Marijuana (Cannabis):

Discontinuing Use

For most people, discontinuing the use of marijuana (cannabis) is not difficult, although it may be associated with mild symptoms of withdrawal including irritability, anxiety and insomnia. However, for some people discontinuing chronic use of cannabis products may be difficult and may be associated with significant withdrawal symptoms.  The following information is presented to assist those experiencing problems when stopping cannabis use.

 

See:

Links to ALL Marijuana Educational Pages

Marijuana Addiction – Cannabis Use Disorder (CUD)

 

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Discontinuing Marijuana (Cannabis) Use

Although many people suffer no ill consequences after stopping chronic use of marijuana (cannabis), studies indicate that more than 50% of people who use cannabis daily or near-daily report withdrawal symptoms when discontinuing use. Cannabis withdrawal symptoms (CWS) can be clinically significant because they may be associated with  functional impairment of normal activities of daily living (ADLs), and the more severe the withdrawal is, the more severe the functional impairment is.  Higher levels of impairment require more intense treatment and are associated with higher rates of relapse to cannabis use. 

 

Symptoms of Cannabis Withdrawal

Typical symptoms of cannabis withdrawal include:

  1. irritability
  2. nervousness
  3. anxiety
  4. depression
  5. increased anger and aggression
  6. decreased quality and quantity of sleep
  7. decreased appetite and food intake.

 

These symptoms typically begin after 24 hoursof abstinence, peak on days 2 to 6, and typically resolve within 2-4 weeks, although more prolonged symptoms are reported.

 

Given the negative mood and behavioral symptoms associated with marijuana abstinence after daily marijuana exposure, it seems likely that the onset of abstinence symptoms partly maintains chronic marijuana use (ie, similar to nicotine, people continue to smoke marijuana each day because abruptly stopping is associated with negative mood). It may be that individuals who have a history of using drugs such as marijuana to modulate mood are particularly sensitive to these effects.

 

Management of Cannabis Withdrawal Symptoms (CWS)

Cannabis Taper

Although there is no studies available about the effect of gradual dose reduction of cannabis on the severity of withdrawal symptoms, the relatively long plasma half-life of various active cannabis metabolites (typically cited as 1-4 days) suggests that a gradual reduction in cannabis use would be an effective strategy. Options for gradual cannabis reduction may include smoking smaller or fewer bongs or joints, commencing use later in the day and having goals to cut down by a certain amount by certain dates.

Behavioral Management

Coping Skills for Decreasing/Stopping Marijuana Use

You can do many things to stop using marijuana. Some may work better than others. Some help you resist the urge to smoke or avoid tempting situations or satisfy your needs in more constructive ways than smoking marijuana. Expect to try several and add any that may be helpful. Think about what worked when you gave up marijuana before or when you made other changes in your life.

 

Be kind to yourself as you begin this change process-you’re doing something to take care of yourself, and you deserve all the comfort and self-acceptance you can get! Remind yourself that learning and changing inevitably mean giving up old ways that, in time, you will feel more comfortable. Provided below are suggestions and coping skills to assist you in decreasing/stopping your marijuana use.

 

Actions

  1. Avoid or escape from situations that make you want to smoke marijuana. Sometimes this is the easiest and most effective way to resist temptation, especially in the beginning.
  2. Delay decisions to give in to temptation; for example you could wait 15 minutes.
  3. Take several deep breaths. Focus on the fresh  air entering your lungs, cleansing and nourishing your body. Let out tension with each exhalation.
  4. Change your physical position. Stand up and stretch, walk around the room, or step outside.
  5. Carry things in you mouth: toothpicks, gum, mints, plastic straws, and low-calorie snacks.
  6. Carry objects to fiddle with: a rubber ball to squeeze, a small puzzle, a pebble, worry beads.
  7. Having a distracting activity available: a crossword puzzle, magazine, book, or a journal to write in.

 

Thoughts

Self-talk. Give yourself a pep talk:

  1. remind yourself of your reasons for slowing or stopping your marijuana use
  2. remind yourself of consequences of using marijuana
  3. challenge any wavering in your commitment to quit

 

Imagery and visualization

You have the ability to relax by mentally constructing a peaceful scene that you can enter whenever you feel stressed (e.g. mountain valley, forest, or a beach). Your peaceful scene should be a setting that you find interesting and appealing. It will be a place that will make you feel safe and secure when you imagine it – where you will be able to let your guard down and completely relax. Using visualization will help you relax and decrease your need to use marijuana for relaxation. Learn self-hypnosis techniques.

See “Using the Mind” and Hypnosis

 

Thought-stopping

Talk yourself out of smoking, by telling yourself you do not need marijuana and that current feelings (e.g. anger, boredom, frustration, irritation, etc.) will pass and get up and do something different. If thoughts persist continue to tell yourself that this will pass and talk to a friend.

 

Distraction

When cravings for marijuana arise distract yourself by focusing on something different: a daydream, a task (such as cleaning or a hobby), a fantasy, or counting backwards from 150 by 3’s.

 

Lifestyle

  1. Exercise or take a brisk walk daily. Get your body used to moving; use stairs instead of elevators; park farther away from your destination; when able walk instead of drive. Exercise has been proven to increase mood and decrease stress.
  2. Practice relaxation or meditation techniques regularly.
  3. Engage in an enjoyable activity not related to work several times per week.
  4. Change routines associated with smoking marijuana, at least temporarily; for example don’t spend time with friends that smoke and do not watch TV programs or movies with heavy marijuana use.

 

Social Interactions and Environment

  1. Remove smoking paraphernalia (pipes, bongs, ashtrays, papers, rolling machines, etc.) from your car and home.
  2. Go to social environments where it is hard to smoke and avoid social gatherings/places where marijuana use is allowed.
  3. Spend time with friends who don’t smoke. Enlist support from family and friends. Ask friends and family not to offer you marijuana or use in your presence.</li >

 

Anger, Frustration, and Interpersonal Conflict

Try to handle the situation directly rather than hide your feelings; if appropriate, be assertive; get some release by squeezing a rubber ball, pounding a pillow, or doing some physical activity; write down your feelings or tell them someone; take deep breaths.

 

Cravings and Urges

The only way to interrupt cravings is to break the chain of responding to them. That is, don’t give in. Eventually they will decrease. Do something to distract yourself; use the techniques listed above and you will find that it will disappear like a wave breaking.

Medication Management

There are currently no FDA-approved, good evidence-based pharmacotherapy treatments for cannabis withdrawal. Some of the medications that have been investigated include bupropion (Wellbutrin), buspirone (Buspar), divalproex sodium, lithium carbonate and nefazodone but none have these have shown much benefit. It is generally recommended that mood stabilizers, anti-psychotics and antidepressants should not be used for the management of acute cannabis withdrawal.

 

However, recent research has produced some evidence to support the use of cannabadiol (CBD), gabapentin and baclofen to reduce withdrawal symptoms of cannabis.

 

Cannabidiol (CBD)

Cannabidiol (CBD) is the second most abundant cannabinoid found in most marijuana strains. Of the pharmacological options, CBD has the best evidence for effectiveness and it is known to be safe and well tolerated with few adverse effects. CBD has minimal direct action at cannabinoid receptors but it has multiple pharmacologic actions including inhibiting the breakdown and reuptake of endocannabinoids and modulation of cannabinoid receptors. CBD has been shown to reduce cannabis withdrawal symptoms during cannabis abstinence and is associated with improvements in psychological well-being and thought processing in cannabis users.

 

CBD is available in the form of hemp flowers that can be smoked or vaped but it is more commonly available as a liquid tincture. CBD tinctures can be found as isolate formulations of CBD only or in combination with terpenes. Terpenes offer benefits for pain, anxiety and sleep and therefore may reduce symptoms of cannabis withdrawal. In some cases, terpenes are also available in isolate formulations.

The following is a list of terpenes commonly believed to have sedative or anxiolytic effects:

 

 

 

Gabapentin (Neurontin)

Gabapentin is a medication frequently used for treating seizures and neuropathic (nerve) pain but has also shown potential benefit in withdrawal symptoms associated with opioids, benzodiazepines and alcohol. It has also been found to be possibly effective in suppressing symptoms of CWS. It is believed to modulate GABAergic mechanisms by blocking the α2δ subunit of the voltage-gated calcium channel. In a recent study, 1,200 mg of gabapentin was divided into three daily doses, the authors found statistically significant reduction in amount and frequency of cannabis used, along with reductions in cannabis-withdrawal symptoms, marijuana cravings, sleep problems, and depression. Improvements in measures of thought processing (“executive functioning”) were also seen.

In the study there were no serious adverse events and the fixed dose of 1,200 mg/day was found to be safe and well tolerated. It should be noted, however, that gabapentin dosing should start low at 100-300mg at night only, then slowly increased in divided doses 3x/day as tolerated until treatment goals are met.

See Gabapentin

 

Baclofen

Baclofen, a selective GABA-B agonist,is commonly used as a muscle relaxer and is believed to possibly improve certain types of pain including that associated with fibromyalgia. It has already been studied for alcohol and cocaine withdrawal and relapse prevention.

 

Baclofen at a dose 40 mg/day was recently reported to reduce cannabis withdrawal symptoms including reduced anxiety, improved mood, improved sleep and greater relaxation and perception of feeling calm. When taken chronically, it also reportedly reduces desire to consume cannabis.

 

Its safety and tolerability is well established although common side effects of baclofen  include sedation and lethargy. These side effects are generally avoided when dosing is started low and gradually increased as needed.

 

Insomnia

Persistent sleep problems related to cannabis withdrawal are best treated by non-pharmacological approaches such as effective sleep hygiene and relaxation techniques including progressive muscular relaxation, meditation and self-hypnosis techniques. If hypnotic medications are recommended for sleep, they are advised to be limited to short term use.

See Sleep and CAM Tx, Insomnia

 

Complementary and Alternative Treatment for Cannabis Withdrawal

N-acetylcysteine (NAC)

N-acetylcysteine (NAC), an antioxidant, reversed alterations to the glutamine system associated with repeated self-administration of a range of addictive drugs. In an open-label study, adolescents received 2,400 mg of NAC daily over a 4-week period with no other intervention. The medication decreased self-reported cannabis use, as well as cannabis craving. It was generally well tolerated, but did produce some mild-to-moderate side effects.

Addiction to Marijuana: Cannabis Use Disorder (CUD)

It is commonly reported that about 10% of people who use cannabis regularly actually have an addiction to cannabis (Cannabis Use Disorder – CUD), while some reports suggest figures as high as 20-30%. When considering a person’s withdrawal symptoms with cannabis, it is important to understand that the severity of withdrawal symptoms does not define or predict the diagnosis of CUD. Any addiction, cannabis included, has definitive characteristics that set it apart from the use, misuse or abuse of a medication or drug. All too often, people believe that difficulty discontinuing the use of a drug or medication due to withdrawal symptoms is equivalent to an addiction to the drug or medication. It is not. To learn more about addiction and what it is,

See Addiction Recovery.

See: Cannabis Use Disorder (CUD)

 

 

References:

Cannabis Withdrawal – Overviews

  1. the-marijuana-withdrawal-syndrome-diagnosis-and-treatment-2005
  2. withdrawal-symptoms-do-not-predict-relapse-2007-pubmed-ncbi-2007
  3. diagnostic-criteria-for-cannabis-withdrawal-syndrome-2012-pubmed-ncbi

 

Cannabis Withdrawal – Measuring Severity

  1. the-cannabis-withdrawal-scale-development-2011
  2. quantifying-the-clinical-significance-of-cannabis-withdrawal-2012
  3. Is the Urine Cannabinoid Level Measured via a Commercial Point-of-Care Semiquantitative Immunoassay a Cannabis Withdrawal Syndrome Severity Predictor? – 2020

 

Cannabis Withdrawal Treatement – Overviews

  1. management-of-cannabis-withdrawal
  2. pharmacological-treatment-of-cannabis-dependence-2011
  3. progress-toward-pharmacotherapies-for-cannabis-use-disorder-an-evidence-based-review-2016
  4. psychosocial-interventions-for-cannabis-use-disorder-2016-pubmed-ncbi

 

Cannabis Withdrawal Treatement – Baclofen

  1. baclofen-in-the-management-of-cannabis-dependence-syndrome-2014

 

Cannabis Withdrawal Treatment- Gabapentin (Neurontin)

  1. a-proof-of-concept-randomized-controlled-study-of-gabapentin-effects-on-cannabis-use-withdrawal-and-executive-function-deficits-in-cannabis-dependent-adults-2012

 

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