Understanding the withdrawal symptoms from cannabis

Cannabis is a unique substance with an excellent safety profile. Many believe that stopping after regular cannabis use poses no risk of withdrawal symptoms. However, that is not necessarily true. While cannabis does not cause physical withdrawal symptoms like opiates or alcohol, the idea that cannabis is not inherently addictive and that withdrawal is an easy process is somewhat misguided. Now, anecdotal stories from daily cannabis users over years or even decades suggest that quitting with no problems is the norm. However, several research findings suggest that cannabis withdrawal can lead to psychological and sometimes psychiatric withdrawal symptoms, including:

• Spontaneous mood swings, including aggression, irritability, anxiety, depression, restlessness and anger.
• Physical complaints such as headaches, vomiting, nausea, abdominal pain.
• Feelings of insomnia and intense fatigue

What research says about cannabis withdrawal

While research has painted an incomplete picture of withdrawal rates associated with cannabis and the addiction one can develop from cannabinoid use, some big questions remain largely unanswered. One of the most prominent meta-analysis studies on cannabis withdrawal, conducted by Anees Bahji, MD, Callum Stephenson and Richard Tyo, BsocSc for the journal JAMA Network, found that among 23,518 participants in observational studies, 47 percent showed significant withdrawal symptoms from cannabis. The majority of withdrawal patients also had many other clinical factors associated with their cannabis use. These factors include concomitant use of tobacco, use of other substances such as LSD or alcohol, or daily use of cannabis.

Based on data from similar studies, in which nearly half of the participants experience withdrawal symptoms, cannabis withdrawal symptoms may not be as rare as is commonly thought—especially among those struggling with concomitant substance use disorders. However, there are also some issues with the JAMA study, which we will now examine.

Understand the meta-analysis

Although the JAMA study shows a clear correlation between heavy cannabis use and withdrawal symptoms, it may not be entirely accurate for a reason. There is no meta-analysis. A meta-analysis is a study that brings together many previous studies that meet certain criteria to increase the likelihood of a particular finding or statistic. In a way, one could argue that completing a meta-analytic study is akin to cherry picking and ignoring other findings. However, using the JAMA study as a basis for determining whether or not cannabis can cause withdrawal symptoms may not be accurate. It is also important to note that much of the JAMA study was not related to the medical use of cannabis, but to recreational use. There is no way for the reader to differentiate between medical cannabis use and recreational use. This distinction is crucial, as many licensed medical dispensaries focus primarily on legally regulated, sometimes low-dose, high-THC and CBD-rich strains for use in medical treatment. However, recreational cannabis tends to contain high levels of THC and significantly lower levels of CBD, which enhances the psychoactive effects and can lead to an increased risk of addiction and subsequent withdrawal.

The Reality of Withdrawal

Even with somewhat patchy evidence, it is clear in some segments of the cannabis-using population that withdrawal symptoms are a reality. While we are not aware of the quality of the cannabis used in the JAMA study, we still do not know how many participants in the study who used cannabis experienced withdrawal symptoms. And we have yet to see the magnitude of these withdrawal symptoms, what specific factors make them more likely, and whether they’re more common in medical or recreational settings.

Remember, help is available if you feel your cannabis use has become problematic in your own life, or if you have stopped using cannabis and are experiencing withdrawal symptoms. Consider seeing a doctor for short-term help with cannabis withdrawal. If you find that your cannabis addiction is too difficult to deal with on your own, you should consider speaking to an addiction specialist or seeking in-person substance use treatment. Regardless of where you are on your cannabis use journey, always remember that there is no harm in cutting back on use or taking an occasional tolerance break.