From the Guidelines
The most effective pharmacological treatment for cannabis addiction is a combination of medications that manage withdrawal symptoms and reduce cravings, with nabilone being a promising option to reduce symptoms of cannabis withdrawal syndrome and craving in persons with cannabis use disorder, as evidenced by the 2021 study published in the British Journal of Anaesthesia 1.
Key Considerations
- Nabilone, a synthetic analogue of D9-THC, has anxiolytic, anti-emetic, and analgesic properties, and can reduce symptoms of cannabis withdrawal syndrome and craving in persons with cannabis use disorder.
- The expert panel agreed that nabilone and nabiximols can be used as a substitution for cannabis therapy, but under the guidance of clinicians familiar with prescribing or authorising cannabis, nabilone, or nabiximols.
- The most appropriate dosages for these interventions are not known, and the already accepted dosages for these medications should not be exceeded.
Treatment Approach
- Medications like nabilone can be used to manage withdrawal symptoms and reduce cravings, in combination with behavioral therapy and counseling.
- Treatment typically continues for 8-12 weeks with regular monitoring for side effects and efficacy, adjusting dosages as needed.
- Patients should be aware that relapse rates remain high, and multiple treatment attempts may be necessary before achieving sustained abstinence.
Recent Recommendations
- The American College of Physicians supports the development of evidence-based medical education on the health effects of cannabis and cannabinoids, and recommends that cannabis content be incorporated into substance use curricula at all levels of physician education 1.
- Public information campaigns should be designed to increase awareness about cannabis use disorder and the efficacy of treatment, and barriers to treatment, such as undue prior authorization and use management, excessive cost sharing, and insufficient access to physicians and other health care professionals with expertise in diagnosing and treating cannabis use disorder, must be addressed.
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 fully evaluate the potential of cannabinoid agonists and other medications as treatments for CUD 3, 5.