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The evidence for cannabis withdrawal syndrome has been demonstrated from a wide variety of
research methodologies and is due to be included as a distinct syndrome for the first time in the
forthcoming revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5). Clinical
studies over the last decade have produced evidence for a ‘cannabis withdrawal syndrome’. The
proportion of clients reporting cannabis withdrawal in treatment studies has ranged from 50-95%.
The following symptoms are the most commonly experienced:
restlessnesssleep difficultiesstrange dreamsnauseanightmares
the clinical consequences of cannabis withdrawal Cannabis withdrawal symptoms can adversely affect quit attempts with some users reporting
using cannabis or other drugs to relieve symptoms.
Although this syndrome does not appear to include major medical or psychiatric consequences,
its severity appears comparable to tobacco withdrawal.
severity and length of symptoms Cannabis withdrawal begins within 24 hours of last cannabis intake, and usually peaks within 3-5
days, and is thought to be largely over after 2 weeks. The symptoms that take longer (some weeks)
to subside include sleep disturbances (including disturbing nightmares) and mood disturbances
such as irritability. Resumption of cannabis use alleviates withdrawal symptoms, thus cannabis
withdrawal is believed to be a major contributor to the high rates of relapse observed clinically.
It should be noted that many cannabis users use other drugs such as tobacco and alcohol. If the
customer is also giving up tobacco, nicotine replacement therapy may also be recommended.
pharmacotherapy for cannabis withdrawalA number of small human laboratory studies on potential pharmacotherapies for cannabis
dependence have appeared in the literature. Buproprion, divalproex, lofexidine, naltrexone,
nefazadone, mirtazapine, lithium and oral THC have been explored but none have an adequate
evidence-base. Some agents such as buproprion and divalproex exacerbate withdrawal symptoms.
There is support for further testing of agonist (THC) approaches and their use in combination
with other medications such as lofexidine. Antagonist therapies have yet to receive adequate
attention, however, both cannabinoid and opioid antagonists appear to warrant more study.
For more help or information please visit the National Cannabis Prevention and Information Centre
website at: or call the Cannabis Information and Helpline on 1800 30 40 50
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cannabis withdrawal syndrome
The cannabis antagonist Rimonobant, has been removed from the US market as a result of
adverse events including suicidal ideation.
In summary, there are currently no evidence-based pharmacotherapy treatments for cannabis
withdrawal. It should also be noted that anti-depressants may exacerbate symptoms of cannabis
symptom-focused approach There is no evidence for symptoms-focused treatment of withdrawal management. Despite the
lack of evidence, it may be appropriate to prescribe short-acting benzodiazepines for withdrawal-
• prescription of benzodiazepine is not recommended for adolescents.
Consultation with specialist services is recommended
• any prescription of benzodiazapines should be short-acting, no more than
Psychosocial interventions (non-pharmacological approaches) are highly recommended for
cannabis withdrawal management. There is growing evidence for psychosocial interventions
generally, and the risks are considered minimal. Areas that have a strong evidence-base generally
include sleep hygiene, progressive muscle relaxation, meditation, exercise and family support.
psycho-education of withdrawal symptoms Psycho-education about withdrawal symptoms is important for customers to help with managing
Consider giving the customer: What’s the deal on quitting? A do-it-yourself guide to quitting
cannabis booklet, available to download or order from www.ncpic.org.au. Also, Reduce Your Use
(www.reduceyouruse.org.au) is an online program designed to help cannabis users quit cannabis
Referral to inpatient management of cannabis withdrawal may be warranted where the individual
• repeatedly failed attempts to abstain• has experienced exacerbation of mental health disorders while undergoing withdrawal• has no social support
concurrent tobacco use For clients who smoke cannabis and use tobacco (independently or mixing), the evidence
indicates that there are better outcomes associated with quitting both tobacco and cannabis
simultaneously. However, inability or client preference to continue tobacco use should not be a
barrier to accessing or continuing cannabis treatment.
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