Does naltrexone help reduce cannabis cravings?

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Last updated: August 17, 2026 • View editorial policy

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Naltrexone Does Not Have Established Efficacy for Cannabis Cravings

Based on current evidence, naltrexone is not recommended as a standard treatment for cannabis cravings. While preliminary research shows some promise, there is insufficient high-quality evidence to support its routine use for cannabis use disorder, and it lacks FDA approval for this indication.

Evidence Assessment

FDA-Approved Indications

Naltrexone is FDA-approved only for alcohol use disorder and opioid use disorder 1. The drug label explicitly states it "has not been shown to affect the use of cocaine or other non-opioid drugs of abuse" 1. Cannabis is not mentioned as an approved indication.

Research Evidence: Mixed and Preliminary

The available research on naltrexone for cannabis use disorder shows conflicting results:

Potentially Supportive Findings:

  • One controlled study found that naltrexone maintenance (50 mg daily) significantly reduced cannabis self-administration and positive subjective effects in daily cannabis smokers, with participants on naltrexone having 7.6 times lower odds of self-administering cannabis 2
  • A small comparative study (N=59) suggested naltrexone was more efficacious than bupropion, escitalopram, or bromazepam for marijuana addiction over 120 days 3
  • An open-label pilot study (N=12) of long-acting injectable naltrexone showed decreased cannabis use days per week, though creatinine-corrected urine THC concentrations did not decrease 4

Contradictory or Null Findings:

  • A recent large trial comparing buprenorphine versus naltrexone for opioid use disorder found that participants receiving buprenorphine used 39% less cannabis than those on naltrexone, suggesting naltrexone may actually be inferior to buprenorphine for reducing cannabis use 5
  • The FDA label notes naltrexone "has not been shown to affect the use of...other non-opioid drugs of abuse" 1

Critical Limitations

All positive studies have significant methodological weaknesses:

  • Very small sample sizes (N=12-69 in most studies)
  • Open-label or uncontrolled designs
  • Short follow-up periods
  • High dropout rates
  • No large-scale randomized controlled trials

Current Guideline Recommendations

No major clinical guidelines recommend naltrexone for cannabis use disorder. The 2024 AGA guideline on cannabinoid hyperemesis syndrome mentions that "no pharmacotherapies have been approved for cannabis use disorder" and notes only that "preliminary evidence from 2 small placebo-controlled, randomized studies suggests that fatty acid amide hydrolase inhibitors and CBD can reduce cannabis use, but larger studies are necessary" 6. Naltrexone is not mentioned.

The 2020 meta-analysis on combined pharmacotherapy and CBT for substance use disorders included cannabis but focused primarily on alcohol, cocaine, and opioids, with naltrexone studied predominantly for alcohol use disorder 7.

Clinical Approach

For patients with cannabis use disorder:

  1. First-line treatment remains behavioral interventions - cognitive behavioral therapy, motivational enhancement therapy, or contingency management 6, 7

  2. If considering pharmacotherapy:

    • There are currently no FDA-approved medications for cannabis use disorder
    • Naltrexone should be considered experimental and only in research settings or after behavioral interventions have failed
    • If the patient has co-occurring alcohol use disorder, naltrexone is appropriate for that indication and may provide ancillary benefit for cannabis use 8

  3. Monitor for adverse effects: Naltrexone can cause hepatocellular injury, nausea, headache, and stomach upset 9, 10. Baseline and periodic liver function tests are recommended 10

  4. Consider buprenorphine if co-occurring opioid use disorder exists, as it may be more effective than naltrexone for reducing cannabis use 5

Common Pitfalls

  • Do not prescribe naltrexone specifically for cannabis cravings outside of research protocols or after exhausting evidence-based behavioral treatments
  • Do not assume opioid antagonism translates to cannabis antagonism - the endocannabinoid and opioid systems interact but are distinct
  • Do not use naltrexone in patients requiring opioid pain management - it will block therapeutic opioid effects 10

References

2
Research

Naltrexone Maintenance Decreases Cannabis Self-Administration and Subjective Effects in Daily Cannabis Smokers.

Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 2015

4
Research

Open-label pilot study of injectable naltrexone for cannabis dependence.

The American journal of drug and alcohol abuse, 2018

9
Guideline

alcoholic liver disease.

Hepatology, 2010

10
Guideline

a primary care approach to substance misuse.

American family physician, 2013

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.