

While not typically causing diarrhea, chronic heavy cannabis use (>4 times per week for over a year) can cause cannabinoid hyperemesis syndrome, characterized by:

• Cyclical vomiting episodes (not diarrhea) 2
• Relief with hot showers (present in 44-71% of cases) 1
• Nausea and abdominal pain 2
• Resolution only with complete cannabis cessation for 6+ months 1

Clinical Approach

If a patient presents with diarrhea and uses cannabis:

• Determine timing: Is diarrhea occurring during active use or after cessation? 1
• If during withdrawal: Expect symptoms to resolve within 1-2 weeks; treat symptomatically with loperamide 1
• If during active use: Look for alternative causes, as cannabis typically slows (not accelerates) GI motility 3
• Avoid opioids for symptom management due to worsening nausea and addiction risk 2, 1

High-Risk Populations

Patients at higher risk for withdrawal syndrome (including diarrhea) include those consuming:

• More than 1.5 g/day of inhaled cannabis 1
• More than 20 mg/day of THC-dominant oil 1
• More than 300 mg/day of CBD-dominant oil 1