Marijuana Detox and Withdrawal Times

Marijuana and its psychoactive properties grew popular throughout the latter half of the 20th century and, in the past few decades, the drug has continued to see increasingly widespread use. This growing popularity of the drug has paralleled, in many states, the push to legalize the substance, both for medical and recreational use. Although more studies need to be done to evaluate the substance’s effectiveness in treating pain or illness, some medical marijuana proponents emphasize the untapped potential of a non-psychoactive constituent of cannabis—cannabidiol, or CBD—while more recreational marijuana strains have been selectively cultivated to increase the average concentration, and therefore potency, of the intoxicating, euphoric tetrahydrocannabinol, or THC.

Is Marijuana Addictive?

Marijuana is the most commonly used illicit substance in the US, according to the 2014 National Survey on Drug Use and Health, with the most prevalent use seen amongst teenagers and young adults. Thanks in large part to efforts of groups lobbying to end marijuana prohibition, many people believe this substance to be safe and nonaddictive. However, like many other intoxicating substances, including legal ones like alcohol and tobacco, marijuana can lead to both dependence and addiction. While addiction risks might not be as pronounced as some other abused substances—the lifetime dependence risk for marijuana has been estimated to be 9% vs. 23% for heroin, 17% for cocaine, and 15% for alcohol, for example—the risk is still there.

A marijuana addiction—that is, problematic, compulsive use of the drug—is diagnosed by clinicians as a marijuana use disorder. Though the diagnosis is made in only a small percentage of marijuana users, it is more common among those who begin to use marijuana earlier in their lives. People who begin to use the drug before the age of 18, according to the National Institute on Drug Abuse (NIDA), are 4-7 times more likely to develop marijuana use disorder than people who begin using the drug in adulthood.

Cannabinoids—the primary psychoactive chemical components of cannabis-derived substances like marijuana, hashish, and hash oil—are also produced in the brain, where they function as neurotransmitters and intercellular signaling molecules. These brain chemicals help neurons transmit signals to each other, and scientists have found that they play a role in a wide range of processes, including insulin sensitivity, energy and fat metabolism, and inflammation. Physiological dependence on marijuana develops as a result of brain adaptations to persistently higher-than-normal levels of exogenous (i.e., those not produced in the body) cannabinoids. When the brain is regularly flooded with these chemicals (e.g., potent levels of THC from daily marijuana use) the risk of developing dependence is increased. Once an individual develops marijuana dependence, they may notice the onset of withdrawal symptoms once they stop using the drug.

Marijuana Withdrawal Symptoms

Regular marijuana users are at risk of developing marijuana dependence and, subsequently, experience withdrawal when they quit or make attempts to cut back on their use. Withdrawal symptoms may include:

• Nausea.
• Tremors.
• Weight loss due to appetite changes.
• Insomnia.
• Irritability.
• Anxiety.
• Depression.
• Mood swings.
• Restlessness.

A study from the Journal of Addiction Medicine surveyed 127 teenagers, 90 of whom heavily used marijuana. Researchers found that 84 percent qualified as dependent on the substance, and 40 percent of them experienced withdrawal symptoms when they ceased using it. The study findings suggest that withdrawal is common among adolescents who report cannabis as their drug of choice.

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Length of Marijuana Detox

Reports on a precise timeline for marijuana vary according to different sources. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the diagnostic criteria for cannabis withdrawal indicate that the characteristic signs and symptoms of withdrawal develop within roughly one week of last use, although some speculate that these discontinuation symptoms will not peak until marijuana and its cannabinoid metabolites are fully cleared from the body—which some estimate could take between 4 and 21 days after last use. Though the cannabis withdrawal syndrome does not usually require medical intervention, some of its troublesome effects, such as sleep disturbances, may persist for more than a month. Most people report complete symptom clearance 3 months out from last use, though many withdrawal symptoms do not last that long.

A more typical, general timeline for marijuana withdrawal follows:

1. The first three days: Withdrawal symptoms can begin within a day or two after the last time the person used marijuana. These symptoms may include anxiety, depression, mood swings, abdominal pain, nausea, appetite changes, headaches, shakiness, fever, sweating, and chills.
2. The first week: Some people may experience their most intense withdrawal symptoms during the first week. After 7-10 days, however, many people report that physical symptoms will begin to diminish, and mood will begin to stabilize. Cravings, depression, and some mood swings could continue, however.
3. The second week: Much of any remaining physical symptoms, like aches, insomnia, or appetite problems, are expected to resolve. Mood will continue to stabilize, although cravings may still continue beyond week 2.
4. The third week: The last traces of marijuana metabolites will mostly be gone from the body, as will the bulk of withdrawal symptoms.
5. The first month: It is somewhat rare that symptoms persist past the first month. However, some long-time, heavy users report some enduring symptoms or what’s known as a protracted withdrawal.

A 2011 Australian study found that marijuana withdrawal symptoms were on par with nicotine withdrawal symptoms. Everyone can react differently to the physical and psychological symptoms. Although the experience is not physically dangerous, the discomfort could make relapse more likely. Past studies have indicated that as many as one-third of those who tried to quit resumed marijuana use to avoid the discomfort of certain withdrawal symptoms (e.g., insomnia).

Complications of Marijuana Withdrawal

Cannabis withdrawal syndrome is the term for the host of withdrawal symptoms marijuana users experience if they have become dependent on or addicted to the substance and then quit cold turkey. Although uncomfortable, this syndrome is not physically dangerous though it could increase the likelihood of relapse.

Beyond the relatively non-severe physical withdrawal, there are some real health complications to consider that could potentially arise in association with chronic marijuana use. Some complications of continued use include:

• Lung problems due to smoke inhalation, including an increased risk of chronic cough, bronchitis, and risk of lung infections like pneumonia.
• Potential cardiovascular issues such as increased heart rate, changes in blood pressure, and orthostatic hypotension.
• Changes in cognitive abilities resulting from impaired learning, memory retention, and attention deficits.

Medical Detox

Medical detox is, in general, is a professional treatment protocol designed to help manage withdrawal and help someone detox from a substance of abuse safely and comfortably. For some types of substance dependence, such as that associated with opioid or alcohol, doctors will prescribe medications to decrease cravings and ease other withdrawal symptoms as a person transitions into early abstinence.

There has been some study into the potential therapeutic use of substances like anticonvulsant medications, such as gabapentin (Neurontin) and valproic acid (Depakote), as well as the anti-smoking medication bupropion (Zyban), being used for marijuana withdrawal. Other research suggests that oral dronabinol (synthetic THC) may be effective for some patients for tapering off the drug.

The National Cannabis Prevention and Information Centre in Australia suggests that a monitored tapering of cannabis itself may also be effective, especially as using marijuana becomes legal in many places. However, there currently are no drugs specifically approved for use in detoxing from marijuana, even on an off-label basis.

Instead, what seems to work for the majority of individuals ending their addiction to marijuana are various types of therapy including pharmacotherapy for specific symptoms, should they prove to be severe. For example, medications like antidepressants and anti-anxiety prescriptions can ease psychological symptoms associated with withdrawal, while the individual works with a therapist.

In addition to pharmacologic adjuncts to treatment, the National Institute on Drug Abuse (NIDA) endorses the following forms of behavioral therapy:

• Cognitive Behavioral Therapy: This type of therapy helps a person learn to identify problematic behaviors and develop strategies to correct these behaviors and increase self-control.
• Contingency Management: This therapy targets good behaviors and puts a system of rewards in place for following through on positive behavioral changes.
• Motivational Enhancement Therapy: Rather than directly treating the person in recovery, this type of therapy strives to motivate an individual to tap their internal resources to produce behavioral changes and promote engagement with some form of treatment.

Some people who attempt to quit marijuana alone may be prone to relapse, especially if withdrawal is significantly distressing. Medical detox followed by an adequate length of professional substance abuse treatment—complete with social support and access to behavioral therapies and counseling—can help people abstain during withdrawal and could increase the chances for long-term sobriety.