Dexamphetamine and Its Contraindication in Cannabis Dependence
Dexamphetamine (dextroamphetamine) is a central nervous system stimulant medication that should NOT be used for treatment of cannabis use disorders or cannabis dependence—this is explicitly contraindicated by WHO guidelines. 1
What is Dexamphetamine?
Dexamphetamine is a psychostimulant medication that acts as a central nervous system stimulant. 2 While it has legitimate medical uses (such as ADHD treatment), it has no role in managing substance use disorders involving cannabis or other psychostimulants. 1
Why It Is Contraindicated for Cannabis Dependence
Direct Guideline Prohibition
The WHO explicitly states that dexamphetamine should not be offered for the treatment of stimulant use disorders, which includes cannabis use disorders. 1 This recommendation appears in evidence-based guidelines for mental, neurological, and substance use disorders and represents a firm contraindication. 1
Rationale for Contraindication
The contraindication exists because:
Substituting one addictive substance for another is counterproductive. Using a stimulant medication to treat cannabis dependence introduces risk of developing dependence on the treatment medication itself. 3, 4
No evidence of efficacy exists. There are currently no available pharmacological treatment interventions proven effective for cannabis dependence, and dexamphetamine has not demonstrated benefit in this population. 5
Risk of polysubstance abuse. Patients with cannabis dependence frequently have comorbid alcohol and other substance abuse or dependence, making introduction of a potentially addictive stimulant particularly hazardous. 5
Evidence-Based Treatment Alternatives
Instead of dexamphetamine, the recommended approach for cannabis dependence includes:
Brief psychosocial interventions (5-30 minutes) incorporating individualized feedback and advice on reducing or stopping cannabis consumption, with follow-up offered. 1, 3
Short-duration psychosocial support modeled on motivational principles in non-specialized settings. 1, 4
Supportive environment for withdrawal management without specific medication. 1, 3 Symptomatic relief may be achieved with medications targeting specific symptoms (anxiolytics for agitation, sleep aids for insomnia) during the withdrawal period. 3, 4
Cognitive behavioral therapy combined with other techniques, which has moderate to large effect sizes (Cohen's d = 0.53-0.9) on cannabis consumption and psychosocial functioning. 6
Critical Clinical Pitfall
Never use dexamphetamine for cannabis use disorders—this represents a fundamental treatment error that could worsen outcomes by introducing a new substance with abuse potential. 3, 4, 7 The only medications with any preliminary evidence in cannabis dependence are gabapentin (weak effect) and cannabinoid-receptor antagonists for withdrawal symptoms, but even these lack regulatory approval. 6, 8