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Endogenous cannabinoids are endogenous lipids that alter brain function. They affect many things such as memory, concentration, and pleasure.

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THC's chemical structure is similar to the brain chemical anandamide. Similarity in structure allows drugs to be recognized by the body and to alter normal brain communication.

THC's chemical structure is similar to the brain chemical anandamide. Similarity in structure allows the body to recognize THC and to alter normal brain communication.

Endogenous cannabinoids such as anandamide (see figure) function as neurotransmitters because they send chemical messages between nerve cells ( neurons) throughout the nervous system. They affect brain areas that influence pleasure, memory, thinking, concentration, movement, coordination, and sensory and time perception. Because of this similarity, THC is able to attach to molecules called cannabinoid receptors on neurons in these brain areas and activate them, disrupting various mental and physical functions and causing the effects described earlier. The neural communication network that uses these cannabinoid neurotransmitters, known as the endocannabinoid system, plays a critical role in the nervous system's normal functioning, so interfering with it can have profound effects.

For example, THC is able to alter the functioning of the hippocampus (see " Marijuana, Memory, and the Hippocampus") and orbitofrontal cortex, brain areas that enable a person to form new memories and shift his or her attentional focus. As a result, using marijuana causes impaired thinking and interferes with a person's ability to learn and perform complicated tasks. THC also disrupts functioning of the cerebellum and basal ganglia, brain areas that regulate balance, posture, coordination, and reaction time. This is the reason people who have used marijuana may not be able to drive safely (see " Does marijuana use affect driving?") and may have problems playing sports or engaging in other physical activities.

People who have taken large doses of the drug may experience an acute psychosis, which includes hallucinations, delusions, and a loss of the sense of personal identity.

THC, acting through cannabinoid receptors, also activates the brain's reward system, which includes regions that govern the response to healthy pleasurable behaviors such as sex and eating. Like most other drugs that people misuse, THC stimulates neurons in the reward system to release the signaling chemical dopamine at levels higher than typically observed in response to natural rewarding stimuli. The surge of dopamine "teaches" the brain to repeat the rewarding behavior, helping account for marijuana's addictive properties.

Diagram showing different parts of the brain and describing marijuana's effects on the brain

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How does marijuana produce its effects? | National Institute on Drug Abuse

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The neural communication network that uses these cannabinoid neurotransmitters, known as the endocannabinoid system, plays a critical role in the nervous system's normal functioning, so interfering with it can have profound effects.

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Overdoses due to marijuana are rare, but not impossible. Signs and symptoms include bloodshot eyes, increased appetite and thirst, vertigo, impaired brain function, and psychotic excitement or depression.

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Monday, February 03, 2020 3:51 PM

Did you catch a glimpse of the winding lines of customers waiting to buy recreational marijuana after it became legal in Illinois?

Maybe that was you standing in line, or perhaps you have a friend who wants to give it a try. If so, knowledge is power, especially when it comes to your health. Here, NorthShore Toxicologist Jerrold Leikin, MD, answers questions about overdosing on marijuana and what you should do if side effects become severe.

Because marijuana contains tetrahydrocannabinol (THC), the psychoactive substance in it, there are health risks associated with using it. But THC concentration varies widely among marijuana strains and products, so users may not know exactly how much they are ingesting, Leikin said.

"Marijuana directly affects the brain, so it's important to know that the amount of THC concentration in marijuana is more than triple the amount it had back in the 60s and 70s," Dr. Leikin said. "However, there's no oversight as far as quality or whether there is contamination. It is not regulated by any governmental agency."

Q. What does an overdose on marijuana look like?
A. Typically, we see users who are extremely anxious and agitated. Their heart rate and blood pressure has increased; they have slow reaction time, and may experience paranoia and fear, even become delusional. It can be a very scary experience. Other symptoms include:

Dizziness, a sensation of floating

Impaired memory and problem solving

Impaired balance and hand steadiness

Bloodshot eyes

Decreased salivation

Urinary frequency

Increased appetite and thirst

Psychotic excitement or depression

Frequent vomiting

Q. What factors affect the reaction to marijuana, in terms of how severe and how long it lasts?
A. Your previous experience with the drug, how it's taken and how strong it is may determine how you react to recreational marijuana. It's difficult to predict because it comes in many different concentrates and forms, such as edibles. Users may ingest more edibles, such as brownies or gummies, not feel the effect, and eat more because it's easier. They can become, over the next few hours, hostile or suffer hallucinations. Side effects can last from 3 to 6 hours or longer in some people.

Q. When should someone seek medical help?
A. When symptoms are severe, get medical attention - call 911 or get someone to drive you to the nearest emergency room. Never drive yourself if you are overdosing. People who are taken to the emergency room may be given breathing support, IV fluids or medicine to relieve symptoms.

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Q&A: Symptoms of Overdosing on Marijuana

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NorthShore Toxicologist Jerrold Leikin, MD, answers questions about overdosing on marijuana and what you should do if side effects become severe.

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Symptoms of marijuana withdrawal includes decreased appetite/weight, nausea and vomiting, aggression, and anxiety/depression.

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Opinions about marijuana use vary-with a range of perceptions regarding its social acceptability, risks, and benefits, use of it as a recreational drug, and whether it can be helpful in treating medical conditions. 1,2

Regardless, using marijuana, especially for a prolonged period of time, can result in problematic use and marijuana use disorder. ¹ In fact, individuals who begin using marijuana before age 18 are 4 to 7 times more likely than adults to develop a marijuana use disorder. ³

For individuals who use marijuana frequently and regularly and then attempt to quit withdrawal symptoms may surface. The cannabis withdrawal syndrome can make it more difficult to stop using marijuana, but recovery is achievable. 5,6 Continue reading to better understand marijuana withdrawal-including the symptoms and duration-and how treatment may be able to help you successfully stop marijuana use.

What is Marijuana Withdrawal?

Individuals who use marijuana-also known as cannabis, pot, weed, grass, bud, herb, Mary Jane, and ganja, among other names-may take it to experience the sense of relaxation, euphoria, and enhanced sensory perception often associated with the drug. 7,8 However, using marijuana regularly-such as on a daily basis or several times each week-and heavily means that when an individual attempts to drastically reduce their intake or stop using weed altogether, withdrawal symptoms may occur. 6,9

A meta-analysis of studies, which involved more than 23,000 individuals, found that 47% of the participants who used marijuana regularly experienced cannabis withdrawal syndrome. ⁵

While cannabis withdrawal syndrome does not carry a high risk of severe adverse effects, withdrawal may impede abstinence and lead to relapse since the reintroduction of marijuana immediately relieves unpleasant withdrawal symptoms. ¹⁰

Marijuana Withdrawal Timeline

For individuals trying to significantly reduce their marijuana use or stop completely after heavy, regular use, acute withdrawal symptoms may surface relatively quickly: ¹⁰

Within 1-2 days, the onset of most symptoms of withdrawal usually begins.

Within 2-6 days, symptoms peak in severity.

Within 3 weeks, most acute symptoms resolve.

Some studies indicate that certain psychological symptoms of withdrawal may last for up to 5 weeks after quitting marijuana use. ¹¹

Sleep problems tend to be the most troublesome for individuals in the first days of abstinence from marijuana-and the reason why many relapse back to marijuana use. 6,12 These sleep disturbances, including insomnia and experiencing strange dreams, may persist for 30-45 days after stopping marijuana use. 12,13

Symptoms of Marijuana Withdrawal

Cannabis withdrawal syndrome, an official diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5.), may be experienced by individuals who stop using cannabis after heavy, long-term use. 11,12 Symptoms of marijuana withdrawal may include: 5,6,14

Anger, irritability, and aggression.

Feelings of nervousness and anxiety.

Restlessness.

Decreased appetite or weight.

Depression.

Insomnia.

Experiencing strange or unsettling dreams.

Headaches, nausea, vomiting, sweating, and abdominal pain.

Tremors.

The presence of 3 or more of these symptoms within one week of lowered marijuana use indicates cannabis withdrawal syndrome. ¹⁴

Causes of Marijuana Withdrawal

Marijuana withdrawal can vary from person to person.

According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), withdrawal from marijuana is generally more common and severe among adults who use the drug than among adolescents who use it. This is likely because adults tend to use marijuana more frequently and in greater amounts than adolescents. ¹²

Polysubstance use (using multiple substances) may also play a role in marijuana withdrawal. Studies show that concurrent use of tobacco, alcohol, and other substances with marijuana may make it more likely for withdrawal symptoms to arise. On the other hand, individuals dependent on opioids, who also use marijuana, are less likely to experience cannabis withdrawal syndrome. 5,6

Marijuana withdrawal symptoms may be more severe for individuals who use more potent marijuana. Research indicates that individuals who engage in "dabbing," a process where marijuana with very high levels of tetrahydrocannabinol (THC) is vaporized and inhaled through a vape pen, reported more intense withdrawal symptoms. 6,15 For reference, these concentrates are 20%-80% THC; typical THC content is 2%-6%. ⁶

Additionally, individuals with mood, anxiety, and personality disorders, and those who suffer from post-traumatic stress disorder (PTSD) are more likely to experience more severe withdrawal symptoms than those without these mental health disorders. ¹²

Furthermore, the severity of withdrawal symptoms may correlate with the risk of relapse. ¹⁰ For instance, adolescents meeting the diagnostic criteria for cannabis use withdrawal are more likely to relapse sooner than those who do not meet the criteria. ¹⁰

Quitting Marijuana

Cannabis withdrawal rarely requires medical intervention. However, inpatient detoxification may be beneficial for some individuals, including: 6,12,16

Those who suffer from co-occurring marijuana use and mental health disorders.

Those with additional physical health problems.

Those who have been diagnosed with severe cannabis use disorder.

Those who misuse multiple substances, including opioids, alcohol, and benzodiazepines in addition to marijuana. Medical detox may be necessary as the withdrawal syndromes associated with these substances can be dangerous, even lethal.

Beyond medically managed detox, these individuals typically benefit from a comprehensive treatment plan, which may entail staying in a residential inpatient program or enrolling in an intensive outpatient program. In either setting, individuals participate in individual and group counseling and behavioral therapy sessions, which may include: ¹⁶

Cognitive-behavioral therapy (CBT). CBT, a type of psychotherapy, helps people become aware of and ameliorate distressing behaviors for the purpose of increasing self-control, stopping substance use or misuse, and working to heal the many associated challenges.

Contingency management (CM). CM utilizes regular monitoring of a certain behavior and gives or takes away positive, tangible rewards as a result of the target behavior occurring or not occurring.

Motivational enhancement therapy (MET). MET, a therapeutic intervention intended to produce fast and internally motivated change in a person, utilizes internal resources for healing and engagement in therapy.

There are currently no FDA-approved medications specifically for the treatment of marijuana use disorder or for the prevention of relapse. Studies suggest that the psychosocial behavioral interventions explained above can be effective in treating marijuana use disorder and in preventing relapse. ¹⁰

Working with a provider that has experience effectively treating cannabis withdrawal and cannabis use disorder, like American Addiction Centers, can help you improve your chances of avoiding relapse. Call

Let one of our compassionate and experienced Admissions Navigators answer your questions, explain your options, and help you get started on your journey to recovery.

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Marijuana Withdrawal Symptoms, Timeline & Treatment

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Read on to learn more about marijuana withdrawal symptoms, a typical marijuana withdrawal timeline, and the best way to quit marijuana for good.

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Cognitive-behavioral therapy, contingency management, and motivational enhancement therapy are all possible treatments to help recover from marijuana misuse.

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Marijuana use disorders appear to be very similar to other substance use disorders, although the long-term clinical outcomes may be less severe. On average, adults seeking treatment for marijuana use disorders have used marijuana nearly every day for more than 10 years and have attempted to quit more than six times. People with marijuana use disorders, especially adolescents, often also suffer from other psychiatric disorders ( comorbidity). They may also use or be addicted to other substances, such as cocaine or alcohol. Available studies indicate that effectively treating the mental health disorder with standard treatments involving medications and behavioral therapies may help reduce marijuana use, particularly among those involved with heavy use and those with more chronic mental disorders. The following behavioral treatments have shown promise:

Cognitive-behavioral therapy: A form of psychotherapy that teaches people strategies to identify and correct problematic behaviors in order to enhance self-control, stop drug use, and address a range of other problems that often co-occur with them.

Contingency management: A therapeutic management approach based on frequent monitoring of the target behavior and the provision (or removal) of tangible, positive rewards when the target behavior occurs (or does not).

Motivational enhancement therapy: A systematic form of intervention designed to produce rapid, internally motivated change; the therapy does not attempt to treat the person, but rather mobilize his or her own internal resources for change and engagement in treatment.

Currently, the FDA has not approved any medications for the treatment of marijuana use disorder, but research is active in this area. Because sleep problems feature prominently in marijuana withdrawal, some studies are examining the effectiveness of medications that aid in sleep. Medications that have shown promise in early studies or small clinical trials include the sleep aid zolpidem (Ambien ®), an anti-anxiety/anti-stress medication called buspirone (BuSpar ®), and an anti-epileptic drug called gabapentin (Horizant ®, Neurontin ®) that may improve sleep and, possibly, executive function. Other agents being studied include the nutritional supplement N-acetylcysteine and chemicals called FAAH inhibitors, which may reduce withdrawal by inhibiting the breakdown of the body's own cannabinoids. Future directions include the study of substances called allosteric modulators that interact with cannabinoid receptors to inhibit THC's rewarding effects.

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Available Treatments for Marijuana Use Disorders | National Institute on Drug Abuse

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Cognitive-behavioral therapy, Contingency management, and Motivational enhancement therapy are available treatments for Marijuana Use Disorder.