Clinical management of cannabis withdrawal

Addiction. 2022 Jul;117(7):2075-2095. doi: 10.1111/add.15743. Epub 2022 Jan 10.


Background and aims: Cannabis withdrawal is a well-characterized phenomenon that occurs in approximately half of regular and dependent cannabis users after abrupt cessation or significant reductions in cannabis products that contain Δ9 -tetrahydrocannabinol (THC). This review describes the diagnosis, prevalence, course and management of cannabis withdrawal and highlights opportunities for future clinical research.

Methods: Narrative review of literature.

Results: Symptom onset typically occurs 24-48 hours after cessation and most symptoms generally peak at days 2-6, with some symptoms lasting up to 3 weeks or more in heavy cannabis users. The most common features of cannabis withdrawal are anxiety, irritability, anger or aggression, disturbed sleep/dreaming, depressed mood and loss of appetite. Less common physical symptoms include chills, headaches, physical tension, sweating and stomach pain. Despite limited empirical evidence, supportive counselling and psychoeducation are the first-line approaches in the management of cannabis withdrawal. There are no medications currently approved specifically for medically assisted withdrawal (MAW). Medications have been used to manage short-term symptoms (e.g. anxiety, sleep, nausea). A number of promising pharmacological agents have been examined in controlled trials, but these have been underpowered and positive findings not reliably replicated. Some (e.g. cannabis agonists) are used 'off-label' in clinical practice. Inpatient admission for MAW may be clinically indicated for patients who have significant comorbid mental health disorders and polysubstance use to avoid severe complications.

Conclusions: The clinical significance of cannabis withdrawal is that its symptoms may precipitate relapse to cannabis use. Complicated withdrawal may occur in people with concurrent mental health and polysubstance use.

Keywords: assessment; cannabis withdrawal syndrome; clinical management; pharmacology; prevalence; time course.

Publication types

  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Analgesics / therapeutic use
  • Cannabinoid Receptor Agonists
  • Cannabis*
  • Dronabinol
  • Hallucinogens*
  • Humans
  • Marijuana Abuse* / complications
  • Marijuana Abuse* / therapy
  • Substance Withdrawal Syndrome* / drug therapy
  • Substance Withdrawal Syndrome* / etiology


  • Analgesics
  • Cannabinoid Receptor Agonists
  • Hallucinogens
  • Dronabinol