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The most popular intoxicating drug after alcohol, marijuana has been exalted and vilified, used in ancient religious ceremonies and twenty-first-century medicine, demonized and dismissed…
Records from ancient China show that cannabis, the natural source of marijuana, was known as early as 2727 BCE. Westerners discovered it in the mid-sixteenth century, but used it primarily as a fiber source (hemp) for making rope, paper and cloth. Its first modern medical use was in the 1830s to reduce pain and nausea in cholera patients. In the early twentieth century, Mexican immigrants helped popularize recreational cannabis smoking (and the name “marihuana,” which became “marijuana”) in the United States.
The Marijuana Tax Act of 1937 was the first federal law criminalizing cannabis sales: in 1970, the Controlled Substances Act made marijuana a Schedule I drug, meaning it had no recognized medical usefulness. By the 1990s, however, the idea of using it to ease suffering from serious illness was gaining new popularity. Cannabis extracts are now ingredients in some FDA-approved medicines. Since 2012, recreational use of marijuana has also been legalized in several states, though not by the federal government.
For a long time, marijuana was thought to be non-addictive: the recognized risks were dangerous behavior under the influence, respiratory damage from smoking, possible long-term brain damage and the chance that marijuana use could make it easier to progress to more dangerous drugs. Now, however, medical science recognizes the existence of marijuana use disorder, which affects about four million Americans. (It’s worth noting that marijuana’s potency has significantly increased over the years: the average per-dose amount of key intoxicating ingredient tetrahydrocannabinol was 3.8 percent in 1991, 12.2 percent in 2014.)
When someone with marijuana use disorder attempts to quit the drug, common withdrawal symptoms include:
Unlike with many drugs, there is little risk a person will suffer overdose by taking more marijuana when partly detoxed. (Actual cases of marijuana overdose are rare and not tied to any documented fatalities, although symptoms include a high pulse rate that could be dangerous to someone with a weak heart.) The greatest risk of marijuana withdrawal (or overdose) is that anxiety, depression or mental confusion will lead the person undergoing detox to do something physically dangerous.
Marijuana has a longer withdrawal period than most addictive drugs. Typically, someone in detox will:
Usually, only people who have used marijuana almost every day for months will be dependent enough to experience symptoms. The more it’s been used, the more unpleasant the withdrawal experience.
Typical difficulties of quitting marijuana are more akin to the difficulties of quitting regular smoking (“I’ve done it a hundred times”) than to the more serious dangers of quitting alcohol or hard drugs. Nonetheless, in 2015 there were 138,000 documented cases of people requesting medical help to discontinue marijuana use. The average case involved daily cannabis use for more than a decade and at least six prior attempts to quit.
Someone struggling with that level of dependence often benefits from inpatient treatment (hospitalization for up to three months). Inpatient care is highly recommended if:
The advantage of inpatient care is it keeps the client in a supportive environment, protected from relapse temptations and access to marijuana. Since most people with marijuana use disorder struggle with other emotional and life-management issues, those in inpatient treatment also benefit from structured daily schedules and easy access to therapy.
In addition, inpatient treatment allows any needed medications to be prescribed and administered on the spot. While there are no medicines approved specifically to manage cannabis withdrawal, some may be given to treat withdrawal symptoms:
Someone whose marijuana use disorder is of short duration, and who has no co-occurring mental-health or substance use disorders, may need only outpatient care (therapy sessions of several hours each, 3–5 times a week). Many people receive inpatient care during the physical-detox period, then transition to outpatient.
A client requesting outpatient care should:
As with inpatient treatment, an outpatient client will receive assistance uncovering the reasons he or she became dependent on marijuana, and planning healthier ways to cope. Therapy approaches used to treat marijuana use disorders include:
While many people stop marijuana use on their own, this is not recommended for anyone with genuine marijuana use disorder, especially someone who may have other psychiatric illnesses. The risk of dangerous or suicidal behavior is too great.
Staying at a professional detox center during the worst of the physical-withdrawal period is the best decision because:
With some drug addictions, doctors recommend tapering the substance off slowly (or implementing a “substitution tapering” program that transfers the client to an alternate, safer drug) to spare body and brain the full shock of quitting cold. This is rarely necessary with marijuana, but detox center staff will advise on the best approach for each individual. Most commonly, a client will simply be encouraged to rest, avoid stressful situations and request counseling if needed.
Other factors to consider when choosing a marijuana-detox program include:
With most addiction disorders, the chance of relapsing at least once after initial recovery is 40 to 60 percent. Marijuana use disorder is no exception: the figure may be even higher if previous attempts to quit are factored in.
Relapse needn’t equal a return to full addiction, and there are many resources to both recover from relapse and prevent it in the first place. Organized peer groups, which provide moral support and accountability, improve recovery rates for any toxic habit. A drug detox center can recommend support groups, and may even sponsor groups of its own through an aftercare or alumni program.
Other helpful techniques for staying clean after marijuana detox:
For related information, see the following articles:
DEAMuseum.org. “Cannabis: History.” Retrieved from https://www.deamuseum.org/ccp/cannabis/history.html
History.com. “Marijuana.” Retrieved from https://www.history.com/topics/history-of-marijuana
Kathmann, M., K. Flau, A. Redmer, C. Trankle, and E. Schlicker (2006, February). “Cannabidiol Is an Allosteric Modulator at Mu- and Delta-Opioid Receptors.” Naunyn-Schmiedeberg’s Archives of Pharmacology, Vol. 372, No. 5, pp. 354–361. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16489449
Mason, Barbara J., Rebecca Crean, Vivian Goodell, John M. Light, Susan Quello, Farhad Shadan, Kimberly Buffkins, Mark Kyle, Murali Adusumalli, Adnan Begovic, and Santosh Rao (2012, February 29). “A Proof-of-Concept Randomized Controlled Study of Gabapentin: Effects on Cannabis Use, Withdrawal and Executive Function Deficits in Cannabis-Dependent Adults.” Neuropsychopharmacology, No. 37, pp. 1689–1698. Retrieved from https://www.nature.com/articles/npp201214
National Institute on Drug Abuse (2018, June). “Available Treatments for Marijuana Use Disorders.” Retrieved from https://www.drugabuse.gov/publications/research-reports/marijuana/available-treatments-marijuana-use-disorders
National Institute on Drug Abuse (2018, June). “Can Marijuana Use During and After Pregnancy Harm the Baby?” Retrieved from https://www.drugabuse.gov/publications/research-reports/marijuana/can-marijuana-use-during-pregnancy-harm-baby
National Institute on Drug Abuse (2018, June). “Is Marijuana a Gateway Drug?” Retrieved from https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-gateway-drug
National Institute on Drug Abuse (2018, June). “Is Marijuana Addictive?” Retrieved from https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-addictive
National Institute on Drug Abuse (2018, June). “Is Marijuana Safe and Effective as Medicine?” Retrieved from https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-safe-effective-medicine
National Institute on Drug Abuse (2018, June). “What Are Marijuana Effects?” Retrieved from https://www.drugabuse.gov/publications/research-reports/marijuana/what-are-marijuana-effects
National Institute on Drug Abuse (2018, June). “What Are Marijuana’s Effects on Lung Health?” Retrieved from https://www.drugabuse.gov/publications/research-reports/marijuana/what-are-marijuanas-effects-lung-health
National Institute on Drug Abuse (2018, June). “What Are Marijuana’s Effects on Other Aspects of Physical Health?” Retrieved from https://www.drugabuse.gov/publications/research-reports/marijuana/what-are-marijuana’s-effects-on-other-aspects-of-physical-health%3F
National Institute on Drug Abuse (2018, June). “What Are Marijuana’s Long-Term Effects on the Brain?” Retrieved from https://www.drugabuse.gov/publications/research-reports/marijuana/what-are-marijuanas-long-term-effects-brain
National Institute on Drug Abuse (2018, June). “What Is the Scope of Marijuana Use in the United States?” Retrieved from https://www.drugabuse.gov/publications/research-reports/marijuana/what-scope-marijuana-use-in-united-states
Silverman, Ellie (2017, November 17). “The Truth Behind the ‘First Marijuana Overdose Death’ Headlines.” The Washington Post. Retrieved from https://www.washingtonpost.com/news/to-your-health/wp/2017/11/17/the-truth-behind-the-first-marijuana-overdose-death/?utm_term=.1d8732221804
Thompson, Matt (2013, July 22). “The Mysterious History of ‘Marijuana.’” National Public Radio, Inc. Retrieved from https://www.npr.org/sections/codeswitch/2013/07/14/201981025/the-mysterious-history-of-marijuana
