Latest Treatment Guidelines for Marijuana Overdose and Withdrawal. Marijuana – or cannabis – is the most commonly used psychoactive drug worldwide. While its use is legal in many countries and states within the U.S., it still remains an illegal substance in many.
The cannabinoid THC, which is technically referred to as delta-9-tetrahydrocannabinol, is responsible for its psychoactive properties. Marijuana has different concentrations of THC, which is how its potency varies.
There are several indicators and symptoms that occur when someone is experiencing cannabis withdrawal. This will typically occur seven days after a significant drop in use in patients that have a history of moderate use for a prolonged period of time.
These symptoms include difficulty sleeping, headaches, twitching, increased irritability, anger, anxiety, stomach pains, and depression.
The treatment used will always align with the severity of the withdrawal. Most marijuana withdrawal cases are mild and they can be handled without extensive treatment. Also, in these instances, the symptoms are not as dangerous and will generally only include slight increases in anxiety levels and/or inconsistent sleep patterns. These patients also don’t experience issues in their personal life, with no impact on their work or at-home life. Those suffering from mild withdrawal can typically avoid cannabis use on their own.
While treatment of mild withdrawal symptoms can be self-monitored there are many clinics that will provide the support and follow-up many require to help them recover fully. Oftentimes keeping busy will occupy the mind enough that the desire for marijuana consumption doesn’t temp the patient. Some experts also suggest that physical activity helps to play a significant role during the recovery process.
When the withdrawal is a bit more severe, the person will have a higher difficulty functioning on a daily basis. Because of this, the probability of relapsing is much higher than it is in someone with mild withdrawal symptoms. These are ideal patients for professional treatment.
These individuals will experience a more severe disturbance in their sleep, which then directly impacts their personal and professional life, translating to poor performance at school and in the workplace. Anxiety and depression in more severe cases of marijuana withdrawal is also common, which leads these individuals to seek self-medication through the use of cannabis.
When someone displays signs of heavy cannabis use and severe withdrawal symptoms, it’s often suggested that medication is used to help, rather than cognitive-behavioral therapy (CBT), and it really comes down to the discretion of the treatment facility and the patient.
The biggest influencing factor is typical whether or not the patient feels like he or she can withdraw from using marijuana without the aid of medication. Some may want to do it without any and quit cold turkey, so to say. In this situation, CBT is a good option to try.
If there are no patient concerns regarding the side effects of using the medication, then this is typically the standard procedure since there are not a lot of studies or clinical data that support the theory that cognitive-behavioral therapy is a superior option when it comes to cannabis withdrawal recovery.
There are several treatment options when it comes to cannabis withdrawal, with the two most popular options worldwide being gabapentin and dronabinol. There is another option – nabiximols – but it’s not approved in the United States, even though some European countries, as well as Canada, have approved its use.
Most marijuana withdrawal experts prefer to start patients on a trial of dronabinol over other options because of its effectiveness to reduce withdrawal symptoms by as much as 50 percent according to many health professionals.
Also, while not backed by trials, it’s also believed that dronabinol contributes to a higher treatment retention rate — upwards of 75 percent — whereas treatment retention is lower when gabapentin is used.
It’s also important to note that patients using dronabinol will test positive for cannabinoids if they are given a drug test. If that is an issue, then gabapentin is recommended, as it will not show up in a urine test.
Oftentimes another medication will be given in addition, when the patient also suffers from a disturbance in sleep because of the cannabis withdrawal. In these situations, zolpidem is a great choice.
The most common treatment option for marijuana withdrawal involves medication and CBT (cognitive behavioral therapy). Every case is different, and the treatment option that is best matched with the patient is always the best option.
When it comes to cannabis withdrawal, it’s important to note that the FDA has not approved any medication. This is no different than the health and supplement industry — the US Food and Drug Administration simply doesn’t approve the medication in some verticals.
There have been several trials, which included more than 200 patients with regular marijuana use, and all concluded that treatment using dronabinol (THC) reduced common withdrawal symptoms by upwards of 50 percent and at minimum, by 25 percent.
Dronabinol, being the most promising medication for marijuana withdrawal symptoms, is a synthetic form of THC. Oral use of the medication is allowed in the U.S. for several applications, but marijuana withdrawal use is not regulated. While it is classified as a controlled substance, it’s a schedule three — whereas most drugs are schedule two — making it less likely to be abused. As far as dosage for cannabis withdrawal, most patients are given between 30 and 90 mg daily.
While highly effective, there are some side effects linked to dronabinol use. These include increased blood pressure and feeling light-headed, along with drowsiness. These are all fairly mild, and as long as use is monitored there shouldn’t be any more serious side effects experienced.
Most marijuana withdrawal cases are mild and can be overcome without the aid of medical treatment. Someone with mild withdrawal symptoms often will not seek out medical help — they self-cure, often through physical exercise, increased meditation and activity — to keep them occupied.
For those that were heavy marijuana users, sometimes the withdrawal symptoms are more extreme and self-treatment isn’t as effective and results in relapse and continued use. When daily marijuana withdrawals are severe it will likely result in continued use, and this can snowball into daily impairment.
While it’s easy to just suggest medication right away, it’s important to consider the individual patient. Some may not be able to go down the medication route due to being drug tested at their place of employment. Also, some may want to avoid therapy via substances, opting for CBT instead.
If there are general concerns about using medication — or drug testing in place — then cognitive behavioral therapy is a great option. If medication is the best route, then dronabinol is the preferred choice, especially in the United States, where the other option, nabiximols, is not available.
In a best-case scenario, a patient that has no drug screening concerns, dronabinol in the preferred treatment medication. If they are subject to screenings, and still want to go with a medication-based treatment plan for their cannabis withdrawal, then gabapentin is a great option to consider.
If a patient is adamant about not using medication then a psychotherapy route can be explored using cognitive behavioral therapy (CBT).
In the event that a patient is only experiencing mild sleep disturbances as a result of marijuana withdrawal, then zolpidem is a preferred option. If zolpidem is less than effective, a switch to nitrazepam is an option to consider.
Again, it all comes down to the individual’s preference regarding the use of medication, as well as his or her withdrawal symptom levels.
Dr. Vikram Tarugu, M.D, is the CEO of Detox of South Florida, Inc and medical professional focused on addiction. A veteran in the medical field with over 25 years of professional experience. He is a consultant for many South Florida Rehab centers. Patients travel from allover the US to seek his help with addiction and Hepatitis C treatment.
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