From the Guidelines
Cannabis use disorder treatment should prioritize psychosocial interventions, such as cognitive-behavioral therapy, as the most effective approach, with medication options like N-acetylcysteine and gabapentin considered for symptom management. When considering treatment options for cannabis use disorder, it's essential to recognize the prevalence of the disorder, particularly in areas where recreational cannabis is legal 1. The American College of Physicians emphasizes the importance of addressing stigma associated with behavioral health and substance use disorders, as well as increasing awareness about the efficacy of treatment for cannabis use disorder 1.
Key treatment considerations include:
- Psychosocial interventions: Cognitive-behavioral therapy (CBT) is cited as an effective but underutilized treatment for cannabis use disorder, helping patients identify triggers, develop coping skills, and maintain motivation for abstinence 1.
- Medication approaches: Although no medications are FDA-approved specifically for cannabis use disorder, research suggests that medications like N-acetylcysteine (NAC) and gabapentin may be beneficial in reducing cravings and managing symptoms 1.
- Addressing co-occurring conditions: It's crucial to address co-occurring mental health conditions, such as anxiety or depression, which often contribute to continued cannabis use 1.
- Individualized treatment: Treatment should be tailored to the individual, often combining psychotherapy with supportive care, and may include mutual support groups like Marijuana Anonymous for additional structure and accountability during recovery.
Given the current state of research, psychosocial interventions should be the primary approach, with medication options considered on a case-by-case basis. The development of evidence-based medical education on the health effects of cannabis and cannabinoids is also essential, as highlighted by the American College of Physicians 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 no FDA-approved medications for the treatment of cannabis use disorder (CUD) 3, 4, 5, 6.
- Evidence-based psychotherapy is limited by insufficient providers, serving very few patients effectively 3.
- Cognitive behavioural therapy, motivational enhancement therapy, and contingency management can substantially reduce cannabis use and cannabis-related problems 4.
- Pharmacotherapies such as cannabinoid agonists have shown promise, but require more rigorous evaluation 4, 5.
- Selective serotonin reuptake inhibitors (SSRIs) and buspirone have been found to be ineffective in reducing cannabis use or improving treatment retention 6.
- Cannabinoids have been found to be ineffective in increasing abstinence rates, reducing cannabis use, or increasing treatment retention 6.
Role of Technology in Treatment
- Technology can be used to create a scalable system to prevent, screen, refer, and provide treatment for CUD 3.
- Ecological momentary assessments (EMA) can be used as a valuable monitoring tool in prevention, screening, and treatment for CUD 3.
- Internet and application-based treatments for CUD, including prescription digital therapeutics, are being developed and have shown promise 3.
- Telehealth has become a more widely accepted option for CUD treatment, especially since the COVID-19 pandemic 3.
Future Directions
- Further research is needed to identify effective pharmacologic treatments for CUD 5, 6, 7.
- Studies should focus on improving existing platforms and incorporating new functions, such as sensors, to optimize a public and clinical health approach to CUD 3.
- Neurobiological findings and innovative treatment approaches, including psychosocial interventions, should be further explored 7.