Pharmacotherapies for cannabis use disorder

Pharmacotherapies with different medications (i.e. preparations containing tetrahydro-cannabinol (THC), selective serotonin reuptake inhibitor (SSRI) antidepressants, mixed action antidepressants, anticonvulsants and mood stabilisers, atypical antidepressant, anxiolytic, norepinephrine reuptake inhibitor, glutamatergic modulator) for cannabis dependent users were assessed in a systematic review (Marshall et al., 2014, 14 RCTs, N= 958) finding no conclusive results on:

• completion of treatment;
• reducing the use of substances; and
• improving withdrawal symptoms and craving.

An update to Marshall et al 2014 (Nielsen et al 2019, 21 RCTs, N= 1 755) also found no conclusive results.

A narrative systematic review (Kondo et al., 2020, 26 RCTs - 14 trials more than the first Marshall et al. review) included trials with cannabinoids, hormones, fatty acid amide hydrolase inhibitor and galantamine. The results confirm the previous systematic reviews, that there is largely insufficient evidence to draw conclusions about the effectiveness of any drug classes tested so far. The review actually found low- to moderate-strength evidence that buspirone, cannabinoids, and SSRIs were ineffective for decreasing cannabis use or improving abstinence.

A more recent systematic review (Bahji et al., 2021, 24 RCTs) performed a network meta-analysis of the different medications tested with individuals diagnosed with cannabis use disorder. The results confirm the previous systematic reviews, that there is largely insufficient evidence to support any particular pharmacological treatment.

Two narrative systematic reviews (Vuilleumier et al., 2022, 8 RCTs, N= 667; Paulus et al., 2022, 40 studies, 24 animal and 16 human studies) assessed the use of cannabinoids for the treatment of cannabis use disorder. Results found promising effects for cannabidiol (CBD) and endocannabinoid modulation, however overall there is insufficient evidence to draw conclusions.