Withdrawal II: Hallucinogens

3 June 2023

A couple years ago I took a course on pharmacology as part of my training in addiction treatment.  There’s one blog in place on withdrawal from alcohol use right here.  At the time that was written, the intent was to draft at least three more, one each on stimulants, hallucinogens, and opioids (which are technically depressants, like alcohol, but with their own identity).  Let’s start with cannabis, probably the second-most commonly encountered drug in the SMART Recovery community, with whom I work.

Cannabis is an hallucinogen which, as your history of words probably signalled, fosters hallucinations.  There are four divisions of hallucinogens:

1. Indolealkylamines: LSD and psilocybin (“magic mushrooms”) which are strictly hallucinogenic;
2. Phenylethylamines: mescaline, ecstasy, and jimson weed which additionally act as stimulants while also being hallucinogenic;
3. Dissociative anaesthetics: PCP and ketamine which also produce depressive effects; and,
4. Cannabis: the only hallucinogen affecting the endocannabinoid neuroreceptor.  The other unique aspect of cannabis use, amongst the hallucinogens, is that physical dependency does follow, making cannabis an addictive drug (Csiernik, 2019, p. 7).   

For anyone who finds the above inadequate, there’s a ton of information out there, just start digging.  Because I often hear rationalizations arguing that cannabis is not really addictive and doesn’t really harm you, I’ll list the categories of harm with only a few high-level details:

Risks Associated with Cannabis Use:

• Amotivational syndrome
  • Apathy and difficulty concentrating
• Anxiety
  • Cannabis can relieve this short-term; long-term increase in social anxiety disorder with regular use
• Bone mineral density
  • Lowered
• Brain development
  • Detrimental shrinkage
• Cannabinoid Hyperemesis Syndrome (CHS)
  • “CHS is characterized by recurrent episodes of intractable nausea and vomiting along with abdominal pain among individuals who have been using cannabis regularly for years.  There is also a risk of renal (kidney) failure due to dehydration.  Compulsive bathing as a means of symptom relief is also a characteristic of CHS (Csiernik, 2019, p. 232).  
• Cardiovascular system
  • Some evidence of cannabis triggering strokes, cardiac events, faster organ aging
• Cognitive deficits
  • Relationship between continued use and increased neuropsychological impairment
• Crohn’s disease
  • Users with this issue, with six months use, more likely to require surgery
• Dental problems
  • Decayed teeth
• Dependency
  • “Cannabis produces both physical and psychological dependency including withdrawal, which consists of behavioural, mood, and physical symptoms highlighted by physical weakness, sweating, restlessness, dysphoria, sleeping problems, anxiety, and craving for continued use” (Ibid).
• Depression
  • “Self-report research indicates that while cannabis can reduce perceived symptoms of depression in the short term, particularly negative affect, its continued use may exacerbate baseline symptoms of depression over time” (Cuttlera et al., 2018 as cited in Csiernik, 2019, p. 234).
• Education
  • “Cannabis use causes acute impairment of attention and learning (Volkow et al., 2016 as cited in Csiernik, 2019, p. 234).
  • Regular cannabis use in adolescence approximately doubles the risks of early school-leaving (Hall, 2015, Ibid). 
• Mental Health
  • Highlights: Can increase severity of PTSD symptoms; regular use increases risk of developing bipolar disorder and can increase symptom severity; increased incidence of suicidality
• Motor Vehicle Collisions
  • Contributing factor to increased risk
• Poisoning
  • Happens when children [or pets] accidentally consume drugs
• Pregnancy
  • Lower birth weights of babies with mothers who use at least once per week
  • Infant sleep disturbance months to (three) years
• Psychosis/Schizophrenia
  • Multiple research sources have found increased incidence of symptoms of these disorders or accelerated onset
• Respiratory Disease
  • Coughing, wheezing, and difficult breathing after exercise
  • Exacerbates asthma
• Sleep
  • Decrease REM sleep in regular users
  • Daily users report more sleep disturbance than those with less use
• Sperm mobility
  • Thin body of studies shows negative effects on male reproductive health (Adapted from Csiernik, 2019). 

Well—if that isn’t a buzzkill for weed, I don’t know what would be!  It’s a serious drug, kids.  Remember, heroin-yielding poppies grow in fields too.  Lots of natural poisons out there and this is just one more.  One of the unique phenomena associated with cannabis is “greening out” which can happen after use but is more likely after combining with alcohol (a typical partying scenario).  “This unpleasant experience can make the user go pale or green and feel sweaty, dizzy, and nauseous.  It is equivalent to an overdose state, with some people even reporting passing out after using cannabis” (Vandrey et al., 2008 in Csiernik, 2019, p. 237). 

Here's the Coles’ Notes version of withdrawal from cannabis:

• Physical dependence can result from as few as 2 joints (cigarettes) per day
• Within 4-8 hours of cessation of use, withdrawal begins
• Symptoms: anger, anxiety, depressed mood, extended amotivational syndrome (apathy), disturbed sleep, gut cramps, insomnia, irritability, restlessness, weight loss, and sweating
• Withdrawal symptoms (above) begin to recede within 48 hours of abstinence and receptors return to normal functioning within about one month
• Sleep issues can also last about a month after cessation

What’s not included in that list are some of the social and psychological issues that arise from withdrawal.  For example, there was a reason you used cannabis.  Chances are it had to do with anxiety, depression, pain, or another real-life issue or disorder.  Those issues are still there and feel much worse.  As SMART Recovery, and other sources, recommend, part of a good withdrawal plan is immediate medical and psychotherapeutic support for your individual issues. 

That approach is recommended under Withdrawal Management (WM) at the U.S. National Library of Medicine.  They describe WM as medical and psychological care of those experiencing withdrawal symptoms.  Under cannabis dependence the advice is that patients be observed every three to four hours to assess complications, worsening anxiety, or dissociation. They also suggest that “...withdrawal is managed by providing supportive care in a calm environment…"and that those who have been using large amounts of cannabis sometimes show psychosis and should be treated by a professional, should that arise.

Finally, if you’re an addicted user reading this, I have seen people recover from chronic cannabis use after decades of habitualization.  It can be done and is done—every day.  Life actually improves and you start, one day at a time, building a life well worth living.

Dan Chalykoff is (finally!) a Registered Psychotherapist (Qualifying).  He works at CMHA-Hamilton and Healing Pathways Counselling, Oakville, where his focus is clients with addiction, trauma, burnout, and major life changes.  He writes these blogs to increase (and share) his own evolving understanding of ideas.  Since 2017, he has facilitated two voluntary weekly group meetings of SMART Recovery.  Please email him (danchalykoff@hotmail.com) to be added to or removed from the Bcc’d emailing list.

References

Csiernik, R. (2019). The Essential Guide to Psychoactive Drugs in Canada: A Resource for Counselling Professionals, Second Edition.  Canadian Scholars.

National Library of Medicine, (2023, May 29).  Clinical Guidelines of Withdrawal Management and Treatment of Drug Dependence in Closed Settings.  https://www.ncbi.nlm.nih.gov/books/NBK310652/