Marijuana use is common, with CDC estimates of at least 3 in 10 users experiencing a marijuana use disorder.1 Frequent users will experience signs of weed withdrawal if they decrease or discontinue use. Common symptoms of the withdrawal are sleeplessness, tiredness, anxiety, moodiness and cravings. Abstainers may also initially experience cravings, nausea, vomiting, and lack of appetite.
What Is Marijuana Withdrawal?
Marijuana use for recreational and medicinal purposes continues to rise in popularity as it becomes a more widely legalized substance. According to the National Institute on Drug Abuse, “Marijuana use disorder becomes an addiction when the person cannot stop using the drug even though it interferes with many aspects of his or her life.”2 It is relatively less common to become addicted to marijuana than other drugs, however many of users develop tolerance and dependence and will experience cannabis withdrawal symptoms if they stop using. Risk of dependence increases with use of marijuana starting below the age of 18 or when used daily.
Recent data suggest that 30% of those who use marijuana may have some degree of marijuana use disorder.2 Dependence occurs when long-term use results in less physical sensitivity to a drug, which then requires greater amounts and frequency to achieve the same result. Marijuana varies in its potency which can complicate awareness of how much is being used. Discomforts caused by the withdrawal of marijuana typically peak in approximately one week and by the second or third week of abstention are largely abated. Psychological symptoms may continue for a few more weeks. Although uncomfortable, quitting cannabis is unlikely to be life threatening. In contrast, Xanax Withdrawal or Benzodiazepine Withdrawal requires a tapering down of the dosage and medical management is recommended.
Marijuana Withdrawal Symptoms
Marijuana withdrawal symptoms can range from mild to severe with the principle consideration being the amount, potency and frequency of use. The more chronic the use, the higher likelihood of significant withdrawal symptoms. Cannabis users who started under the age of 18, polysubstance users, and those with co-occurring disorders are also more likely to experience significant symptoms of withdrawal.
Marijuana withdrawal symptoms may include:
- Insomnia
- Anxiety
- Nervous breakdown
- Depression
- Stomach problems, nausea, decreased appetite
- Strange and vivid dreams
- Tiredness
- Irritability
- Craving
Weed Withdrawal Timeline
Withdrawal from cannabis use may start quickly upon withdrawing from the drug. WIthin the first 24-72 hours, an individual will likely experience loss of appetite, anxiety and insomnia. Stomach pain, vomiting and perspiration are likely for chronic users. At this stage many people will show signs of relapse due to the discomfort. Within the first week to ten days the symptoms will peak with many of the physical symptoms level off as the body becomes less dependent on the THC. By 10 to 20 days from last use, the major withdrawal symptoms are subsiding, although cravings and psychological symptoms may persist.
A 2015 study of 29 non-treatment seeking male cannabis users between 18 and 65 years examined withdrawal in a closed research environment for 30 days.3 They were selected based on reporting cannabis use of at least one year, at least 5 days per week and lacking evidence of other drug dependence, other than tobacco. Study findings indicated that abstinence withdrawal symptoms were highest in the initial phase of monitored abstinence but decreased over time, whereas sleep disturbances seemed to continue and even increase over time. Symptoms influence the likelihood of relapse: 65–70% of cannabis smokers reported relief of abstinence effects as a factor in their relapse to cannabis intake.3 Managing some of the symptoms is therefore an important consideration in improving the success of detox efforts.
Causes of THC Withdrawal
“The consistent finding that the time course of symptoms varies may be caused by a wide range of underlying mechanisms. Some symptoms may occur as soon as cannabis use ceases and blood-levels of THC and other active components in cannabis begin to drop. Other symptoms may not occur until THC is nearly completely eliminated from the bloodstream.”4 The effect of marijuana withdrawal may be compared with how tobacco withdrawal affects users, nicotine increases dopaminergic system activity, which leads to the craving and withdrawal effect.
Cannabinoids interact directly on the brain through the endocannabinoid system. Specifically, the endocannabinoid system consists of receptors known as CB1 and CB2. CB1 receptors are prevalent in the brain in areas that interact with memory, cognition, anxiety, pain reception, and coordination. CB2 receptors are found throughout the peripheral nervous system and are important in anti-inflammatory activity in the body.
Chronic THC use has been implicated in stroke through what is known as oxidative stress, similar to tobacco use. “Sarafian et al. have previously shown that marijuana cigarettes promote the formation of ROS while lowering the intracellular levels of glutathione.4 In addition, other investigators found that THC, the main psychoactive component in cannabis, acts as a potent promoter of OS and inflammation, thus appearing as a risk factor for the onset of ischemic stroke.”5 Similar to alcoholism or binge drinking, the amount and frequency of use is the key factor in how the user will experience withdrawal. The more often a substance is used and the higher the amount, the greater accommodations the body will have to make to its absence. However, unlike alcohol, marijuana lingers in the body in the fatty tissues for weeks after the last use. For severe alcohol users, rapid withdrawal can be life threatening whereas, withdrawing from marijuana dependency is not.
6 Ways to Minimize Weed Withdrawal Symptoms
Managing or alleviating symptoms of marijuana withdrawal can be thought of in terms of strategies that increase physical comfort during withdrawal: those that improve behaviors associated with use and those that improve emotional well-being. Keeping an open mind about trying new behaviors and being consistent is vital to moving from compulsive use of any habit forming substance to abstinence. As new behaviors are formed and associated with positive physical and emotional experiences, cravings will begin to subside.
Below are six tips to help alleviate marijuana withdrawal symptoms:
- Stay hydrated: Not only does a hydrated body feel better but dehydration is a common symptom of withdrawal.
- Healthy, regular meals: A healthy balance of proteins, carbohydrates and fats will promote satiety and stable hormone levels which will help you feel better.
- Exercise: Exercise boosts mood and overall well-being. If you are new to exercise try walking and gentle stretching. More experienced exercisers will benefit from continuing their routine and perhaps finding a complimentary activity to their preferred exercises e.g. if you typically concentrate on strength, find some new mobility routines.
- Practice self-care: When it comes to self care think beyond the usual advice. Consider prioritizing your well-being above social pressures to do things that may be associated with marijuana use.
- Socialize with intention: Reducing isolation with social relationships is a healthy coping skill but be sure that the relationships you choose are with people who also promote healthy behaviors.
- Wean off slowly: Taking a harm-reduction approach can make the withdrawal symptoms more manageable. Gradual reduction in the amount and frequency of use, as well as the delivery system can help. Marijuana concentrates (“dabs”), blunts, spliffs and vapes tend to deliver more intense highs. Reducing the intensity of the “buzz” can help with the choice to eventually abstain.
Weed Withdrawal Treatment
Withdrawing from cannabis use, especially when use has been frequent and long-term is best managed through an integrated approach. This holistic health model may involve, individual and group care, inpatient or outpatient care, and perhaps medication to address all causes of the disorder. Deciding when to seek treatment is an individual decision, however some considerations are being unable to stop on your own, preoccupation with using, experiencing reduced ability to manage your life and relationships due to drug use or experiencing severe symptoms such as marijuana-induced hyperemesis or rapid onset of withdrawal symptoms when you attempt to abstain..
Addiction treatment resources that may be helpful for marijuana withdrawal include:
At Home Care
Many people find that they can safely and successfully detox from cannabis at home. You may want to have an understanding friend or partner stay with you for a few days to a week while the worst of the symptoms subside. It can be helpful to discuss your planned detox with your primary care physician or a psychiatrist.
Some things you can do to prepare for an at-home detox include:
- Rid your home of marijuana and smoking devices
- Stock up on healthy groceries
- Plan some alternative activities such as hobbies during detox
- Plan some things to get you out of the house
- Plan to journal about thoughts and feelings that arise
- Alter your routine especially the parts that remind you of smoking
Rehab & Detoxification Centers
Addiction treatment centers offer detox and inpatient treatment and often after care as well. Prior to admission, you will need a clinical evaluation where the need for treatment will be evaluated using ASAM criteria.(FN6) Determining the best setting will depend upon whether marijuana is the only drug being used in excess and whether there are any co-occurring somatic or mental health disorders as well. A social worker in a community health setting such as a non-profit, county mental health center or Federally Qualified Health Center will be able to link you to treatment options, as well as help with any other needs you may have. In patient treatment programs will offer a range of therapeutic modalities, relapse planning and medical oversight.
Intensive Outpatient Programs
Intensive Outpatient Programs can offer a middle ground between home detox and inpatient treatment. These programs offer intensive treatment including group,individual treatment, relapse prevention and support for detox and cravings. Some Intensive Outpatient Therapy programs are specifically designed not to disrupt work schedules. However, it is recommended to consider taking medical leave (FMLA) to allow participants to concentrate on recovery.
Support Groups & Therapy
Individual therapy can help you address the emotional reasons that led to compulsive use of marijuana, beliefs and behaviors that support recovery and any co-occurring behavioral health conditions that underlie marijuana use disorder. Your therapist will also help you develop coping skills for managing cravings and avoiding relapse. You can support coping skills and enhance your recovery through group therapy or support groups. You can find a therapist using an online therapist directory.
Some therapies that can address addiction and withdrawal symptoms include:
- Cognitive Behavioral Therapy (CBT): Cognitive Behavioral Therapy examines the thoughts that underlie drug use. Clients learn to reframe those thoughts and improve the feelings, motivations and behaviors that follow. CBT is also effective for co-occurring anxiety or depression.
- Dialectical Behavior Therapy (DBT): Dialectical Behavior Therapy focuses on the development of mindfulness and coping skills to mange stressful situations. By building moment to moment awareness the client will be able to choose behaviors and environments that promote sobriety.
- Eye Movement Desensitization and Reprocessing Therapy (EMDR): EMDR is a therapeutic modality which specifically addresses trauma. When trauma is the underlying reason for drug use, EMDR can be helpful in recovery.
- Contingency Management Therapy: This is a behavior-based approach that involves introduction or removal of rewards based upon monitoring of recovery positive behaviors.
- Motivational Enhancement Therapy: This person-centered approach relies on the client’s internal reasons and desire to stop using. Motivational enhancement therapy identifies the stage of change the client is experiencing and works within that framework. As the desire to change grows, “change talk” is supported.
Medications
Medication-supported treatment of addiction is an evidence-based approach for treatment of many substance use disorders. It gives the user relief from cravings and the most difficult symptoms of withdrawal until a recovery oriented lifestyle and coping skills are put in place. While there is no specific FDA approved medication for cannabis use disorder, many medications have proven supportive in recovery and are part of evidence supporting off label protocols. Sedatives (like benzodiazepines) can be helpful to decrease nausea, improve appetite and sleep during withdrawal.
Vitamins such as a quality multivitamin, B, C and E vitamin supplements can support overall health and reduce the oxidative stress caused by drug use and subsequent withdrawal. Calcium and magnesium supplements can help calm the nervous system and reduce anxiety.
Some medications that may be used for marijuana withdrawal symptoms include:
- Ambien/Zolpidem is used to address insomnia during withdrawal. Ambien may be habit forming and must be monitored carefully.
- BuSpar/Buspirone is an anti anxiety medication used to treat the cravings brought on by withdrawal.
- Neurontnin/Gabapentin is a medication that has been FDA approved for a variety of conditions including neuropathic pain, It is frequently used off-label for anxiety and insomnia, alcohol use disorder and may be used to decrease markers of cannabis use, withdrawal, and craving.
- FAAH inhibitors/inactivators increase the concentration of endocannabinoids. Ibuprofen, sulindac sulfone, indomethacin and dipyrone are some examples of FAAH inhibitors. Typically used for chronic pain conditions, these may be used to reduce some of the discomforts of cannabis withdrawal.
- Allosteric Modulators are thought to offer the therapeutic properties of endogenous cannabinoid action such as gastroprotective effect without cannabimimetic negative effects such as sedation. Examples are benzodiazepines like diazepam, alprazolam and chlordiazepoxide and are used for their ability to reduce anxiety and improve sleep.
- Varenicline. Varenicline is medication approved for tobacco-cessation treatment. However, it has been demonstrated to reduce cannabis withdrawal symptoms but thus far has not been effective in preventing relapse.
- Cannabidiol (CBD) is a naturally occurring phytocannabinoid in cannabis and cannabis products, and is the second most abundant compound after THC. It is non-intoxicating and is used for treatment of pain and nausea. It is important to note that OTC CBD products do not have sufficient doses of CBD to be effective for medical use.
Final Thoughts
Cannabis users may be seeking to moderate their use, while others want to abstain completely from marijuana use. Many may be concerned with adverse effects, which will vary based on the individual. Admittedly, there will be some discomfort involved in stopping but there are treatments to help. It is important to be honest with yourself and others about the frequency and amount of marijuana use to formulate a plan. Discuss your weed consumption with your healthcare team and family before taking the first step.
