Key Takeaways
- Cannabis withdrawal is real and most likely after daily or heavy use, even though for years many people were told it did not exist.
- The common symptoms are irritability, anxiety, trouble falling asleep, vivid or strange dreams, a smaller appetite, restlessness, low mood, and cravings.
- Symptoms usually begin within a day or two of stopping, peak in the first week, and ease over a few weeks, with sleep and dreams often the last to settle.
- Stopping cannabis is not dangerous the way stopping a benzodiazepine or heavy drinking can be, so the problem is comfort and sleep, not safety.
- In most daily users this is physical dependence, not addiction, because the brain adjusted to a drug that was there every day and needs time to readjust.
- For heavy daily use, a planned stop or a step-down is easier than a sudden one.
- Regular sleep and meals, daylight, and movement help while it passes, and severe low mood or anxiety deserves a physician’s attention.
Cannabis withdrawal is a cluster of symptoms, mostly irritability, anxiety, poor sleep, vivid dreams, low appetite, restlessness, and low mood, that follows stopping after daily or heavy use. Symptoms typically begin within a day or two, peak in the first week, and fade over a few weeks, with sleep and dreams the last to settle.
What does cannabis withdrawal feel like?
Most people describe feeling edgy and out of sorts rather than sick. You are irritable over small things, anxious for no reason you can name, and the appetite that cannabis used to bring is gone. Food becomes a chore.
Sleep is the complaint that brings people to a doctor. Falling asleep takes longer, the night is restless, and when sleep does come, the dreams are vivid, strange, and sometimes unpleasant. Many people have not remembered a dream in years, and now they are having three a night.
Restlessness, a low mood, and cravings round out the picture. Unfortunately, for years many doctors doubted that cannabis, or marijuana, withdrawal was real, and many people were simply told it did not exist.
Dr. Leeds is an osteopathic physician in Fort Lauderdale, Florida, whose work is helping patients come off medications they have become dependent on. Cannabis is not a drug he prescribes or recommends. Yet, what happens when a daily habit stops is a tapering question. So, what happens, and how long does it last?
When do symptoms start, and how long do they last?
For most people, the first signs arrive within a day or two of the last use. The irritability and the poor sleep come first, and the appetite drops around the same time. The first week is usually the worst of it.
After that, most symptoms ease over a few weeks. Appetite returns, the edge comes off the irritability, and the restless feeling fades. Sleep and dreams are often the last to settle.
While this is the common pattern, it is not a schedule. Someone who used a little on weekends may notice nothing, and someone who used heavily every day for years may need longer than a few weeks. The heavier and longer the use, the more there is to readjust.
Keep in mind that the brain does not read a calendar. It readjusts on its own time, and the pattern above is only the common one.
Is cannabis withdrawal dangerous?
No. Stopping cannabis is not dangerous in the way that stopping a benzodiazepine or heavy drinking can be. A benzodiazepine such as Xanax or Klonopin, stopped suddenly after long daily use, can cause seizures, and heavy daily drinking stopped suddenly is dangerous too.
The Maudsley Deprescribing Guidelines, chapter 3, put it plainly for benzodiazepines: “in a very few instances, stopping abruptly can cause seizures and can be life threatening.”
There is no medical emergency waiting in the first week, and no one needs a hospital bed to get through strange dreams. The question with cannabis is comfort and sleep, not safety.
The one caution is about mood. When low mood or anxiety becomes severe, it deserves a physician’s attention, and thoughts of suicide at any point deserve immediate help. Call 911 for a medical emergency and 988 for a mental health crisis.
Why does it happen? Dependence is not addiction.
An analogy that might help is a dimmer switch. Imagine a room where the lights have been held at half brightness every evening for years. The eyes in that room have opened wide to cope, and it looks normal to them.
Now turn the dimmer off. For a while everything is too bright and hard to settle into, not because the room changed, but because the eyes have not adjusted back yet. While this is not a perfect analogy, that glare is a fair picture of the irritability, the restless nights, and the dreams.
The brain does the same with cannabis that arrives every evening for months or years. It adjusts its own settings to compensate, and when the cannabis stops, the compensation keeps running.
That is physical dependence. Physical dependence is not addiction. In fact, it is the body’s adaptation to a drug, nothing more.
Addiction is different. It is a pattern of behavior, where the drug takes over a person’s priorities, the use continues despite real harm, and the ability to choose is lost. Many daily cannabis users do not have an addiction problem. They have a habit they decided to end, and a brain that needs a few weeks to catch up.
Of course, the two can overlap. Even then, the physical part is handled the same way, with time and patience, and no one deserves a label for it.
What helps while it passes?
For heavy daily use, a planned stop or a step-down is usually easier on the nervous system than a sudden one. It means picking a date, or stepping down for a short while first, instead of running out one night.
Fortunately, the rest is ordinary. Keep a regular bedtime and a regular wake time, even after a bad night, because the body resets its clock on routine. Eat meals at the usual hours whether or not you are hungry, so the appetite has a schedule to return to.
Get daylight in the morning and move during the day. A walk is enough. Daylight and movement are the two cheapest sleep aids there are, and neither one comes with a prescription.
Be patient with the dreams. They fade on their own. Going back to the dimmer switch, the worst thing to do is flip it on and off every few days, because the eyes never get the chance to adjust. Pick a plan and give it the weeks it needs.
And, when low mood or anxiety is more than a passing edge, see a physician. Some people used cannabis for years to quiet an anxiety or a sadness that is still there underneath. There is more on this site about smoking marijuana for anxiety and depression.
What if you are also tapering a benzodiazepine?
Some patients who are tapering off a benzodiazepine already use cannabis, often for sleep. Do they have to stop it first? Do they have to stop it at all? And, what happens to the taper if they do?
Dr. Leeds does not prohibit cannabis across the board. In his judgment, a patient who is already using it, tolerating it well, and helped by it is not usually asked to stop abruptly, because an abrupt stop can disrupt a taper. It is decided patient by patient, as harm reduction, never as a recommendation to start.
Nothing here says that cannabis treats benzodiazepine withdrawal, and nothing on this site will. The point is narrower. Two withdrawals at once are harder than one, and the benzodiazepine taper comes first.
So, if you are in a taper and want to stop cannabis as well, bring it up with your prescriber before you do, and plan the order together. The question of weed and Xanax during a benzo taper is covered in its own article. Your doctor would rather hear the question than find out afterward.
Frequently asked questions
Can cannabis withdrawal cause insomnia for weeks?
Yes, it can. Trouble falling asleep is usually one of the first symptoms and one of the last to leave, and for a heavy daily user a few weeks of poor sleep is within the common pattern.
If it has not begun to improve after several weeks, or comes with severe anxiety or low mood, see a physician.
Do vivid dreams mean something is wrong?
No. Vivid, strange, or unpleasant dreams are one of the most recognizable features of cannabis withdrawal. They are a sign that the brain is readjusting, and they do not mean it has been damaged. They settle on their own, usually after the other symptoms have faded.
Does CBD help cannabis withdrawal?
Nobody can say with confidence. Cannabidiol, or CBD, is a component of the cannabis plant. There is no reliable guidance yet on CBD for cannabis withdrawal, so there is no claim to make here, either way. Cannabis is not promoted here for any purpose, and that includes treating withdrawal from cannabis itself.
Should you stop cannabis before a benzodiazepine taper?
Not necessarily, and not abruptly. When a patient comes to Dr. Leeds already using cannabis, tolerating it well, and sleeping better with it, he does not usually ask for a sudden stop before or during the taper, since the sudden stop itself can disrupt the taper. That decision belongs to the patient and the prescriber together, and none of this is a reason for anyone to start.
Can cannabis withdrawal cause depression?
It can bring on a low mood, and for most people that lifts over the same few weeks as the other symptoms. Sometimes the low mood was there before the cannabis, and stopping uncovers it.
If sadness deepens, outlasts the rest of the withdrawal, or comes with thoughts of suicide, that is a medical matter, and willpower has nothing to do with it. Call 988 for a mental health crisis and 911 for a medical emergency, and see a physician.
Dr. Leeds’ practice is built on medically supervised tapering and deprescribing, benzodiazepines first, with every patient seen directly by him. For a patient in Florida who is tapering a benzodiazepine and wondering where cannabis fits, that is a question to bring to a visit rather than guess at. Contact the office today to ask about a consultation.
This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
