Withdrawal From Marijuana Leaves Users ‘Markedly Ill’
Cannabis withdrawal is a cluster of symptoms that can appear in a physically addicted cannabis/marijuana user who stops taking the drug or substantially decreases his or her normal level of intake. In a study scheduled for publication in 2014 in the journal Drug and Alcohol Dependence, a team of German researchers sought to determine if the appearance and severity of any given person’s cannabis withdrawal symptoms are related to the amount of the active cannabis/marijuana ingredient THC present in his or her system. The researchers also included the presence of certain THC breakdown products in their investigation.
The study’s authors note that the majority of the enrolled participants had cannabis withdrawal symptoms that placed them in a screening category known as “markedly ill.” Even after 16 days of abstinence, substantial amounts of THC were found in the bloodstreams of 28 percent of the group.
Cannabis Dependence and Withdrawal
A physical dependence on cannabis/marijuana occurs when a user takes the drug often enough to alter the basic working conditions in a part of the brain called the pleasure center. This alteration makes the continued intake of cannabis/marijuana a chemically necessary activity. Cannabis dependence is essentially synonymous with cannabis addiction. Under terms currently used in the U.S., cannabis dependence/addiction forms one aspect of a larger condition called cannabis use disorder, which also includes dysfunctional, non-addicted cannabis abuse. Roughly 9 percent of cannabis users will develop diagnosable symptoms of dependence/addiction, according to the National Institute on Drug Abuse. Rates of diagnosable problems are much higher for teens and daily or habitual users.
Taken together, the symptoms of cannabis withdrawal are one of the primary indicators of a diagnosable case of cannabis use disorder. Prominent examples of these symptoms include appetite reduction, an anxious mental state, insomnia or other sleep disruptions, an unusually irritable mood and a craving for continued marijuana intake. These symptoms typically appear within 24 hours of cannabis cessation, reach maximum intensity in a couple of days and mostly taper off within a week. Like other forms of substance withdrawal, cannabis withdrawal can easily be unpleasant enough to encourage a return to active substance use.
THC is the common abbreviation for a substance called tetrahydrocannabinol. This substance plays the largest role in creating the drug effects typically associated with cannabis/marijuana use. It also plays a primary role in the establishment of physical dependence in addicted cannabis users. The THC content of any given batch of cannabis/marijuana can vary widely, although a general trend toward increasing THC potency has been in effect in the U.S. for roughly three decades. When THC breaks down in the body, it creates chemical byproducts that include substances called THC-OH and THC-COOH.
Do THC Levels Affect Cannabis Withdrawal?
In the study slated for publication in Drug and Alcohol Dependence, researchers from the University of Duisburg/Essen and a second German institution used an examination of 39 adults seeking treatment for cannabis dependence/addiction to explore the connection between the course and severity of cannabis withdrawal and body levels of THC and the breakdown products THC-OH and THC-COOH. When each study participant first stopped using cannabis and was admitted for dependence treatment, he or she underwent two testing procedures designed to detect cannabis withdrawal symptoms. Follow-up testing was conducted an additional four times at intervals of two, four, eight and 16 days after the last incidence of cannabis/marijuana intake. The researchers used blood samples to gauge THC, THC-OH and THC-COOH levels on each of these five occasions.
The researchers concluded that, on average, cannabis withdrawal symptoms reached a peak in the study participants four days after cannabis abstinence began. Sixteen days after the beginning of abstinence, noticeable withdrawal symptoms were still typically present. In declining order, the most prominent symptoms were continued cravings for cannabis/marijuana use, agitation, anxiousness and insomnia. Generally speaking, these symptoms affected the women participants substantially more powerfully than the men.
Initially, those individuals with the highest THC content in their bloodstreams had the lowest rates for significant cannabis withdrawal symptoms. However, this relationship between THC and withdrawal symptoms did not last, and the researchers ultimately concluded that the level of THC or THC byproducts present in the body has no clear relationship to the severity or duration of cannabis withdrawal symptoms.3