CoChat
Sign Up
Cited by 156Cannabis and Cannabinoid ResearchSubstance Abuse Treatment and OutcomesSmoking Behavior and Cessation

Pharmacotherapies for cannabis dependence.

Open access
Marshall, Kushani, Gowing, Linda, Ali, Robert, Le Foll, Bernard·2014·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd008940.pub2PMC PMC4297244
Open this paper in CoChat — free account

Abstract

BACKGROUND: Cannabis is the most prevalent illicit drug in the world. Demand for treatment of cannabis use disorders is increasing. There are currently no pharmacotherapies approved for treatment of cannabis use disorders. OBJECTIVES: To assess the effectiveness and safety of pharmacotherapies as compared with each other, placebo or supportive care for reducing symptoms of cannabis withdrawal and promoting cessation or reduction of cannabis use. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (to 4 March 2014), MEDLINE (to week 3 February 2014), EMBASE (to 3 March 2014) and PsycINFO (to week 4 February 2014). We also searched reference lists of articles, electronic sources of ongoing trials and conference proceedings, and contacted selected researchers active in the area. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials involving the use of medications to reduce the symptoms and signs of cannabis withdrawal or to promote cessation or reduction of cannabis use, or both, in comparison with other medications, placebo or no medication (supportive care) in participants diagnosed as cannabis dependent or who were likely to be dependent. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by The Cochrane Collaboration. Two review authors assessed studies for inclusion and extracted data. All review authors confirmed the inclusion decisions and the overall process. MAIN RESULTS: We included 14 randomised controlled trials involving 958 participants. For 10 studies the average age was 33 years; two studies targeted young people; and age data were not available for two studies. Approximately 80% of study participants were male. The studies were at low risk of selection, performance, detection and selective outcome reporting bias. Three studies were at risk of attrition bias.All studies involved comparison of active medication and placebo. The medications included preparations containing tetrahydrocannabinol (THC) (two studies), selective serotonin reuptake inhibitor (SSRI) antidepressants (two studies), mixed action antidepressants (three studies), anticonvulsants and mood stabilisers (three studies), an atypical antidepressant (two studies), an anxiolytic (one study), a norepinephrine reuptake inhibitor (one study) and a glutamatergic modulator (one study). One study examined more than one medication. Diversity in the medications and the outcomes reported limited the extent that analysis was possible. Insufficient data were available to assess the utility of most of the medications to promote cannabis abstinence at the end of treatment.There was moderate quality evidence that completion of treatment was more likely with preparations containing THC compared to placebo (RR 1.29, 95% CI 1.08 to 1.55; 2 studies, 207 participants, P = 0.006). There was some evidence that treatment with preparations containing THC was associated with reduced cannabis withdrawal symptoms and craving, but this latter outcome could not be quantified. For mixed action antidepressants compared with placebo (2 studies, 179 participants) there was very low quality evidence on the likelihood of abstinence from cannabis at the end of follow-up (RR 0.82, 95% CI 0.12 to 5.41), and moderate quality evidence on the likelihood of treatment completion (RR 0.93, 95% CI 0.71 to 1.21). For this same outcome there was very low quality evidence for the effects of SSRI antidepressants (RR 0.82, 95% CI 0.44 to 1.53; 2 studies, 122 participants), anticonvulsants and mood stabilisers (RR 0.78, 95% CI 0.42 to 1.46; 2 studies, 75 participants), and the atypical antidepressant, bupropion (RR 1.06, 95% CI 0.67 to 1.67; 2 studies, 92 participants). Available evidence on gabapentin (anticonvulsant) and N-acetylcysteine (glutamatergic modulator) was insufficient for quantitative estimates of their effectiveness, but these medications may be worth further investigation. AUTHORS' CONCLUSIONS: There is incomplete evidence for all of the pharmacotherapies investigated, and for many of the outcomes the quality was downgraded due to small sample sizes, inconsistency and risk of attrition bias. The quantitative analyses that were possible, combined with general findings of the studies reviewed, indicate that SSRI antidepressants, mixed action antidepressants, atypical antidepressants (bupropion), anxiolytics (buspirone) and norepinephrine reuptake inhibitors (atomoxetine) are probably of little value in the treatment of cannabis dependence. Preparations containing THC are of potential value but, given the limited evidence, this application of THC preparations should be considered still experimental. Further studies should compare different preparations of THC, dose and duration of treatment, adjunct medications and therapies. The evidence base for the anticonvulsant gabapentin and the glutamatergic modulator N-acetylcysteine is weak, but these medications are also worth further investi

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1002/14651858.cd008940.pub2

Cites

110 of 110 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • SSRIs, mixed-action antidepressants, bupropion, buspirone, and atomoxetine did not demonstrate effects suggesting they would help for CUD treatment.

    “selective serotonin reuptake inhibitor (SSRI) antidepressants, mixed-action antidepressants, atypical antidepressants (bupropion), anxiolytics (buspirone), and norepinephrine reuptake inhibitors (atomoxetine) did not demonstrate effects that would suggest that these medications would help for CUD treatment 50.”

    From Psychosocial and pharmacological interventions for the treatment of cannabis use disorder (2018) · cites this paper as [50]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. Frewen A Montebello ME Baillie A Rea F Effects of mirtazapine on withdrawal from dependent cannabis use 16-21 6 2007 21 Proceedings of the 69th Annual Scientific Meeting of the College on Problems of Drug Dependence Quebec City, Canada MEDLINE: FREWEN2007
  2. Frewen AR An examination of withdrawal symptoms and their relationship with outcomes in a combined behavioural and pharmacological intervention for dependent cannabis users 2009 Thesis (Macquarie University)
  3. Johnston J Lintzeris N McGregor I Allsop DJ Helliwell D Winstock A A double blind, randomised, placebo controlled trial of lithium carbonate for the management of cannabis withdrawal [conference abstract] Drug and Alcohol Review 2013 32 43
  4. Johnston J Lintzeris N McGregor I Guastella A Allsop D Helliwell D Winstock A Preliminary findings from a double blind, randomised, placebo controlled trial of lithium carbonate for the management of cannabis withdrawal [conference abstract] Drug and Alcohol Review 2012 31 45
  5. Haney M Cooper ZD Bedi G Vosburg SK Comer SD Foltin RW Nabilone decreases marijuana withdrawal and a laboratory measure of marijuana relapse Neuropsychopharmacology 2013 38 8 1557 65 DOI: 10.1038/npp.2013.54; MEDLINE: AN 23443718 23443718 PMC3682150 · DOI

Cited by

Sorted by citations

Related

Authors
Marshall, K., Gowing, L., Ali, R., & Le Foll, B.
Affiliations
  • The University of Adelaide (AU)
  • Centre for Addiction and Mental Health ; University of Toronto; Translational Addiction Research Laboratory; 33 Russell Street Toronto ON Canada M5S 2S1
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2014-12-17
Volume
1
Issue
12
Pages
CD008940-CD008940
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd008940.pub2
PMC
PMC4297244
OpenAlex
W1708796529
Cited by
156
References
110
Citations by year
2025: 5 · 2024: 9 · 2023: 9 · 2022: 7 · 2021: 18 · 2020: 10 · 2019: 15 · 2018: 19 · 2017: 24 · 2016: 24 · 2015: 16
FWCI
2.74
Type
journal article
Language
en
Update notices
new_version (2019-01-28)
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • ANU Open Research (Australian National University) (submittedVersion)
Funders
National Institute on Drug Abuse (R21DA031906)
Topics
  • Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
Keywords
cannabis use disorder, pharmacotherapy, cannabis withdrawal, cannabis abstinence, treatment completion, tetrahydrocannabinol, selective serotonin reuptake inhibitors, antiepileptic drugs, mood stabilizers, anxiolytics, norepinephrine reuptake inhibitors, treatment safety
MeSH terms
Adult, Anticonvulsants, Antidepressive Agents, Marijuana Abuse, Female, Humans, Male, Dronabinol, Randomized Controlled Trials as Topic, Selective Serotonin Reuptake Inhibitors

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review