Title:Pharmacological Treatment of Cannabis-Related Disorders: A Narrative Review
Volume: 22
Issue: 42
Author(s): David A. Gorelick
Affiliation:
Keywords:
Cannabis, marijuana, cannabis use disorder, comorbidity, pharmacology, treatment, intoxication, withdrawal.
Abstract: Background: Cannabis is the most widely used illicit psychoactive substance
world-wide, yet no medication is approved for the treatment of intoxication, withdrawal, or
cannabis use disorder (CUD).
Objective: To comprehensively review the current state of knowledge.
Method: Search of the PubMed electronic data base and review of reference lists of relevant
articles to identify controlled clinical trials of pharmacological treatment.
Results: The search identified 4 trials for specific intoxication symptoms (none for global
intoxication), 7 trials for withdrawal, and 12 phase II trials for CUD. One or two trials each
suggest that propranolol is effective for some intoxication symptoms, antipsychotics for
cannabis-induced psychosis, and dronabinol (synthetic THC) and gabapentin for cannabis
withdrawal. Of 10 medications and one medication combination studied in 12 trials for
CUD, only two medications were effective (in single trials): gabapentin and Nacetylcysteine
(in adolescents). Not effective were dronabinol and several antidepressants,
anticonvulsants, and antianxiety medications. Three trials of antidepressants for CUD with comorbid depression
gave inconsistent results. A trial of atomoxetine for CUD with comorbid ADHD showed no efficacy. Five trials
of second-generation antipsychotics for CUD with comorbid schizophrenia showed none better than any other.
Conclusion: Further research is needed to confirm the efficacy of gabapentin for withdrawal and gabapentin and
N-acetylcysteine for CUD and to develop new medications for all 3 cannabis-related disorders.
