Comprehensive Interventions for Reducing Cannabis Use

Judit Tirado-Muñoz; Juan I. Mestre-Pintó; Magí Farré; Francina Fonseca; Marta Torrens

Disclosures

Curr Opin Psychiatry. 2018;31(4):315-323. 

In This Article

Advances in Pharmacological Interventions for Cannabis use

One review provided an update on the present status of pharmacological treatment for CUD and withdrawal.[17] Table 3, modified form Brezing and Levin,[17] lists evidence-supported medications currently available in the off-label treatment of CUD and substance withdrawal.

Although there are no clearly effective medication treatments for CUD, some medications demonstrated effectiveness in the treatment of CUD and cannabis withdrawal. Evidence from the review of CUD pharmacological treatments,[17] has been synthesized here focusing on cannabinoid (cannabinoid agonists and cannabinoid antagonists) and noncannabinoid approaches.

Cannabinoid Agonists

For targeting global cannabis withdrawal, nabiximols, nabilone and oral THC may be useful. Although has not yet being tested in clinical settings, Nabilone may be useful for preventing relapse.

Cannabinoid Antagonists

Many different pharmacological approaches have been trialed and they include the development of cannabinoid receptor antagonist, Rimonabant, which had to be withdrawn in the clinical trial stage because of a too high prevalence of side effects including anxiety, depression and suicide.[25]

Noncannabinoid Approaches

Review supports the use of mirtazapine and quetiapine in reducing some cannabis withdrawal symptoms. Same goes for Zolpidem and likely benzodiazepines, in targeting particular some cannabis withdrawal symptoms such as sleep disturbances. Though reductions in CUD or prevention of relapse have been proved, a lack of larger adult's samples to test the efficacy of Topiramate, N-Acetylcysteine, Gabapentin and chronic dosing of naltrexone are still lacking. Regarding Oxytocin, one of the two RCT reviewed here, showed promising results in the way Oxytocin enhances the effect of MET on cannabis outcomes. Nevertheless, results should be considered with caution since has been tested in a pilot study[26] and no sufficient literature exists to determine its clinical utility. The two trials included in the review are based on pilot studies with small samples sizes, thus replication studies are needed.

In addition, we reviewed the latest published studies on pharmacological therapy for cannabis users seeking treatment. A pilot study involving cannabis-dependent adults compared MET and oxytocin to MET and placebo in a 4 weeks RCT.[26] The MET intervention consisted of three 45–60-min sessions (study weeks 1, 2 and 4). Intervention also included a personalized feedback report to discuss problems related to use, challenges to behaviour change, as well as reasons for quitting and goal settings. Prior to the first two of three MET sessions, Oxytocin (40 IU) or placebo was intranasally administered. Reductions in cannabis use on the day oxytocin and MET was administered (M = -1.45, SEM = 0.58, P = 0.022) were found among participants receiving MET + oxytocin while participants received placebo did not show reductions. In spite of that, no overall treatment effect of oxytocin on mean daily cannabis use amount between sessions was found.

Moreover, a 6-week RCT pilot study examined efficacy of Topiramate + MET compared with placebo + MET for treating cannabis use among 66 heavy cannabis users.[27] MET consisted in three 50-min manual-driven sessions administered during study weeks nos. 1, 3 and 5. Based on motivational interviewing, the first session focused on enhancing motivation to reduce or quit cannabis use, while during sessions 2 and 3, participants received a personalized cannabis use feedback. Participants also had the opportunity to discuss with counsellors about the progress towards cannabis goals by identifying barriers to change, and considering problem solving and behavioural change. Topiramate was titrated over 4 weeks and then stabilized at 200 mg/day for 2 weeks. Although results showed that Topiramate was more active than placebo in reducing quantity (g/day of use) of smoked cannabis, it did not affect abstinence rates. In addition, participants reported adverse effects, suggesting that Topiramate is poorly tolerated by young patients.

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