Cannabis Withdrawal Symptoms

Diagnostic Criteria and Prevalence

Cannabis withdrawal syndrome (CWS) is recognized in the DSM-5 and occurs when there is abrupt cessation of prolonged or heavy cannabis use accompanied by three or more characteristic symptoms 1

Regular cannabis users who stop smoking marijuana will typically experience withdrawal symptoms including irritability, anxiety, sleep disturbances, decreased appetite, restlessness, altered mood, and physical discomfort such as abdominal pain, tremors, sweating, fever, chills, or headaches 1, 2
Irritability or anger 1, 2
Anxiety 1, 2
Restlessness 1, 2
Altered mood 1
Tremors 1
Sweating 1
Fever or chills 1
Decreased appetite 1
Stomach pain or abdominal discomfort 1

The severity of withdrawal symptoms correlates with the amount of cannabis used before cessation 1, 2
Withdrawal is more likely to occur in those consuming more than 1.5 g/day of inhaled cannabis 1, 2
Withdrawal is more likely to occur in those consuming more than 300 mg/day of CBD-dominant oil 1, 2
Withdrawal is more likely to occur in those consuming more than 20 mg/day of THC-dominant cannabis oil 1, 2
Users consuming cannabis products with unknown CBD/THC content more than 2-3 times daily may also develop withdrawal symptoms 1, 2
Symptoms are unlikely to occur in patients consuming 300 mg/day or less of smoked CBD-dominant cannabis (approximately one cigarette) 1

Withdrawal symptoms may theoretically contribute to increased distress and decreased tolerance of pain 3
Withdrawal from an analgesic or anxiolytic cannabis regimen might contribute to increased pain perception 3

Cannabis users with opioid dependence are less likely to experience CWS 1
Cannabis withdrawal may exacerbate psychiatric disorders in vulnerable individuals 4

Patients can safely withdraw from THC, as cannabis withdrawal is a well-characterized, self-limited syndrome that typically resolves within 2-4 weeks and can be managed in outpatient settings for most individuals, according to the American Academy of Addiction Psychiatry 5

The Centers for Disease Control and Prevention recommends screening for mental health and substance use disorders before initiating withdrawal, and patients should be monitored for complications such as severe depression or psychosis requiring specialist consultation 6
The American Society of Addiction Medicine suggests that supportive counseling and psychoeducation are the primary management strategies for most patients, and symptomatic relief can be provided as needed, such as sleep aids or anxiety management 5

The Substance Abuse and Mental Health Services Administration notes that patients with substance use disorders, including those with opioid dependence, should be screened for mental health and substance use disorders before initiating withdrawal, and inpatient admission may be clinically indicated for those with comorbid mental health disorders or polysubstance use 6
The National Institute on Drug Abuse recommends ensuring access to ongoing support and relapse prevention resources, as withdrawal symptoms are a significant contributor to relapse and difficulty maintaining abstinence 6, 5