Clinical question
Compared with placebo or no pharmacotherapy (supportive care), how effective are pharmacotherapies for reducing symptoms of cannabis withdrawal and promoting cessation or reduction of cannabis use?
Bottom line
Selective serotonin reuptake inhibitor antidepressants, mixed action antidepressants, atypical antidepressants (bupropion), anxiolytics (buspirone) and noradrenaline reuptake inhibitors (atomoxetine) were of little value in the treatment of cannabis dependence. Tetrahydrocannabinol might be of potential value based on qualitative data from individual studies, though meta‐analyses found no significant effect on treatment outcomes, and THC preparations should be considered to still be experimental. The evidence base for THC, the anticonvulsant gabapentin, the glutamatergic modulator N‐acetylcysteine, and oxytocin was weak, and it was not possible to quantitatively estimate their effectiveness. At this point in time, psychological approaches, such as motivational enhancement therapy and cognitive behavioural therapy, remain the mainstay of treatment for cannabis use disorders.
Caveat
The quality of evidence for many of the outcomes was low or very low due to small sample size, inconsistency and risk of attrition bias. Quantitative analysis was not possible for most of the outcomes and was limited for most of the pharmacotherapies investigated.
Context
Cannabis use is relatively common and widespread worldwide. Demand by cannabis users for treatment has been increasing in most regions of the world. Moves in some countries to decriminalise or legalise cannabis use is likely to result in this trend continuing. Currently there are no medicines specifically for the treatment of cannabis use.
Cochrane Systematic Review
Nielsen S et al. Pharmacotherapies for cannabis dependence. Cochrane Reviews, 2019, Issue 1. Art. No.: CD008940. DOI: 10.1002/14651858.CD008940.pub3. This review contains 8 reviews involving 21 studies and 1755 participants.
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