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Treatment of cannabis withdrawal

David A Gorelick, MD, PhD
Section Editor
Andrew J Saxon, MD
Deputy Editor
Richard Hermann, MD


Cannabis (also called marijuana) is the most commonly used illegal psychoactive substance worldwide [1]. Its psychoactive properties are primarily due to one cannabinoid: delta-9-tetrahydrocannabinol (THC); THC concentration is commonly used as a measure of cannabis potency [2].

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 [3]. 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".)


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 [4], meditation or prayer, relaxation techniques, herbal preparations, or alcohol and over-the-counter analgesics, sedatives, and hypnotics [5].  

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Literature review current through: Nov 2017. | This topic last updated: Aug 24, 2017.
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  1. United Nations Office on Drugs and Crime, World Drug Report 2016, Vienna 2016.
  2. Swift W, Wong A, Li KM, et al. Analysis of cannabis seizures in NSW, Australia: cannabis potency and cannabinoid profile. PLoS One 2013; 8:e70052.
  3. Bonnet U, Preuss UW. The cannabis withdrawal syndrome: current insights. Subst Abuse Rehabil 2017; 8:9.
  4. Buchowski MS, Meade NN, Charboneau E, et al. Aerobic exercise training reduces cannabis craving and use in non-treatment seeking cannabis-dependent adults. PLoS One 2011; 6:e17465.
  5. Copersino ML, Boyd SJ, Tashkin DP, et al. Cannabis withdrawal among non-treatment-seeking adult cannabis users. Am J Addict 2006; 15:8.
  6. Gorelick DA. Pharmacological Treatment of Cannabis-Related Disorders: A Narrative Review. Curr Pharm Des 2016; 22:6409.
  7. Levin FR, Mariani JJ, Brooks DJ, et al. Dronabinol for the treatment of cannabis dependence: a randomized, double-blind, placebo-controlled trial. Drug Alcohol Depend 2011; 116:142.
  8. Allsop DJ, Copeland J, Lintzeris N, et al. Nabiximols as an agonist replacement therapy during cannabis withdrawal: a randomized clinical trial. JAMA Psychiatry 2014; 71:281.
  9. Trigo JM, Lagzdins D, Rehm J, et al. Effects of fixed or self-titrated dosages of Sativex on cannabis withdrawal and cravings. Drug Alcohol Depend 2016; 161:298.
  10. Levin FR, Mariani JJ, Pavlicova M, et al. Dronabinol and lofexidine for cannabis use disorder: A randomized, double-blind, placebo-controlled trial. Drug Alcohol Depend 2016; 159:53.
  11. Haney M, Hart CL, Vosburg SK, et al. Effects of THC and lofexidine in a human laboratory model of marijuana withdrawal and relapse. Psychopharmacology (Berl) 2008; 197:157.
  12. Mason BJ, Crean R, Goodell V, et al. A proof-of-concept randomized controlled study of gabapentin: effects on cannabis use, withdrawal and executive function deficits in cannabis-dependent adults. Neuropsychopharmacology 2012; 37:1689.
  13. Vandrey R, Smith MT, McCann UD, et al. Sleep disturbance and the effects of extended-release zolpidem during cannabis withdrawal. Drug Alcohol Depend 2011; 117:38.
  14. Herrmann ES, Cooper ZD, Bedi G, et al. Effects of zolpidem alone and in combination with nabilone on cannabis withdrawal and a laboratory model of relapse in cannabis users. Psychopharmacology (Berl) 2016; 233:2469.
  15. Allsop DJ, Bartlett DJ, Johnston J, et al. The Effects of Lithium Carbonate Supplemented with Nitrazepam on Sleep Disturbance during Cannabis Abstinence. J Clin Sleep Med 2015; 11:1153.
  16. Weinstein A, MIller H, Tal E, et al. Treatment of cannabis withdrawal syndrome using cognitive-behavioral therapy and relapse prevention for cannabis dependence. J Groups Addiction Recovery 2010; 5:240.