From the Guidelines
Treatment for cannabis use disorder should prioritize cognitive-behavioral therapy (CBT) and motivational enhancement therapy (MET), as these psychotherapeutic approaches have shown effectiveness in addressing the disorder, despite the lack of FDA-approved medications specifically for this condition. According to the American College of Physicians' position paper published in the Annals of Internal Medicine in 2024 1, psychosocial interventions like CBT are cited as effective but underutilized treatments of cannabis use disorder.
Key aspects of treatment include:
- Cognitive-behavioral therapy (CBT) to identify triggers and develop coping strategies
- Motivational enhancement therapy (MET) to resolve ambivalence about quitting
- Contingency management, which provides tangible rewards for abstinence, can be effective when combined with other therapies
- Support groups like Marijuana Anonymous offer peer support using a 12-step model
While medications are not specifically approved for cannabis use disorder, some clinicians may use medications off-label to address specific symptoms, such as gabapentin for withdrawal symptoms, N-acetylcysteine to reduce cravings, and sometimes buspirone or SSRIs for co-occurring anxiety, as noted in the context of treating substance use disorders and their associated symptoms 1.
It's crucial to address barriers to care, including fear of stigma, self-reliance, time constraints, and lack of insurance coverage, to increase treatment rates for cannabis use disorder, as highlighted by the American College of Physicians' support for initiatives to address stigma associated with behavioral health, including substance use disorder 1.
From the FDA Drug Label
Patients with a history of substance abuse or dependence, including marijuana or alcohol, may be more likely to abuse dronabinol capsules as well Assess each patient’s risk for abuse or misuse prior to prescribing dronabinol capsules and monitor patients with a history of substance abuse during treatment with dronabinol capsules for the development of these behaviors or conditions.
Treatment options for cannabis use disorder are limited, and dronabinol may be considered in certain cases. However, it is essential to assess the patient's risk for abuse or misuse prior to prescribing dronabinol capsules, as patients with a history of substance abuse or dependence may be more likely to abuse the medication.
- Key considerations:
- Monitor patients with a history of substance abuse during treatment with dronabinol capsules.
- Weigh the potential benefits against the risks before prescribing dronabinol capsules to patients with a history of seizures or other factors that can lower the seizure threshold.
- Consider dose reduction or discontinuing dronabinol capsules if a patient develops worsening nausea, vomiting, or abdominal pain while on treatment 2.
From the Research
Treatment Options for Cannabis Use Disorder
- There are currently no FDA-approved medications for the treatment of cannabis use disorder (CUD) 3, 4, 5, 6.
- Evidence-based psychotherapy, such as cognitive behavioral therapy, motivational enhancement therapy, and contingency management, can substantially reduce cannabis use and cannabis-related problems, but enduring abstinence is not a common outcome 4, 7.
- Technology, including ecological momentary assessments (EMA) and internet-based treatments, has the potential to serve as a valuable monitoring tool in prevention, screening, and treatment for CUD 3.
- Telehealth has become a more widely accepted option for CUD treatment, especially following the COVID-19 pandemic 3.
- Psychedelics have garnered interest as a potential therapeutic class for CUD, but more research is needed to fully understand their effectiveness and potential risks 5.
- Pharmacotherapies, such as selective serotonin reuptake inhibitors (SSRIs) and cannabinoids, have shown limited effectiveness in reducing cannabis use or improving treatment retention 6.
Challenges and Future Directions
- The lack of resources for prevention and treatment of CUD has resulted in a significant gap between the need for services and access to treatment 3.
- More research is needed to identify effective pharmacologic treatments for CUD, particularly given the increasing access to and use of cannabis in the general population 6.
- The development of innovative treatment approaches, including psychosocial interventions and pharmacological interventions, is crucial for addressing the growing need for CUD treatment 7.