Marijuana Withdrawal: A Safe Schedule to Follow

Marijuana comes from a plant native to South America that produces several intoxicating chemicals, most importantly delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). The stems, leaves, and flowers of the plant are dried and sold all over the United States.

They are still sold by illicit sources smuggling the drug across the Mexican border, but they are also increasingly sold through legal sources that sell medical and even recreational marijuana.

Most states in the U.S. have legalized some medicinal use of this drug, and several states have passed recreational use of the intoxicating substance. However, the federal government still lists marijuana as a Schedule I drug under the Controlled Substances Act (CSA), enforced by the Drug Enforcement Administration (DEA).

Marijuana is widely abused and it is addictive. Addiction is associated with physical dependence on the substance, which can lead to withdrawal symptoms if you try to stop abusing the drug suddenly. Marijuana’s withdrawal symptoms are not life-threatening, but trying to quit “cold turkey,” or without any social and medical support can lead to relapse.

It is also rare to overdose on marijuana. However, people who abuse it are more likely to abuse other drugs, including alcohol, which can put them at risk of poisoning or overdose. Long-term marijuana abuse can damage the brain, including memory, cognition, and judgment.

Marijuana Addiction Can Happen to Anyone Who Abuses This Drug

Marijuana is both a psychedelic drug, with effects similar to mild versions of hallucinogenic substances and a central nervous system (CNS) depressant, with relaxing effects like those associated with alcohol or opioid drugs. Most people are familiar with marijuana as dried plant material sold in small amounts, which is then rolled into a cigarette or joint papers and smoked. It is also vaporized with e-cigarettes or vaporizers, made into an oil that can be smoked or eaten, or cooked into baked goods or candy and consumed orally. In rare cases, marijuana is brewed into a tea, but this practice is not widespread in the United States.

The high from smoking marijuana starts within 10 to 30 minutes, while edible versions can take about 30 minutes to an hour to become fully active in the body. The high usually lasts two to three hours.

Various effects are associated with a marijuana high:

• Relaxation
• Feeling pleasant, happy, or giddy
• Altered sense of time
• Impaired memory
• Trouble thinking clearly
• Tranquility
• Altered senses, including seeing brighter colors or feeling tactile sensations
• Delusions, hallucinations, and psychotic symptoms when taken in very large doses
• Negative mood, including depression, anxiety, or paranoia

There are negative side effects and long-term damage to health that can come with marijuana abuse:

• Breathing problems from smoking or vaping
• Increased heart rate that may be associated with a panic attack
• Nausea and vomiting
• Weight gain from “the munchies”
• Mood disorders, including depression or anxiety
• Temporary paranoia
• Psychotic symptoms from very large doses
• Trouble thinking clearly, making decisions, or remembering events

NIDA reports that about four million people in the U.S. met the diagnostic criteria for marijuana use disorder in 2015. This condition was added to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Only about 138,000 people voluntarily sought treatment for the disorder in 2015.

Meanwhile, marijuana use is becoming more popular among adolescents, which increases their risk of struggles with substance abuse later in life.

According to the 2017 Monitoring the Future (MTF) Survey:

The U.S. Centers for Disease Control and Prevention (CDC) reports that 1 in 10 marijuana users will become addicted to the drug. Among people who begin abusing the drug before they turn 18, that statistic goes up to 1 in 6.

There are specific signs that someone may be addicted to marijuana:

• Choosing to abuse the drug instead of participating in other activities like school, work, or social events
• Changes to social group, hygiene, sleep, eating, and other behaviors
• Mental and physical health changes, including mood disorders or lung infections
• Knowing that the drug is causing problems and continuing to use it anyway
• Trying to quit and being unable to stop using it

 

Abusing marijuana can lead to physical dependence, which occurs when the introduction of a chemical like THC leads to a rush of neurotransmitters, including dopamine and serotonin, and the brain has a more difficult time managing these neurotransmitters without the presence of the drug. When THC is not present, the person may feel sluggish, depressed, or sick or experience other symptoms that are associated with withdrawal.

The National Institute on Drug Abuse (NIDA) reports that 30 percent of people who abuse the drug have some level of marijuana use disorder, or addiction to the drug, which often involves physical dependence on the substance. About nine percent of people who abuse marijuana report dependence and about 17 percent who begin abusing the drug in their teenage years report becoming dependent on the drug to feel normal.

The Discomfort of Marijuana Withdrawal

The most common symptoms reportedly associated with marijuana withdrawal include:

• Irritability
• Mood swings
• Sleep disturbances
• Decreased appetite
• Cravings for the drug
• Restlessness

 

These symptoms begin within a day or two after quitting and they can last up to two weeks, depending on how long you abused the drug, how much has built up in your body, and how much you abused at a time.

Most withdrawal symptoms are psychological, predominantly involving mood changes and cravings for more of the drug. However, some physical symptoms may include:

• Abdominal pain
• Sweating
• Shakiness
• Physical discomfort like muscle aches and joint pain
• Fever
• Chills
• Headaches

 

A report on the DSM-5 definition of cannabis withdrawal found that, among those who abused cannabis three or more times per week for a year, 44 percent reported experiencing at least two withdrawal symptoms while 34 percent reported experiencing three or more symptoms.

While it has not been fully verified for clinician use, the DSM-5 lists a 15-item Marijuana Withdrawal Checklist of symptoms, including behavioral changes and physical illness. This can help clinicians determine how severe a person’s marijuana withdrawal experience is, so they can better understand how to approach treatment.

Cannabis Withdrawal Syndrome

The physical withdrawal symptoms will last for less than a week. Psychological symptoms may persist in what is known as cannabis withdrawal syndrome (CWS). Cravings, some aches and pains, appetite changes, and mood struggles may persist after the drug has fully left the body.

Signs of CWS include:

• Anxiety that does not go away
• Irritability and mood swings
• Trouble sleeping, including insomnia or nightmares
• Decreased appetite and rapid weight loss
• Depression
• Physical tremors or shakiness

To determine if a patient has developed CWS, a physician will keep track of withdrawal symptoms as they appear and then clear. If at least three of these symptoms develop within a week of quitting marijuana, the person may require additional oversight to manage the syndrome. For example, cannabis hyperemesis, or nausea associated with CWS, was reported in one surveyed individual. This started about five days after quitting and lasted until 20 days after quitting. Per reports, CWS generally lasts 14 to 21 days.

Cannabis withdrawal syndrome will go away, but it will take longer than the standard marijuana withdrawal process. Working with physicians, therapists, and a support team can alleviate many of the psychological symptoms that are associated with CWS.

Factors that influence whether someone will develop cannabis withdrawal syndrome include:

• Amount of cannabis abused and how often
• Gender
• Age
• Genetics
• Environmental factors
• Family history of addiction
• Personal history of substance abuse or mental illness
• Attempts to quit marijuana abuse in the past

Women report stronger withdrawal symptoms, especially physical symptoms, compared to men. People who have co-occurring mental health conditions and marijuana addiction are more likely to need long-term residential treatment to manage symptoms of both conditions.

The Evidence-Based Process of Ending Addiction

Although some studies have indicated the potential of some drugs, like gabapentin, to ease marijuana withdrawal symptoms, there are currently no forms of medication-assisted treatment (MAT) that can be used to taper off dependence on marijuana. However, working with a physician through a detox program is the best approach to successfully ending the body’s dependence on the drug. A physician can monitor symptoms of withdrawal after an intake assessment and offer over-the-counter or prescription medications as needed. Some drugs may treat nausea, pain, or appetite problems.

The supervising physician will also monitor their patient for signs of CWS. One study reported that 35 to 75 percent of patients who detoxed through an outpatient program developed CWS after the program was complete. In a rehabilitation program, therapists and other addiction specialists will be able to help clients manage CWS with additional counseling.

Beginning With Detox

Because detox does not use MAT to taper physical dependence on marijuana, the main focus of treating marijuana addiction is behavioral counseling, provided through a rehabilitation program. After detox, which should involve medical supervision to manage any withdrawal symptoms that get uncomfortable and to diagnose CWS if it occurs, you should enter a rehabilitation program for behavioral counseling.

Start by speaking with a physician, counselor, or addiction specialist about your concerns regarding your marijuana use. They can help you find resources and the right professionals to start the treatment process. The first step in treatment is detox, but detox is not enough; it must be followed by therapy.

There are many options available when it comes to marijuana addiction treatment. Choosing what is best involves a discussion between you and your clinician. They can help you decide whether outpatient or inpatient treatment would work better for you. Many people find that they benefit most from inpatient treatment if they struggle with CWS.

During withdrawal, there are some steps you can take to support your overall health:

• Stay hydrated with water.
• Avoid sugary or fattening foods, which may intensify cravings.
• Stay away from alcohol and tobacco.
• Eat healthy, regular meals, focusing on vegetables with lean proteins.
• Exercise a little every day, at least 30 minutes of gentle movement.
• Make a list of friends and family to call or visit for support when you feel cravings or stress.

Rehabilitation programs provide group therapy and they often provide individual therapy, exercise classes, nutritional counseling, art therapy, and other approaches to support you as you build a healthy life in recovery from marijuana addiction. Remain in your rehabilitation program for 90 days (three months), as this is typically how long it takes for behavioral changes to take hold and become lifestyle changes. You may begin with 30 days of inpatient treatment and then transition to 60 or more days of outpatient care once you feel stronger in recovery.

Once you complete rehabilitation, work with your therapist or addiction specialist to make an aftercare plan. This should include the above lifestyle changes, ongoing medical and therapy appointments, support group participation, and other steps that will support you in remaining sober and healthy.

The process of addiction treatment may seem daunting and leave you feeling overwhelmed. But, that’s alright. This is where The Palm Beach Institute steps in.

Sources

(June 2018) Drug Facts: Marijuana. National Institute on Drug Abuse. Retrieved from https://www.drugabuse.gov/publications/drugfacts/marijuana

(October 29, 2013) Marijuana. Center for Substance Abuse Research. Retrieved from http://www.cesar.umd.edu/cesar/drugs/marijuana.asp

(June 2018) Marijuana: Is Marijuana Addictive? National Institute on Drug Abuse. Retrieved from https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-addictive

(2018) Marijuana. National Institute on Drug Abuse. Retrieved from https://www.drugabuse.gov/drugs-abuse/marijuana

(February 27, 2018) Marijuana and Public Health: Marijuana: Can It Affect Your Health? Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/marijuana/health-effects.html

(August 9, 2017) Cannabis (Marijuana) Withdrawal. Psych Central. Retrieved from https://psychcentral.com/disorders/cannabis-marijuana-withdrawal/

(2014) Cannabis Withdrawal – A New Diagnostic Category in DSM-5. Israeli Journal of Psychiatry and Related Sciences. Retrieved from https://cdn.doctorsonly.co.il/2015/01/08_Cannabis-Withdrawal.pdf

(August 2017) The Cannabis Withdrawal Syndrome: Current Insights. Dovepress: Substance Abuse and Rehabilitation. US National Library of Medicine, National Institutes of Health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414724/