Is Nabilone (cannabidiol) suitable for treating cannabis cravings?

Nabilone is Not Recommended for Cannabis Cravings

Nabilone is not recommended for treating cannabis cravings as there is insufficient evidence supporting its efficacy for this indication, and it carries significant abuse potential as a synthetic cannabinoid. 1, 2

Evidence Assessment

FDA-Approved Indications

• Nabilone (Cesamet) is an orally active synthetic cannabinoid approved only for chemotherapy-induced nausea and vomiting 3
• It is not FDA-approved for cannabis use disorder or cravings

Efficacy for Cannabis Cravings

• A 2021 systematic review and network meta-analysis found that while nabilone reduced cannabis use compared to placebo in limited studies, it was not effective for cannabis cravings specifically 1
• A 2022 systematic review concluded that nabilone failed to demonstrate efficacy in the treatment of cannabis use disorder 2
• A small randomized controlled pilot study (n=18) showed no difference in cannabis use between nabilone (2mg/day) and placebo groups 4

Risks and Concerns

1. Abuse Potential:

   • Nabilone has complex effects on the central nervous system similar to cannabis 3
   • It can produce euphoria, relaxation, and mood changes in the recommended dosage range 3
   • Has potential for abuse and psychological dependence 3

2. Side Effects:

   • Common adverse effects include drowsiness, dizziness, vertigo (60-70% of patients) 5
   • More serious effects can include postural hypotension, ataxia, vision disturbance, and toxic psychoses 5
   • Can produce changes in mood (euphoria, detachment, depression, anxiety, panic, paranoia) 3

3. Cognitive Effects:

   • Decrements in cognitive performance and memory 3
   • Decreased ability to control drives and impulses 3
   • Alterations in perception (distortions in objects, sense of time, hallucinations) 3

Alternative Approaches for Cannabis Use Disorder

For patients with cannabis use disorder seeking treatment:

1. First-line treatments:

   • Cognitive behavioral therapy and motivational enhancement therapy are recommended as effective treatments 6

2. For withdrawal management:

   • Consider synthetic THC (dronabinol) for patients who were heavy cannabis users (>1.5 g/day of high-THC cannabis or >20 mg/day of THC oil) experiencing moderate to severe withdrawal symptoms 6
   • Dronabinol has shown improved retention in treatment (RR=1.27) 1
   • Symptom-specific medications may be used (acetaminophen/NSAIDs for pain, benzodiazepines for anxiety) 6

3. Promising alternatives:

   • Cannabidiol (CBD) may be effective for treating cannabis withdrawal symptoms without the psychoactive effects of THC 6
   • Gabapentin has shown efficacy in reducing cannabis cravings (d=-2.42) 1

Clinical Recommendation

Given the lack of evidence supporting nabilone for cannabis cravings, its abuse potential, and the availability of better-studied alternatives, clinicians should not prescribe nabilone for cannabis cravings or cannabis use disorder. Instead, focus on evidence-based psychotherapeutic approaches and consider other pharmacotherapies with better supporting evidence for specific symptoms of cannabis withdrawal when needed.