More than half of people who use medical marijuana products to ease pain also experience clusters of multiple withdrawal symptoms when they’re between uses, a new study finds.
And about 10% of the patients taking part in the study experienced worsening changes to their sleep, mood, mental state, energy and appetite over the next two years as they continued to use cannabis.
Many of them may not recognize that these symptoms come not from their underlying condition, but from their brain and body’s reaction to the absence of substances in the cannabis products they’re smoking, vaping, eating or applying to their skin, says the University of Michigan Addiction Center psychologist who led the study.
When someone experiences more than a few such symptoms, it’s called cannabis withdrawal syndrome — and it can mean a higher risk of developing even more serious issues such as a cannabis use disorder.
In the new research published in the journal Addiction, a team from the U-M Medical School and the VA Ann Arbor Healthcare System reports findings from detailed surveys across two years of 527 Michigan residents.
All were participating in the state’s system to certify people with certain conditions for use of medical cannabis, and had non-cancer-related pain.
“Some people report experiencing significant benefits from medical cannabis, but our findings suggest a real need to increase awareness about the signs of withdrawal symptoms developing to decrease the potential downsides of cannabis use, especially among those who experience severe or worsening symptoms over time,” says Lara Coughlin, Ph.D., the addiction psychologist who led the analysis.
The researchers asked the patients whether they had experienced any of 15 different symptoms – ranging from trouble sleeping and nausea to irritability and aggression – when they had gone a significant time without using cannabis.
The researchers used an analytic method to empirically group the patients into those who had no symptoms or mild symptoms at the start of the study, those who had moderate symptoms (meaning they experienced multiple withdrawal symptoms) and those who had severe withdrawal issues that included most or all of the symptoms.
They then looked at how things changed over time, surveying the patients one year and two years after their first survey.
At baseline, 41% of the study participants fell into the mild symptoms group, 34% were in the moderate group and 25% were classed as severe.
Many people who turn to medical cannabis for pain do so because other pain relievers haven’t worked, says Coughlin, an assistant professor in the Department of Psychiatry who sees patients as part of U-M Addiction Treatment Services.
They may also want to avoid long-term use of opioid pain medications because they pose a risk of misuse and other adverse health consequences.
She notes that people who experience issues related to their cannabis use for pain should talk with their health care providers about receiving other pain treatments including psychosocial treatments such as cognitive behavioral therapy.
The perception of cannabis as “harmless” is not correct, she says. It contains substances called cannabinoids that act on the brain—and that over time can lead the brain to react when those substances are absent.
In addition to a general craving to use cannabis, withdrawal symptoms can include anxiety, sleep difficulties, decreased appetite, restlessness, depressed mood, aggression, irritability, nausea, sweating, headache, stomach pain, strange dreams, increased anger and shakiness.
Previous research has shown that the more symptoms and greater severity of symptoms a person has, the less likely they are to be able to reduce their use of cannabis, quit using it or stay away from it once they quit.
They may mistakenly think that the symptoms happen because of their underlying medical conditions, and may even increase the amount or frequency of their cannabis use to try to counteract the effect—leading to a cycle of increasing use and increasing withdrawal.
Coughlin says people who decide to use a cannabis product for a medical purpose should discuss the amount, route of administration, frequency and type of cannabis product with their regular health provider. They should also familiarize themselves with the symptoms of cannabis withdrawal and tell their provider if they’re experiencing them.
Feeling the urge to use cannabis after a period without use, such as soon after waking up, can be a sign of a withdrawal syndrome, she notes. So can the inability to cut back on use without experiencing craving or other symptoms of withdrawal.
Because there is no medically accepted standard for medical cannabis dosing for different conditions, patients are often faced with a wide array of cannabis products that vary in strength and route of administration. Some products could pose more risk for development of withdrawal symptoms than others, Coughlin says.
For example, people who smoked cannabis tended to have more severe withdrawal symptoms than others, while people who vaped cannabis reported symptoms that tended to stay the same or get worse, but generally did not improve, over time.
As more states legalize cannabis for medical or general use, including several states that will legalize its use based on the results of last November’s election, use is expected to grow.
More about the study
The researchers asked the patients about how they used cannabis products, how often, and how long they’d been using them, as well as about their mental and physical health, their education and employment status.
Over time, those who had started off in the mild withdrawal symptom group were likely to stay there, but some did progress to moderate withdrawal symptoms.
People in the moderate withdrawal group were more likely to go down in symptoms than up, and by the end of the study the number of the people in the severe category had dropped to 17%. In all, 13% of the patients had gone up to the next level of symptoms by the end of the first year, and 8% had transitioned upward by the end of two years.
Sleep problems were the most common symptom across all three groups, and many in the mild group also reported cravings for cannabis. In the moderate group, the most common withdrawal symptoms were sleep problems, depressed mood, decreased appetite, craving, restlessness, anxiety and irritability.
The severe withdrawal symptom group was much more likely to report all the symptoms except sweatiness. Nearly all the participants in this group reported irritability, anxiety, and sleep problems. They were also more likely to be longtime and frequent users of cannabis.
Those in the severe group were more likely to be younger and to have worse mental health. Older adults were less likely to go up in withdrawal symptom severity, while those who vaped cannabis were less likely to transition to a lower withdrawal-severity group.
The study didn’t assess nicotine use, or try to distinguish between symptoms that could also be related to breakthrough pain or diagnosed/undiagnosed mental health conditions during abstinence.
Coughlin and her colleagues hope future research can explore cannabis withdrawal symptoms among medical cannabis patients further, including the impact of different attempts to abstain, different types of use and administration routes, and interaction with other physical and mental health factors. Most research on cannabis withdrawal has been in recreational users, or “snapshot” looks at medical cannabis patients at a single point in time.
Further research could help identify those most at risk of developing problems, and reduce the risk of progression to cannabis use disorder, which is when someone uses cannabis repeatedly despite major impacts on their lives and ability to function.
Signs of Marijuana Abuse
If you’re concerned someone you care about is using marijuana, being aware of the signs of abuse is the first step toward finding out. Some common signs that may indicate marijuana use include:
- Bloodshot eyes
- Increased appetite
- Lack of motivation
- Weight gain
- Nervous or paranoid behavior
- Impaired coordination
- Slowed reaction time
- Dry mouth
- Memory impairment
- Lack of motivation
- Impaired judgment
- Distorted perception
- Relaxed state, sleepiness
- Feeling “high” or euphoria
- Slowed or poor coordination
The Dangers of Marijuana
The majority of Americans don’t have any more of a problem with marijuana than they do with alcohol. Some states have even legalized recreational marijuana use. This doesn’t mean marijuana use is risk-free.
The psychological consequences of prolonged marijuana abuse aren’t completely understood. Some studies suggest that marijuana addiction may increase the chances of developing mental disorders such as depression, anxiety, motivational disorder and schizophrenia.
It isn’t surprising that marijuana use affects short-term memory and the ability to retain new information. The long-term effects on memory and learning, however, are uncertain.
Immediate Side Effects of Marijuana Abuse
The short-term side effects of marijuana aren’t life-threatening, but there are potential dangers of use. Marijuana-related emergency room admissions increased by 59 percent from 2006 to 2010, according to the United Nations Office on Drugs and Crime. Some of the immediate side effects of marijuana include:
- Elevated heart rate
- Impaired motor function
- Impaired cognition
Long-term Effects of Marijuana Abuse
The long-term side effects of marijuana abuse aren’t as damaging as other drugs. However, there are discernible effects possibly attributed to marijuana. Although there isn’t any concrete evidence that chronic marijuana use has damaging effects in adults, this is not the case in adolescents. Some possible side effects of long-term use may include:
- Mood swings
- Reduced ability to learn
- Lung infections
- Inhibited mental development
- Panic attacks
- Memory loss
Possible Effects on Teens
The potential long-term risks of marijuana abuse were highlighted in a study conducted by Duke University. It was shown that among 1,037 people, those who regularly used marijuana as teens experienced an average decrease of eight IQ points. However, the study also noted that IQ differences could be due to other factors.
Recognizing a Marijuana Addiction
One of the biggest signs of a marijuana addiction is an insatiable urge to use marijuana no matter the negative outcome. This could mean getting high at work or spending more on the drug than is affordable. Generally, most people addicted to marijuana don’t feel normal unless they can get high.
Some clinical warning signs of marijuana addiction include needing larger amounts of marijuana to get high and prioritizing marijuana use over social or occupational responsibilities.
Intervention for a Marijuana Problem
If marijuana is hindering a healthy and productive life for someone you care about, staging an intervention can be a good way to help them make a change. Oftentimes, people who have become addicted to marijuana do not believe they can be addicted, which is why they haven’t gotten help. An intervention is the perfect time to present them with the facts: marijuana is addictive and can have a negative impact on their life.
Parents of teens who have started abusing marijuana regularly may stage an intervention to explain the potential developmental issues that may crop up in the future.
Marijuana Withdrawal, Treatment and Next Steps
Some people who have used marijuana for years have reported symptoms of withdrawal when they attempted to quit. Unlike those quitting heroin or alcohol, the primary symptoms of marijuana withdrawal are primarily psychological rather than physical.
Chronic marijuana users who quit cold-turkey may experience irritability, insomnia, cravings, depression, restlessness, changes in sleep patterns, changes in eating patterns, and anxiety.
Most marijuana withdrawal symptoms develop within the first 24–72 hours after the last use, peak within the first week, and last approximately 1–2 weeks. Sleep difficulties may last more than 30 days. Post-Acute Withdrawal symptoms (PAWS) are reported to last anywhere from 12, 18, or 24 months. Some PAWS include restlessness, irritability, agitation, diminished appetite, poor concentration, increased anxiety, difficulty with decision-making skills, diminished ability functioning at same level as prior to using marijuana, and cravings. The process of PAWS are inexorable and it is crucial to learn healthy coping skills to manage PAWS in order to remain sober
Seeking help through treatment can teach users how to get over the emotional hurdles of quitting marijuana. Treatment often includes a therapist who can coach patients through rough days and support groups that can provide comfort. Contact a dedicated treatment provider if you or someone you care about needs help finding treatment.
Marijuana Withdrawal Symptoms
Symptoms of withdrawing from marijuana vary according to an individual’s level of dependency. For example, a person with a mild dependence on marijuana may experience minor physical and psychological discomfort, such as headaches or restlessness.
On the other hand, those with severe forms of marijuana addiction may endure more intense withdrawal symptoms, including sweating, fever, chills and hallucinations. In general, the longer the individual has used marijuana, the more severe their symptoms will be. Luckily, in most cases marijuana withdrawal symptoms will largely subside after about a month in most cases.
The most common symptoms include:
- Mood changes
- Stomach pains
- Appetite loss/weight loss
- Insomnia or fatigue
If someone smokes today’s high-potency marijuana daily, what happens if they stop? Fully 50 percent will suffer withdrawal symptoms. Sleep will be poor, appetite will decline and there might be vomiting or abdominal pain.
A 17-year-old daily user recently told me, ‘I can’t sleep or eat at all unless I smoke.’ Anxiety and irritability increase. Some users experience muscle twitching or limb spasms…Most symptoms will clear in less than a week, but the experience is rough. Many heavy users resume smoking in mid-withdrawal.- Dr. Grace M. McGorrian, Pittsburgh Post-Gazette, 2015
Detox Options for Marijuana
In cases where the patient resides in a state where marijuana is legal and possesses a legitimate prescription, doctors may use a tapering down method to help users overcome withdrawal symptoms.
This method involves reducing the amount and frequency of marijuana used over a period of time. Tapering off the drug allows the brain to slowly adjust to lower levels of THC, resulting in less intense withdrawal symptoms. In most circumstances, however, use of marijuana is ceased immediately upon entering detox, and non-narcotic comfort medications are provided.
While some are able to safely detox from marijuana on their own, doctors are able to prescribe medications to help reduce withdrawal symptoms. For example, metoclopramide or promethazine can help with nausea and vomiting. Headaches or muscle pains can be treated with paracetamol or ibuprofen. It is important to consult a doctor about how to best treat withdrawal symptoms.
How Long Does Marijuana Withdrawal Last?
The duration of withdrawal from marijuana is different for everyone. For most heavy marijuana users, withdrawal symptoms begin on the first day after quitting and peak within 48 to 72 hours. Symptoms generally last two to three weeks and dissipate over time.
|Marijuana Withdrawal Timeline|
|Day 1||During the first day of withdrawal from marijuana, feelings such as irritability, anxiety and insomnia are common.|
|Days 2 – 3||This period is typically the peak of withdrawal symptoms. Cravings can be strong, so relapse is most likely during this time. Sweating, chills and stomach pains have also been reported during this period.|
|Days 4 – 14||Over the next several weeks, symptoms generally improve. However, depression can set in as brain chemistry changes and adapts to functioning without THC. Marijuana cravings may still be present as well.|
|Days 15+||Most, if not all, symptoms should be gone by week three. Those with severe psychological addictions have reported feelings of depression and anxiety for up to several months after discontinuing marijuana use.|
Treating A Marijuana Addiction
After safely detoxing with the help of medical professionals, a person with a psychological dependence on marijuana should seek further treatment at a rehab center.
An outpatient program is best suited for those with milder forms of marijuana dependence, while inpatient programs are recommended for more severe addictions.
Outpatient programs are available to those who wish to remain at home during treatment, but also want the help and advice of professionals as they pursue recovery.
Inpatient programs provide a high level of care in a structured environment, allowing people to focus solely on their recovery.
reference link : https://www.addictioncenter.com/drugs/marijuana/withdrawal-detox/
More information: Lara N. Coughlin et al, Progression of cannabis withdrawal symptoms in people using medical cannabis for chronic pain, Addiction (2021). DOI: 10.1111/add.15370