What Is Cannabis Withdrawal?

Cannabis is the plant genus that produces marijuana, which refers to the dried leaves, stems, seeds, and flowers from the plants. It is the most used addictive drug after tobacco and alcohol.

Marijuana has both short-term and long-term effects on the brain and can lead to a substance use disorder. Some people who use marijuana for a long time and try to stop experience symptoms of withdrawal. Read more about marijuana and cannabis withdrawal in this overview.

Definition

Cannabis is the most generic term and is typically used when discussing the compounds derived from the plant, including those in marijuana. In this article, the term cannabis will be used when discussing anything related to the substances from the plants.  

Cannabis withdrawal was not recognized until the fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5) in 2013. It is characterized by a withdrawal syndrome that develops after stopping or significantly decreasing heavy or long-term cannabis use.

In general, withdrawal from a substance is typically associated with a substance use disorder, which is the case with cannabis. When experiencing withdrawal, many people have the urge to use the substance again to decrease the symptoms they are experiencing.

Symptoms

Cannabis withdrawal can lead to a variety of symptoms, including:   

• Grouchiness, anger, or aggression
• Difficulty sleeping and fatigue
• Decrease in appetite
• Anxiety
• Cravings
• Difficulty concentrating
• Physical symptoms like abdominal pain, shaking or tremors, sweating, fever or chills, and headache

The symptoms of cannabis withdrawal may start as soon as the first 24 hours after the last use of cannabis, peaking during the first week, and lasting up to one month.

Usually, cannabis withdrawal syndrome is not as severe as alcohol or opioid withdrawal, but it still can cause significant distress and make quitting difficult, as well as lead to relapse. The severity of withdrawal symptoms can relate to the amount and potency of cannabis used, gender, and other environmental and genetic factors.

Causes

Using cannabis can lead to someone developing a substance use disorder. This is an illness related to continuing to use the substance even when it is causing problems in their life.

Studies have shown that somewhere between 9% and 30% of people using cannabis may develop some form of a cannabis use disorder. If an adolescent or youth starts using it before the age of 18, they are four to seven times more likely than adults to develop a cannabis use disorder.

Research has shown an association between chronic use of cannabis and changes in specific receptors in the brain, called cannabinoid-1 receptors (CB-1). These changes are associated with cannabis withdrawal symptoms.

Diagnosis

The DSM-5 diagnostic criteria for cannabis withdrawal include: 

• Stopping cannabis use that has been heavy and prolonged (typically daily or almost daily for at least a few months) 
• At least three of the below signs and symptoms begin within one week of stopping cannabis use
• Irritability, anger, aggression
• Nervousness or anxiety 
• Difficulty sleeping
• Decreased appetite or weight loss
• Restlessness
• Depressed mood 
• One or more of these physical symptoms causing significant discomfort: abdominal pain, shakiness/tremors, sweating, chills or fever, or headache

If someone is concerned about themselves or a loved one having cannabis use disorder and/or withdrawal, it is important to tell their doctor or mental health professional. They will perform a thorough history, asking questions about cannabis use and any effects it may have had both while using it and stopping. They may also refer you or your loved one to a psychiatrist or addiction medicine specialist, who has further training in the diagnosis and treatment of substance use disorders. 

While symptoms may not be severe enough to need medical attention, medication or behavioral strategies may help the symptoms and improve the likelihood of quitting cannabis in those trying to achieve this.

Treatment

Cannabis withdrawal is important because it can cause symptoms that affect daily functioning, as well as lead to continued use due to relapse. Adults who have sought treatment for cannabis use disorders have roughly used cannabis almost daily for greater than 10 years and tried to quit more than six times. 

Studies have shown that treating a patient’s co-morbid psychiatric disorders with standard treatments, like therapy and medication, may lead to a decrease in cannabis use, especially those who are heavy users.

Behavioral Interventions

Some behavioral treatments have shown promise in treating cannabis use disorder, including: 

• Cognitive-behavioral therapy (CBT): This form of psychotherapy teaches strategies to notice and correct problematic thoughts and behaviors. This can help address substance use, self-control, as well as other related problems.
• Contingency management: This approach monitors the target behavior and providing or removing a tangible reward when it occurs or does not occur. 
• Motivational enhancement therapy: This intervention is meant to create self-motivated change.
  

Medications

While there are no medications approved by the Food and Drug Administration for cannabis use disorder, there is ongoing research being done. Sleep problems are common in cannabis withdrawal, so some medications being studied include: 

• Ambien (Zolpidem): This is a sleeping aid prescription medication. 
• BuSpar (Buspirone): This is an anti-anxiety medication. 
• Neurontin (Gabapentin): This is an anti-epileptic, or anti-seizure, which may improve anxiety and sleep. 

There are also two other psychiatric medications that may decrease certain symptoms of cannabis withdrawal, the antipsychotic Seroquel (quetiapine) and antidepressant Remeron (mirtazapine). 

Another agent being studied is N-acetylcysteine, a nutritional supplement.

A Word from Verywell

Cannabis is a commonly used substance and is the most widely used drug after tobacco and alcohol. It can cause both short- and long-term effects and potentially lead to addiction, making it hard for someone to quit. If you are experiencing withdrawal symptoms and trying to stop the usage of cannabis, reach out to your healthcare provider or mental health professional. They will be able to provide support and resources, as well as potential treatment options.