Treatment of cannabis withdrawal
- David A Gorelick, MD, PhD
David A Gorelick, MD, PhD
- Professor of Psychiatry
- University of Maryland School of Medicine
Cannabis (also called marijuana) is the most commonly used illegal psychoactive substance worldwide . Its psychoactive properties are primarily due to one cannabinoid: delta-9-tetrahydrocannabinol (THC); THC concentration is commonly used as a measure of cannabis potency .
Cannabis withdrawal is manifested by a constellation of signs and symptoms occurring within one week after abrupt reduction or cessation of heavy and prolonged cannabis use; the syndrome typically includes irritability, anger, anxiety, depression, and disturbed sleep . Physical symptoms, such as abdominal discomfort, headache, muscle tremors, or twitching, are relatively uncommon.
Treatment of cannabis withdrawal is reviewed here. The epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis of cannabis withdrawal are reviewed separately. The clinical manifestations, course, assessment, and diagnosis of cannabis use disorder are also reviewed separately. The epidemiology and health consequences of cannabis use and cannabis use disorder are also reviewed separately. The pathogenesis, pharmacology, and treatment of cannabis use disorder in adults are also reviewed separately. Acute intoxication from cannabis and synthetic cannabinoids are also reviewed separately. (See "Cannabis withdrawal: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Cannabis use and disorder: Epidemiology, comorbidity, health consequences, and medico-legal status" and "Cannabis use and disorder: Pathogenesis and pharmacology" and "Treatment of cannabis use disorder" and "Cannabis (marijuana): Acute intoxication" and "Synthetic cannabinoids: Acute intoxication".)
APPROACH TO SELECTING TREATMENTS
Mild withdrawal — The majority of acute cannabis withdrawal episodes are mild and resolve without a need for formal treatment. As an example, an individual with mild withdrawal might have a mild sleep disturbance and anxiety but is performing normally at work or school and is confident that s/he can abstain from cannabis use.
Individuals with this level of mild withdrawal often self-treat with physical exercise , meditation or prayer, relaxation techniques, herbal preparations, or alcohol and over-the-counter analgesics, sedatives, and hypnotics .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- APPROACH TO SELECTING TREATMENTS
- Mild withdrawal
- Moderate to severe withdrawal
- - New presentation
- Medication versus CBT
- Selection among medications
- - Inadequate treatment response
- - Sleep disturbance
- INDIVIDUAL TREATMENTS
- - Delta-9-tetrahydrocannabinol
- Administration of dronabinol
- Administration of nabiximols
- Side effects
- - Gabapentin
- - Zolpidem
- - Nitrazepam
- Cognitive-behavioral therapy
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS