Cannabis withdrawal
Timeline
| Phase | Timing |
|---|---|
| Onset | 1–2 days after last use |
| Peak symptoms | ~Day 3 |
| Most symptoms resolve | 1–2 weeks |
| Full resolution | Up to ~30 days |
DSM-5 symptoms
Irritability/anger, anxiety, sleep disturbance, appetite reduction, restlessness, depressed mood, physical discomfort.
Mechanism
Not simple dopamine depletion. Best model:
- CB1 downregulation → receptor recovery lag
- Reduced effective endocannabinoid tone (2-AG / anandamide)
- CRF-driven amygdalar hyper-reactivity
CB1 normalization begins ~2 days abstinence; most recovery by ~4 weeks.
Detection implication
Withdrawal sleep patterns (insomnia, REM rebound) can look like substance use events if the model isn’t aware of the abstinence state.
Treatment
No FDA-approved medications. CBD is best pharmacologic candidate (Phase III ongoing). NAC is contested (positive trial lacked replication). Gabapentin has one promising small RCT.