Detox Local

Marijuana Withdrawal & Detox

Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN

Written By: Phillippe Greenough

Article Updated: 09/14/2020

Number of References: 14 Sources

Marijuana use has been on the rise in America over the last 20 years. Even though use rates are increasing, there is still widespread doubt and ignorance as to the existence of marijuana withdrawal. Also known as cannabis, it was only recently that the American (2013 via the DSM-V) and international (2015 via the ICD-10) medical communities recognized cannabis withdrawal syndrome (CWS) as a legitimate medical condition. CWS has seen greater incidence recently, both due to the increasing use rates as well as the increased purity and potency of legally produced marijuana. In this guide, we will look at the specifics of marijuana withdrawal such as the symptoms, the expected timeline, and the psychological and physical ramifications.

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Symptoms of Marijuana Withdrawal

While marijuana withdrawal does produce minor physical symptoms, the majority of the symptoms are psychological in nature. These symptoms do not fit neatly into the typical categories of acute or post-acute withdrawal symptoms, as the entire experience of marijuana withdrawal is quite mild compared to withdrawal from other drugs. That being said, it is by no means “easy” to undergo withdrawal from marijuana. The very fact that these symptoms are so protracted can make the experience exhausting and extremely stressful. It is always recommended to enter a marijuana detox center when expecting withdrawal.

Some of the most frequently reported symptoms of marijuana withdrawal include:

  • Cravings for Marijuana
  • Diaphoresis (excessive sweating)
  • Irritability and Increased Aggression
  • Insomnia (with vivid dreams or nightmares when sleep is achieved)
  • Increased Anxiety and Restlessness
  • Mild Depression
  • Clouded or Disorganized Thinking
  • Headaches
  • Decreased Appetite
  • Stomach Cramps or Pain
  • Nausea
  • Shakiness or Mild Tremor
  • Psychosis (very rare)

To get a more comprehensive picture of the symptoms of marijuana withdrawal, it will be helpful to understand a little more about exactly how marijuana works. Marijuana has a very complicated and multifaceted mechanism of action which affects a wide range of neurological systems. Some of these systems include the brain’s endocannabinoid system, the neurotransmitters serotonin and dopamine, and indirectly on the opioid system.

The endocannabinoid system is used, in part, to moderate the function of other neurotransmitters and plays a role in consciousness and cognition, pain management, memory, motor functions, appetite, and moderating immune responses. The 2 major natural cannabinoids that are produced by the body are anandamide and 2-arachidonoylglycerol (2-AG). While there are over 60 cannabinoid compounds in the marijuana plant, the most psychoactive ones by far are delta-6-tetrahydrocannabinol (THC) and cannabidiol (CBD). These compounds will mimic the endocannabinoids and stimulate the endocannabinoid system in a much stronger way than the brain and body are used to.

The main way that THC utilizes the cannabinoid system is through interactions at the CB1 receptors. CB1 receptors are found all throughout the brain, with the highest concentrations located in the hippocampus, basal ganglia, cerebellum, and cerebral cortex. These areas of the brain have a wide range of functions which include memory formation, emotional regulation, motor control, and regulating higher consciousness. Stimulation of the CB1 receptor also produces, through mechanisms unknown, stimulation of the natural opioid system of the brain, particularly at the μ-opioid receptor. This may be partially responsible for the euphoria, pain reduction, and pleasure produced through marijuana use.

The main euphoric and addictive properties of marijuana use are produced through THC induced dopamine release. Dopamine is an excitatory neurotransmitter that produces feelings of pleasure, reward, and can reinforce the behaviors which led to these feelings. Through chronic marijuana use, the brain will reduce sensitivity to dopamine to compensate for the chronically elevated levels in an attempt to reduce the risk of neurotoxicity. This process is known as downregulation.

CBD, while being less psychologically active than THC, may be able to increase the brain’s sensitivity to serotonin. Serotonin is a mood regulator in the brain and increased sensitivity can produce a mood-elevating and antidepressant effect. Additionally, CBD induced increases of serotonin receptor sensitivity can result in the body downregulating its normal responses to serotonin. CBD also has a somewhat mysterious mechanism of action that interacts with the way THC activates the endocannabinoid system. It appears to modify the way that THC interacts with the CB1 receptors, and may provide neuroprotective effects which reduce the psychotropic effects of THC. Finally, CBD may also be a mild painkiller although this is produced through anti-inflammatory means rather than the natural opioid system of the brain.

Through the chronic use of marijuana, the brain will begin to adapt to the changes that marijuana produces. This can result in the downregulation of a variety of neurotransmitters but is particularly strong regarding dopamine, serotonin, and possibly the opioid system. This is the brain’s attempt to maintain balance and efficient function, but will quickly lead to marijuana tolerance and eventually dependence. Once these changes have occurred, someone will begin to feel withdrawal symptoms when they do not use marijuana. These symptoms will worsen the longer marijuana is used, as these changes become more difficult to reverse.

Marijuana Withdrawal Timeline

Marijuana withdrawal is an extremely drawn-out process which on average takes around 28 days to complete. While 4 weeks is the average withdrawal duration, there is great variability in this timeline between individuals, ranging from 3 days for physical symptoms to 5 weeks for post-acute symptoms. The symptoms of withdrawal typically peak at around 4 days since the last use and decline gradually over the next several weeks. A general guide of the symptom timeline progression may look like:

First Week

Excessive sweating and insomnia are usually the first symptoms to appear. The first 4 days are commonly the most difficult with the severity of other symptoms increasing during this time. Anxiety, restlessness, and cravings are the most severe symptoms which will appear suddenly and rapidly escalate. Anger and irritability may become more pronounced during this time as well. All of the above symptoms will escalate between days 1 and 4, and begin decreasing gradually during or after the fourth day. Depression may appear but typically remains fairly stable and mild during the first week. Nausea and stomach pain may begin and increase gradually in the first few days, plateau on the fourth day, then begin a slow resolution. Appetite may be nonexistent for the first few days, and then begin to normalize very slowly.

Second Week

The second week will be much less intense, with a great reduction in symptoms between the middle of the first week and the beginning of the second week. Insomnia, excessive sweating, vivid dreams or nightmares, and reduced appetite will be slightly reduced, but certainly still present. Cravings, anxiety, and restlessness will remain but should be greatly reduced. Anger, irritability, and depression will typically resolve along a similar trajectory to each other, reducing over the course of the second week.

Third and Fourth Weeks

Weeks 3 and 4 will follow a common trend of symptom reduction. The worst of the symptoms during this time may be excessive sweating, insomnia, and vivid dreams. Cravings and anxiety may remain in some capacity until the end of the fourth week, but continue to decrease in severity during this time. Appetite may take some time to fully return to normal but should be well on its way by this time.

The fact that THC is highly fat-soluble is partially responsible for the extended duration of marijuana withdrawal. While most other drugs are water-soluble, THC must undergo extensive metabolism to produce water-soluble metabolites which can then be excreted in urine and feces. This results in THC remaining in someone’s body for much longer than other drugs and may subsequently extend the withdrawal process over a longer timeline than most other illicit drugs. It should be noted that the process of withdrawal is the brain restoring neurotransmitter function and balance to the levels prior to marijuana use. This process cannot begin in earnest until the levels of THC, CBD, and the various other cannabinoids in marijuana have dropped below the average limit that the brain adapted to through downregulation. This may begin within hours or days of the last use but can take quite some time to complete.

The Importance of Marijuana Detox

Entering a marijuana detox can make the withdrawal experience much less unpleasant and also reduce the risks, which are commonly low to begin with. Through medications, medical supervision, and psychiatric care most of the withdrawal symptoms can be reduced and managed. Additionally, any co-occurring mental health issues someone may be struggling with can be addressed and treated through one of these detox programs.

Marijuana Detox Center Guide

Physical Effects of Marijuana Withdrawal

The most direct physical symptoms of marijuana withdrawal are commonly described as abdominal discomfort, nausea, and headaches. These are not typically dangerous but are very unpleasant. These symptoms can last around a week, although they do decline in intensity during this time.

-Gastrointestinal Effects

While smoking marijuana is known to increase appetite, marijuana withdrawal can produce an opposite effect and decrease appetite. In addition to nausea, stomach cramps and abdominal discomfort are very common as well. This is thought to be due to a variety of factors that result from the effects of both THC and CBD.

A minor contributor to digestive issues is thought to be the effect that THC has on μ opioid receptors. This class of opioid receptors is present in large numbers in the gut and has a profound impact on the digestive process. THC induced imbalances in μ opioid receptor function are likely a contributor to nausea and abdominal pain which is common during marijuana withdrawal.

It seems that the way CBD can contribute to digestive issues may be fairly direct in that it increases sensitivity at certain serotonin receptors. While serotonin is a neurotransmitter responsible for mood regulation in the brain, it plays a crucial role in the digestive tract as well. Around 95% of all serotonin in the body is located in the gut and enteric nervous system where it acts to moderate intestinal contractions and facilitate effective digestion. This serotonin disruption produced through withdrawal is largely responsible for nausea, stomach pain, and abdominal cramping which is an extremely common symptom.

Psychological Effects of Marijuana Withdrawal

The majority of the symptoms experienced during marijuana withdrawal are psychological in nature. These symptoms are longer lived than the physical symptoms but are typically quite mild, although often unpleasant. These effects arise from a variety of interactions produced mainly by THC and CBD, and the subsequent changes made by the brain in response to consistent marijuana use. The brain is capable of restoring balance to these systems, but this is a very slow process that often takes many months.

Some of the most common symptoms experienced during withdrawal include:

Anxiety and Irritability

Irritability and anxiety are some of the most frequently reported symptoms of marijuana withdrawal. These symptoms are produced through neurological changes to serotonin and dopamine systems, and the subsequent structural changes that are made by the brain in response to these neurotransmitter changes. The disruption to these neurotransmitter systems can conspire to produce moderate anxiety and irritability which maybe some of the more intense and longer-lasting effects of withdrawal.

Marijuana Cravings

Marijuana withdrawal produces some very strong and long-lived cravings. This is mainly due to dopamine system disruption in the limbic system, the so-called “reward center” of the brain. Marijuana induced dopamine surges will, over time, change the signaling structure in certain areas of the brain including the limbic system. This will reduce feelings of reward and pleasure which are normally produced from natural sources like eating or sex. After a time, the only way someone can experience positive feelings is through continued marijuana use. This produces strong neurological connections between enjoyable feelings and marijuana use. During withdrawal, this results in a person feeling deeply unfulfilled with the knowledge that smoking marijuana will make them feel better. Intense cravings may persist for many months after withdrawal has been completed and are often the longest-lived symptom.

Clouded or Disorganized Thinking

Cognitive difficulties are a very common symptom of marijuana withdrawal, although it often goes unrecognized. Many people have a stereotypical archetype of “the stoner” and these symptoms often mesh well with this expectation. These symptoms are in fact temporary and due to complex neurological changes in the regions of the brain responsible for higher reasoning and executive function such as the cerebral cortex. This area is greatly affected by THC and this produces profound changes in perceptions and awareness, attention and memory, and consciousness.

These changes may persist for a time even after marijuana use has ceased, and this may make someone appear mentally slow. The cognitive problems produced during withdrawal are not necessarily an issue of reduced perceptions per se, but rather a difficulty in integrating information from disparate sources into a comprehensive and sensible whole. In practice, this means that there may be a disconnect between someone hearing a conversation, seeing the person who is talking, and remembering what this person has said in the previous moments. This leads to a jumbled and confused mental state in which almost all higher brain functions are slowed, isolated, and much less effective.

Insomnia

Being one of the more common and seemingly mild of marijuana withdrawal symptoms, insomnia can nevertheless be one of the most infuriating. The difficulty in falling asleep can subjectively worsen many other symptoms such as anxiety and depression. Once the brain has adapted to the depressant effects of marijuana and marijuana is removed, the brain will remain in an excited state for many weeks making sleep very difficult. Not only will sleep be difficult to obtain, but very vivid and intense dreams or nightmares are quite common if and when sleep is achieved.

There are several reasons for withdrawal insomnia, and one of the largest contributors has to do with limbic system disruption. The hypothalamus is a component of the limbic system and is a crucial component in daily cycle regulation in the body. It is a primary moderator with regards to sleep cycles, appetite, digestion, and a variety of hormonal functions. Disruptions in the hypothalamus due to withdrawal can affect all of these systems, but healthy sleep cycles are often the most heavily influenced.

What Factors Influence The Intensity of Marijuana Withdrawal?

While the severity of symptoms from marijuana withdrawal can differ quite a lot between people, there are several contributing factors that play a role. Some of these are influenced by decisions, and are within a marijuana user’s control, while others are completely out of someone’s ability to influence. Some people seem to recover quickly in just a week or two while others may experience symptoms for many months. Additionally, some people will only experience mild symptoms while others can experience severe psychological issues for an extended time.

Some of the factors which contribute to the intensity and duration of withdrawal symptoms include:

  • Amounts of marijuana someone used
  • Length of time someone used marijuana
  • A genetic predisposition for addiction
  • Co-occurring mental health issues (schizoaffective disorders in particular )
  • Someone’s body fat percentage

Clearly, the amounts of marijuana someone used play a large role in the withdrawal symptom severity. This is due to the fact that the more marijuana someone uses, the greater the degree of downregulation which the brain performs. This means that if someone uses a lot of marijuana, their brain has higher consistent levels of dopamine and to a lesser degree serotonin, thus the brain will make greater changes to bring those higher levels within safe limits.

Additionally, the length of time that someone uses marijuana will affect this process. The longer someone is using marijuana consistently, the more long term these downregulated neurotransmitter levels become. This means that during marijuana withdrawal, the brain will be slower to complete the upregulation and recovery process, since there is more downregulation to undo, resulting in longer and possibly more intense withdrawal symptoms.

The previously mentioned factors are influenced by a marijuana user’s behaviors, but genetic predisposition has been decided long before someone was even born. Genetics play a large role in the ease and speed with which someone may become an addict. The exact manner and amount of influence that this effect has is still unclear, but it certainly has many repercussions. This may mean that someone with addiction on both sides of their family may become more addicted more quickly than someone who has no family history of addiction. This may result in someone with a genetic predisposition experiencing worse withdrawal symptoms than someone without a predisposition, even if they have used the exact same amounts of marijuana for the exact same length of time. A more serious impact of genetics may have more to do with the chances of someone achieving lasting recovery, as a genetic predisposition to addiction makes it more challenging and difficult to remain sober.

Previous mental health conditions may play a role not only in the intensity of withdrawal symptoms but also in the range of symptoms that someone may experience. It is known that marijuana use can worsen or accelerate the onset of certain psychological conditions such as schizophrenia and bipolar spectrum disorders. The mechanisms of action for these effects are unclear at present, but there is a wealth of research and documentation that marijuana may increase the risks and/or accelerate the progression of these conditions.

Marijuana is unique among illicit drugs in the sense that it, and it’s metabolites, is lipophilic and thus highly soluble in fats. This lipophilicity, along with the particulars of marijuana metabolism means that the active ingredients of marijuana (particularly THC) may remain in body fat for many weeks after the last use. The higher a percentage of body fat someone has, the more THC will be stored in their fat cells.

Marijuana Withdrawal Treatment

Finding treatment for marijuana withdrawal can make all the difference in the world. Not only will entering treatment reduce the symptoms of withdrawal, but it will also provide a much higher chance of successful recovery. Marijuana detox centers specialize in helping people make it through the detox process in the most comfortable way possible. Getting over this first hurdle of withdrawal is much more realistic with help, support, and medical care.

While attending a marijuana detox center is certainly the first step, there are further treatment options once detox has been completed. Finishing the withdrawal process is a huge step, but it is only the beginning of long term recovery. Marijuana addiction treatment centers can provide help in the form of medications, therapeutic techniques, and supportive treatments. Someone will certainly have better odds if they are armed with as many recovery tools as possible.

Medications for Marijuana Withdrawal

There are currently no FDA approved medications for the treatment of marijuana withdrawal. That being said, there are a variety of medications that may be used to treat the individual symptoms of withdrawal. These come in the form of several different classes of medication, but the shared goal of these medications is symptom reduction. Through counterbalancing the marijuana-induced downregulation, the severity of withdrawal symptoms may be greatly reduced.

Some of the most commonly used medication types for withdrawal treatment include:

  • Antidepressants (both common and atypical)
  • Anti-Anxiety Medications
  • GABA Agents
  • Blood Pressure Medications (usually β-blockers for anxiety treatment)

These medications, and others, may be used to treat both the physical and psychological symptoms of withdrawal. There is active research into medications specifically for marijuana withdrawal treatment, but at present, these classes have been found quite effective.

Therapies for Marijuana Withdrawal

In addition to medications, there are several therapies that have been found helpful and effective for treating withdrawal and helping someone achieve lasting recovery. These often take the form of behavioral and talk therapies, addiction education classes, and developing healthy coping skills. These may be used initially during detox as well as further in recovery treatment.

Some of the most commonly used therapies for withdrawal treatment include:

  • Group and Individual Therapy
  • Cognitive Behavioral Therapy (CBT)
  • Meditation Exercises
  • Experiential Stories and Testimonials from Recovering Marijuana Addicts

These are just a few, but there is a wide range of therapeutic techniques that are helpful in marijuana withdrawal treatment. Marijuana detox and withdrawal completion is only the beginning, and these therapies can help someone develop momentum in their recovery. Continuing care is needed if someone is to have a realistic chance of successful treatment.

In addition to detox and continuing treatment in a professional setting, there are some additional things someone could pursue to increase their chance of success. This includes support groups, 12 step programs, or religious model recovery programs. There is a treatment option available that will suit anyone’s specific needs, spiritual or religious views, and desires.

There is no single “correct” way to recover from addiction, it only requires that someone is trying their absolute best. It is possible to reclaim or build a new life after marijuana addiction, but it does require work and outside help. Reaching out for help is often the scariest part of recovery but it is necessary. If someone is struggling with marijuana withdrawal and addiction, there are people ready and willing to help.

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