When Pittsburgh Steelers wide receiver Martavis Bryant stopped his regular cannabis consumption in order to pass the NFL’s drug test, he encountered an unexpected challenge. Insomnia kept him up at night. “I would get frustrated,” Bryant told Sports Illustrated. “I’d yell, ‘Why can’t I sleep!?’”
The answer may have been cannabis withdrawal syndrome, or CWS.
For regular, long-term cannabis consumers who want to take a tolerance break or need to abstain completely, cannabis withdrawal syndrome can be a mild but very real challenge. It’s nowhere near the severity of withdrawal induced by tobacco, alcohol, or other drugs, but it may be irritating and mildly discomforting for a few days. In fact, it may most resemble the withdrawal a daily coffee drinker might feel upon going cold turkey.
“For many people who smoke marijuana, withdrawal is a non-issue,” says Roger Roffman, a University of Washington researcher who studied cannabis use for more than 25 years. People who consume cannabis occasionally, or use a higher amount for a short period of time, generally don’t experience any withdrawal symptoms. “But the person who smokes a lot of dope for quite a long period of time is likely to have an experience of withdrawal,” Roffman says.
Insomnia is often an indicator of CWS, but symptoms aren’t limited to sleeplessness.
According to German researchers who recently published an overview of the current CWS knowledge in Substance Abuse Rehabilitation, discontinuation of regular consumption can lead to one or a number of these symptoms:
- Sleeping problems
- Dysphoria, a feeling of general unease or dissatisfaction
- Craving for resumed cannabis use
- Stomach pain
Any combination of those symptoms occur in 35% to 75% of patients who quit cannabis after longtime regular use. (It’s a wide percentage range because different percentages were found in several separate studies.)
Symptoms of cannabis withdrawal “are much less severe than those associated with withdrawal from chronic opioid or depressant use,” researchers with the National Institute on Drug Abuse (NIDA) wrote in a 2015 study, “but aversive enough to encourage continued cannabis use and interfere with cessation attempts in some individuals.”
In that NIDA study, scientists noted that the effects induced by simply discontinuing exposure “are not severe and can be hard to detect, probably due to the slow elimination of lipophilic compounds like THC from the brain.”
Because the federal government—specifically, agencies like NIDA itself—has made it so difficult to conduct cannabis research, the NIDA scientists used studies of non-human animals to describe the typical symptoms. So we know what CWS in rats looks like: “symptoms include scratching, face rubbing, licking, wet-dog shakes, arched back and ptosis.” Ptosis is the medical term for droopy eyelids.
If you’re stopping cannabis use after regular intake, face licking and wet-dog shakes are not likely to figure among the symptoms you will experience. The severity of CWS among humans “is dependent on the amount of cannabis used pre-cessation, gender, and heritable and several environmental factors,” the German researchers noted. Women, they wrote, tended to report stronger symptoms of CWS, and their experience included more physical discomfort, nausea, and stomach pain.
These mood and behavioral symptoms are usually “of light to moderate intensity,” the researchers wrote.
Symptoms typically start within the first two days of cessation, and stop within four weeks of abstinence.
The symptoms and mild severity of CWS resemble the experience of patients going through caffeine withdrawal, a condition described in the DSM-5 as including headache, fatigue, drowsiness, dysphoric mood, irritability, depression, nausea, muscle aches and impairment of cognitive or behavioral performance.