Cannabis Withdrawal

• Cannabis withdrawal is commonly in individuals seeking treatment for cannabis use and in heavy users who not seeking treatment (>50%).^[1]
• In those who use cannabis regularly during some period of their lifetime, around 33% report experiencing cannabis withdrawal.

• Most symptoms have their onset within the first 24 to 72 hours of stopping cannabis use, peak within the first week, and last approximately 1-2 weeks.
• Insomnia can last more than 30 days for some individuals.
• As a result of the withdrawal symptoms, some individuals may self-medicate, or use other drugs to provide relief from cannabis withdrawal symptoms.
• Those with severe withdrawal symptoms have significant disruptions to their daily living.

• Heavy cannabis users are at the greatest risk for experiencing withdrawal.^[2]

Cessation of cannabis use that has been heavy and prolonged (i.e. - usually daily or almost daily use over a period of at least a few months).

At least 3 of the following signs and symptoms develop within approximately 1 week after Criterion A

1. Irritability, anger, or aggression
2. Nervousness or anxiety
3. Sleep difficulty (e.g. - insomnia, disturbing dreams)
4. Decreased appetite or weight loss
5. Restlessness
6. Depressed mood
7. At least 1 of the following physical symptoms causing significant discomfort:
   • Abdominal pain
   • Shakiness/tremors
   • Sweating
   • Fever
   • Chills
   • Headache

The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

• Common symptoms of withdrawal include irritability, anger, aggression, anxiety, depression, restlessness, sleep difficulty, decreased appetite, and/or weight loss.
  • There can also be fatigue, yawning, poor concentration, and rebound periods of increased appetite and hypersomnia that follow initial loss of appetite and insomnia.^[3]
• Cannabis withdrawal can cause significant distress and contribute to difficulty stopping use or cause relapse in those trying to abstain.

• The amount, duration, and frequency of cannabis use that is needed to cause withdrawal symptoms is unknown.^[4]

• Other substance withdrawal
  • Since many symptoms of cannabis withdrawal are also symptoms of other substance withdrawal syndromes, careful evaluation should focus on ensuring that the symptoms are not better explained by cessation from an other substance (e.g., tobacco or alcohol withdrawal)
• Other mental disorder or medical condition
  • Many symptoms of the symptoms of withdrawal can resemble that of a primary depressive, bipolar disorder, and anxiety disorder general, or another medical condition.

• As clinically indicated based on the differential diagnosis.

• As clinically indicated.

• There are no approved pharmacological treatments for cannabis withdrawal.
  • There is some evidence that gabapentin may reduce withdrawal symptoms.^[5]
  • N-acetylcysteine (NAC) may also lead to a reduction of cravings.
  • Cannabinoid replacement therapy (using nabilone or dronabinol) has shown some promise.^[6]