1
|
Sahlem GL, Kim B, Baker NL, Wong BL, Caruso MA, Campbell LA, Kaloani I, Sherman BJ, Ford TJ, Musleh AH, Kim JP, Williams NR, Manett AJ, Kratter IH, Short EB, Killeen TK, George MS, McRae-Clark AL. A preliminary randomized controlled trial of repetitive transcranial magnetic stimulation applied to the left dorsolateral prefrontal cortex in treatment seeking participants with cannabis use disorder. Drug Alcohol Depend 2024; 254:111035. [PMID: 38043228 PMCID: PMC10837319 DOI: 10.1016/j.drugalcdep.2023.111035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Cannabis use disorder (CUD) is a common and consequential disorder. When applied to the dorsolateral prefrontal cortex (DLPFC), repetitive transcranial magnetic stimulation (rTMS) reduces craving across substance use disorders and may have therapeutic clinical effects when applied in serial-sessions. The present study sought to preliminarily determine whether serial-sessions of rTMS applied to the DLPFC had a therapeutic effect in CUD. METHODS This study was a two-site, phase-2, double-blind, randomized-controlled-trial. Seventy-two treatment-seeking participants (37.5% Women, mean age 30.2±9.9SD) with ≥moderate-CUD were randomized to active or sham rTMS (Beam-F3, 10Hz, 20-total-sessions, two-sessions-per-visit, two-visits-per-week, with cannabis cues) while undergoing a three-session motivational enhancement therapy intervention. The primary outcome was the change in craving between pre- and post- treatment (Marijuana Craving Questionnaire Short-Form-MCQ-SF). Secondary outcomes included the number of weeks of abstinence and the number of days-per-week of cannabis use during 4-weeks of follow-up. RESULTS There were no significant differences in craving between conditions. Participants who received active-rTMS reported numerically, but not significantly, more weeks of abstinence in the follow-up period than those who received sham-rTMS (15.5%-Active; 9.3%-Sham; rate ratio = 1.66 [95% CI: 0.84, 3.28]; p=0.14). Participants who received active-rTMS reported fewer days-per-week of cannabis use over the final two-weeks of the follow-up period than those receiving sham-rTMS (Active vs. Sham: -0.72; Z=-2.33, p=0.02). CONCLUSIONS This trial suggests rTMS is safe and feasible in individuals with CUD and may have a therapeutic effect on frequency of cannabis use, though further study is needed with additional rTMS-sessions and a longer follow-up period.
Collapse
Affiliation(s)
- Gregory L Sahlem
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA.
| | - Bohye Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Nathaniel L Baker
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Brendan L Wong
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Margaret A Caruso
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Lauren A Campbell
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Irakli Kaloani
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Brian J Sherman
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Tiffany J Ford
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Ahmad H Musleh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Jane P Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Nolan R Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Andrew J Manett
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Ian H Kratter
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Edward B Short
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Terese K Killeen
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Mark S George
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Aimee L McRae-Clark
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| |
Collapse
|
2
|
Titus-Lay E, Nehira J, Courtney J, Jee J, Kumar M, Tiet J, Le V, Durbin-Johnson B, Chen MS, Vinall R. A pharmacist-led community-based survey study: Determining the impact of the Covid-19 pandemic on actionable factors associated with worse cancer outcomes and cancer health disparities. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 11:100311. [PMID: 37533758 PMCID: PMC10392607 DOI: 10.1016/j.rcsop.2023.100311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/12/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023] Open
Abstract
Purpose The goals of this cross-sectional community-based survey study were to assess the impact of the Covid-19 pandemic on actionable factors which are known to contribute to worse cancer outcomes, and to determine whether race and ethnicity-based differences exist. Methods A survey study which captured demographic information and changes in cancer outcomes-related factors since the start of the Covid-19 pandemic, was conducted at a public Covid-19 vaccination clinic over a period of 10 days during March 2021. Surveys were administered in multiple languages. Chi-square tests and ANOVA followed by post-hoc Dunnett testing assessed for race and ethnicity-based differences. Results A total of 949 people participated (61.6% participation rate). Ninety-three surveys were removed based on inclusion criteria giving a final participant number of 856. Many participants reported postponing cancer screenings (17.8%) and cancellation of medical appointments (22.8% and 25.8% reported cancelled appointments by providers or themselves, respectively) due to the pandemic. Participants also reported decreased physical activity (44.7%) and increased tobacco and/or marijuana usage (7.0%). Conversely, participants reported consuming more fruits and vegetables (21.4%) and decreasing alcohol consumption (21.4%). Several race-related differences but no ethnicity-related differences were observed. Conclusion Our data can be used to help guide pharmacist-led targeted outreach in our community which will help mitigate Covid-19 pandemic-driven changes in behaviors associated with worse cancer outcomes and exacerbation of cancer health disparities. To our knowledge, this is the first cancer outcomes-related study to be conducted at a public Covid-19 vaccination site and is the first pharmacist-led study in this area.
Collapse
Affiliation(s)
- Erika Titus-Lay
- California Northstate University College of Pharmacy (CNUCOP), Elk Grove, CA 95757, USA
| | - Jeffrey Nehira
- California Northstate University College of Pharmacy (CNUCOP), Elk Grove, CA 95757, USA
| | - Jennifer Courtney
- California Northstate University College of Pharmacy (CNUCOP), Elk Grove, CA 95757, USA
| | - Jacquelyn Jee
- California Northstate University College of Pharmacy (CNUCOP), Elk Grove, CA 95757, USA
| | - Marissa Kumar
- California Northstate University College of Pharmacy (CNUCOP), Elk Grove, CA 95757, USA
| | - Jenny Tiet
- California Northstate University College of Pharmacy (CNUCOP), Elk Grove, CA 95757, USA
| | - Vivi Le
- California Northstate University College of Pharmacy (CNUCOP), Elk Grove, CA 95757, USA
| | - Blythe Durbin-Johnson
- Department of Public Health Sciences, School of Medicine, University of California Davis, One Shields Avenue, Davis, CA 95616, USA
| | - Moon S. Chen
- Division of Hematology and Oncology, UC Davis School of Medicine, Sacramento, CA 95817, USA
| | - Ruth Vinall
- California Northstate University College of Pharmacy (CNUCOP), Elk Grove, CA 95757, USA
| |
Collapse
|
3
|
Sahlem GL, Kim B, Baker NL, Wong BL, Caruso MA, Campbell LA, Kaloani I, Sherman BJ, Ford TJ, Musleh AH, Kim JP, Williams NR, Manett AJ, Kratter IH, Short EB, Killeen TK, George MS, McRae-Clark AL. A Preliminary Investigation Of Repetitive Transcranial Magnetic Stimulation Applied To The Left Dorsolateral Prefrontal Cortex In Treatment Seeking Participants With Cannabis Use Disorder. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.10.23292461. [PMID: 37503294 PMCID: PMC10370231 DOI: 10.1101/2023.07.10.23292461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background Cannabis use disorder (CUD) is a common and consequential disorder. When applied to the dorsolateral prefrontal cortex (DLPFC), repetitive transcranial magnetic stimulation (rTMS) reduces craving across substance use disorders and may have a therapeutic clinical effect when applied in serial sessions. The present study sought to preliminarily determine whether serial sessions of rTMS applied to the DLPFC had a therapeutic effect in CUD. Methods This study was a two-site, phase-2, double-blind, randomized-controlled-trial. Seventy-two treatment-seeking participants (37.5% Women, mean age 30.2±9.9SD) with ≥moderate-CUD were randomized to active or sham rTMS (Beam-F3, 10Hz, 20-total-sessions, with cannabis cues) while undergoing a three-session motivational enhancement therapy intervention. The primary outcome was the change in craving between pre- and post-treatment (Marijuana Craving Questionnaire Short-Form-MCQ-SF). Secondary outcomes included the number of weeks of abstinence and the number of days-per-week of cannabis use during 4-weeks of follow-up. Results There were no significant differences in craving between conditions. Participants who received active rTMS reported numerically, but not significantly, more weeks of abstinence in the follow-up period than those who received sham rTMS (15.5%-Active; 9.3%-Sham; rate ratio = 1.66 [95% CI: 0.84, 3.28]; p=0.14). Participants who received active rTMS reported fewer days-per-week of cannabis use over the final two-weeks of the follow-up period (Active vs. Sham: -0.72; Z=-2.33, p=0.02). Conclusions This trial suggests rTMS is safe and feasible in individuals with CUD and may have a therapeutic effect on frequency of cannabis use, though further study is needed with additional rTMS-sessions and a longer follow-up period.
Collapse
Affiliation(s)
- Gregory L. Sahlem
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Bohye Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Nathaniel L. Baker
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brendan L. Wong
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Margaret A. Caruso
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lauren A. Campbell
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Irakli Kaloani
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Brian J. Sherman
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Tiffany J. Ford
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Ahmad H. Musleh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Jane P. Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Nolan R. Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Andrew J. Manett
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ian H. Kratter
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Edward B. Short
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Terese K. Killeen
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mark S. George
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina, USA
| | - Aimee L. McRae-Clark
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina, USA
| |
Collapse
|