Debunking the Myths of Marijuana Withdrawal “Syndrome”
“Reefer Madness” ideology has yet to be quashed, where well-to-do, model students take one fateful puff and they are severely hooked, avoiding Trainspotting-esque withdrawal symptoms and instead spiral into a marijuana-laced world of paranoia, aggression, academic failure and mental illness. To the contrary, there are pro-marijuana myths, where marijuana could never be addictive and is a benign, happy little drug that can do absolutely no harm. As such, marijuana withdrawal syndrome is still considered by some to be just about as real as leprechauns, unicorns and the Easter bunny!
Back in reality, becoming addicted to cannabis is a real phenomenon. If you can get addicted to sausages (you can!) why not the green stuff? Putting it simply, addictions are compulsive behaviors that we continue to do despite the negative consequences.
Relatedly, marijuana withdrawal is real and is a diagnostic indicator of marijuana addiction. As with experiencing withdrawal from any addiction, there are physiological and psychological consequences that are unpleasant enough to encourage continued use for some users that are trying to quit.
As stated in a 2015 review in Clinical Pharmacology and Therapeutics:
“Chronic cannabis users typically experience unpleasant withdrawal symptoms when use is discontinued. These symptoms are much less severe than those associated with withdrawal from chronic opioid or depressant use, but aversive enough to encourage continued cannabis use and interfere with cessation attempts in some individuals.”
That being said, there is a load of uneducated nonsense perpetuated about marijuana addiction and withdrawal. Even today, major newspapers — like The Telegraph and The Daily Mail in the UK — have used blatant lies as front-page headlines, such as:
“Cannabis as Addictive as Heroin”
This shameless tabloid hysteria is continuing the misunderstanding of marijuana addiction and withdrawal, keeping us in the fiction and ideology-fueled dark ages. In reality, both of the mythical extremes — pot being super addictive and life destroying, or a totally innocent health giving and withdrawal-free substance — are just that, they are all smoke and mirrors, they are simply polar extreme modern day myths. The reality of marijuana addiction and withdrawal is somewhere in between.
Despite many gung-ho naysayers wasting their breath with the same old over opinionated claptrap, some real, tangible and clinical evidence is mounting that, if it can be heard over the nonsensical rabble, may be policy, life and society changing. Here are the latest, up-to-the-minute scientific facts on marijuana withdrawal syndrome (which we should note, as always, are susceptible to change and development).
Marijuana Addiction and Withdrawal: The Facts
Literally all scientific means of assessing the risk of taking a drug of abuse, from margin of exposure to expert panel ranking methods, are largely in agreement with one another. They place weed and its infamous active ingredient, THC, at the bottom of a very long list of addictive substances, where alcohol, heroin, crack cocaine and metamfetamine, and the seemingly benign and legal staple cigarettes and its active ingredient, nicotine, generally take the spotlight.
As published in the journal, Drug and Alcohol Dependence:
“The cumulative probability estimate of transition to dependence was 67.5% for nicotine users, 22.7% for alcohol users, 20.9% for cocaine users and 8.9% for cannabis users.”
This means that 9% of people who use marijuana are estimated to become dependent on it. As with all drugs, this value increases to ~16% for those who start smoking pot as teens, which is far less than for other drugs (e.g. 50-75% for cigarettes). Moreover, the chance of getting hooked if you smoke it for the first time after age 25 is practically nil, as described by Professor of Psychiatry, J. Michael Bostwick, M.D. in a paper published in Mayo Clinic Proceedings:
“The risk for new-onset dependence is essentially zero after the age of 25 years, whereas cocaine dependence continues to accrue until the age of 45 years. Likewise, the average age at first alcohol use is the same as for marijuana, but alcohol users will keep on making the transition from social use to dependence for decades after first use.”
With this in mind, the overwhelming majority of adults that smoke a little pot once in a while will not become addicted and thus never be at risk of experiencing withdrawal symptoms that promote relapse and spur addiction. However, as with every psychoactive drug, for more vulnerable users, such as those with chronic stress management problems, mental illness or a genetic predisposition to addiction, the chance of becoming addicted and experiencing withdrawal is undoubtedly greater.
So yes, marijuana withdrawal syndrome is real (it ain’t no Santa Claus, that’s for sure). Chronic and repeated overstimulation of the endocannabinoid system by regularly smoking marijuana can dampen the brain’s natural response to the essential neurotransmitter and cannabinoid receptor activator, dopamine. When abstaining, lower stimulation of cannabinoid receptors can result in the need, be it deemed psychological or physical, to continue use or ride out the negative consequences, i.e. adverse withdrawal symptoms.
Marijuana Withdrawal Syndrome: The Symptoms
So, what will someone addicted to marijuana expect to experience during withdrawal?
We found no research on gradual cannabis abstinence in the literature. However, as the gradual reduction of an agonist substance of dependence is typically associated with less severe and clinically significant withdrawal, The National Cannabis Prevention and Information Centre, NCPIC, surmise that:
“The relatively long plasma half-life of various active cannabis metabolites (typically cited as 1-4 days), suggests that a gradual reduction in cannabis use would be an effective strategy for people with cannabis dependence, where individuals are able to exert some control over their use or where access to their cannabis is regulated by a third party… Advice on gradual cannabis reduction may include smoking smaller bongs or joints, smoking fewer bongs or joints, commencing use later in the day and having goals to cut down by a certain amount by the next review.”
This is an area of research worthy of looking into, although not as profitable or evidently as popular as the many studies already published on a monthly basis investigating the use of pharmaceuticals to aid cannabis cessation.
On the flipside, for those going cold-turkey, 50% of dependent users experience mild to no symptoms, while the other 50% experience DSM-V worthy symptoms of cannabis withdrawal syndrome:
- Within the first week, insomnia, loss of appetite or increase in appetite (considered equally as common), physical symptoms (stomach pain, shakiness/tremors, sweating, fever, chills or headache) and restlessness tend to approach a peak in their severity. Physical symptoms are generally reported as lower rates than other symptoms.
- In the later phase of withdrawal, irritability/anger and vivid, unpleasant dreams, tend to be at their worst more than a week after cessation. There are less reports of depressed moods in comparison with irritability and nervousness (see next point).
- The symptom of nervousness has shown differing time-courses between studies. One study observed nervousness immediately after cessation, for another, nervousness was at its worst after 9 days.
- Generally, cannabis withdrawal has been reported to follow a clear time-course with a peak in overall severity of symptoms at ~10 days after last use, followed by a gradual decline over the next 20 days.
That sounds much like the personal reports of marijuana withdrawal symptoms in BrainBlogger’s first ever post on Marijuana Withdrawal Syndrome. For example:
“After using heavily for the past 7 years, and basically all day every day for the last 6 months my side effects are major. i still cant sleep properly although at least now im getting 6 hours which isnt too bad. nausea every day. i have a bad stomach to begin with but i usually dont get sick every day. hot and cold sweats. im freezing right now but about half an hour ago i was boiling. i havent eaten properly since i stopped. the thing i dont like is that i feel spaced out constantly. i feel like im bent even when im not. and not bent in a calm relaxing way either.”
Spice Addiction and Withdrawal
Although deserving of a dedicated article it is important we mention the marijuana-based drug you may never have heard about, spice. Spice is actually a series of synthetic cannabinoids originally developed by pharmaceutical companies that fully activate cannabinoid receptors in the brain, whereas the main active substance in marijuana, THC, is merely a partial agonist in comparison.
While governments around the world are debating the legalization of marijuana, these largely legal synthetic drugs, that compared with marijuana next to nothing is known about, are beginning to ring serious alarm bells.
With natural cannabis, although many of the active chemicals have not been fully investigated, some, like CBD are known to have antipsychotic, anticonvulsive, anti-anxiety and neuroprotective properties that are considered to offset the potential negative side-effects from the main active ingredient THC. With spice products on the otherhand, they don’t contain these protective chemicals and instead only a super-potent version of THC.
Not only is the high itself is totally different and can be highly hallucinogenic and disorientating, it can even cause seizures, overdose and death, with seizures also known to be a symptom of withdrawal. There are a lot of potentially dangerous unknowns with spice. Just because its a legal pharmaceutical doesn’t mean its safe or effective.
Marijuana Withdrawal Syndrome: A Step Too Far?
Have you heard of nicotine withdrawal syndrome? Nope. Why? Because it has never been defined as such in any newspaper I could find online. Even drugs with the worst reputation when it comes to withdrawal symptoms, like heroin, crack and cocaine, have NEVER been defined as a “syndrome” by the mainstream media, although they are referred to as such in science journals. In fact, did you know that caffeine withdrawal has also been given the syndrome title?
Although syndrome simply means a group of signs and symptoms that occur together and characterize a particular abnormality or condition, it seems that journalists have unrightfully ganged up on ganja, portraying it as the only drug deserved of being associated with the more serious sounding term, syndrome.
With promise in being equal to or more effective than some pharmaceutical drugs in treating a number of illnesses (the list is eye-bogglingly phenomenal), shouldn’t we drop the “syndrome” fear mongering in the mainstream media?
It’s simple. It’s not widely addictive. The overwhelming majority of adults can enjoy its effects and not become addicted, and only half of those that become dependent will feel severe withdrawal symptoms. Indeed measures should be taken to understand and protect those at greatest risk from harm, yet we should not blow this out of proportion to prevent hindering the effective and beneficial uses of the cannabis plant.
Let’s not create smoke where there is no fire. Unless we equally apply the term, withdrawal syndrome, to other drugs, let’s drop the currently damaging term, syndrome, from popular media and stick with the bold, the descriptive, the representative, the simple: marijuana withdrawal.
Allsop DJ, Norberg MM, Copeland J, Fu S, & Budney AJ (2011). The Cannabis Withdrawal Scale development: patterns and predictors of cannabis withdrawal and distress. Drug and alcohol dependence, 119 (1-2), 123-9 PMID: 21724338
Budney AJ, & Hughes JR (2006). The cannabis withdrawal syndrome. Current opinion in psychiatry, 19 (3), 233-8 PMID: 16612207
Gorelick DA, Levin KH, Copersino ML, Heishman SJ, Liu F, Boggs DL, & Kelly DL (2012). Diagnostic criteria for cannabis withdrawal syndrome. Drug and alcohol dependence, 123 (1-3), 141-7 PMID: 22153944
Hesse M, & Thylstrup B (2013). Time-course of the DSM-5 cannabis withdrawal symptoms in poly-substance abusers. BMC psychiatry, 13 PMID: 24118963
Lopez-Quintero C, Pérez de los Cobos J, Hasin DS, Okuda M, Wang S, Grant BF, & Blanco C (2011). Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug and alcohol dependence, 115 (1-2), 120-30 PMID: 21145178
Nutt DJ, King LA, Phillips LD, & Independent Scientific Committee on Drugs (2010). Drug harms in the UK: a multicriteria decision analysis. Lancet, 376 (9752), 1558-65 PMID: 21036393
Sampson CS, Bedy SM, & Carlisle T (2015). Withdrawal Seizures Seen In the Setting of Synthetic Cannabinoid Abuse. The American journal of emergency medicine PMID: 25825034