From the Guidelines
The most effective pharmacological treatment for cannabis addiction is a combination of psychosocial interventions and symptom management medications, with N-acetylcysteine (1200mg twice daily) showing promise in reducing cannabis use, particularly in adolescents, as evidenced by recent studies 1.
Treatment Approach
The treatment of cannabis addiction typically involves a multi-faceted approach, including:
- Psychosocial interventions, such as cognitive behavioral therapy or contingency management
- Symptom management medications, such as gabapentin (300-600mg three times daily for 1-2 weeks), mirtazapine (15-30mg at bedtime for sleep and appetite), or buspirone (15mg twice daily for anxiety)
- Medications to reduce cannabis use, such as N-acetylcysteine (1200mg twice daily) or Naltrexone (50mg daily)
Medication Options
Some clinicians may also use dronabinol (5-10mg twice daily), a synthetic THC, for managing withdrawal through a tapering approach, as suggested by studies on cannabis withdrawal syndrome 1. However, the most appropriate dosages for these interventions are not well established, and expert guidance is recommended.
Importance of Expert Guidance
The expert panel agreed that these products were not suitable for patients consuming cannabis products with minimal THC content, and that expert guidance in the form of clinicians familiar with prescribing or authorising cannabis, nabilone, or nabiximols should be sought 1.
Monitoring and Follow-up
Patients should be monitored for side effects and treatment efficacy with regular follow-up appointments, and treatment duration typically ranges from 4-12 weeks depending on individual response.
From the Research
Pharmacological Treatment of Cannabis Addiction
- There are no approved pharmacotherapies for cannabis use disorder (CUD) 2, although several drug classes have shown promise and require further evaluation.
- Cannabinoid agonists, such as tetrahydrocannabinol preparations, warrant further research as potential treatments for CUD 3.
- Other medications that have been tested for CUD include antidepressants, anxiolytics, glutamatergic modulators, and the neuropeptide oxytocin 3.
- Nabilone, a synthetic THC analogue, has been shown to produce sustained, dose-related increases in positive mood and few cognitive decrements in marijuana smokers, suggesting its potential as a medication for marijuana dependence 4.
- A systematic review of pharmacotherapies for CUD found that the evidence was largely insufficient, with low-strength evidence suggesting that selective serotonin reuptake inhibitors (SSRIs) and buspirone are ineffective, and low- to moderate-strength evidence suggesting that cannabinoids do not increase abstinence rates or improve treatment retention 5.
Challenges in Treating Cannabis Addiction
- Treatment of CUD is often complicated by comorbid mental health and other substance use disorders 2.
- The legalization of non-medical cannabis use in some countries may increase the prevalence of CUD by making more potent cannabis products more readily available at a lower price 2.
- Special populations that warrant consideration in CUD treatment include those with concurrent mental health conditions and those who develop dependence through therapeutic use 3.
Future Research Directions
- Further research is needed to identify effective pharmacologic treatments for CUD, particularly in light of the increasing access to and use of cannabis in the general population 5.
- Larger, longer-term trials are needed to evaluate the efficacy and safety of potential treatments for CUD, including cannabinoid agonists and other medications 3, 5.