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Murphy JG, Dennhardt AA, Utzelmann B, Borsari B, Ladd BO, Martens MP, White HR, Yurasek AM, Campbell KW, Witkiewitz K. A pilot trial of a brief intervention for cannabis use supplemented with a substance-free activity session or relaxation training. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2024; 38:255-268. [PMID: 38271079 PMCID: PMC11065625 DOI: 10.1037/adb0000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVE Cannabis use is increasing among college students and commonly co-occurs with anxiety symptoms in this age group. Interventions that reduce anxiety may also reduce cannabis use. Behavioral economic theory suggests that substance use reductions are most likely when there is an increase in substance-free reinforcement. This randomized pilot trial evaluated the efficacy of a brief motivational intervention (BMI) for cannabis supplemented by either a substance-free activity session (SFAS) or a relaxation training (RT) session for reducing cannabis use, problems, craving, and anxiety symptoms. METHOD One hundred thirty-two college students (Mage = 19.9; 54% female; 67% White, 31% Black) who reported five or more past-month cannabis use days were randomized to: (a) assessment-only (AO); (b) BMI plus SFAS; or (c) BMI plus RT. Participants in the BMI conditions received two individual counselor-administered sessions plus a brief phone booster session. Outcomes were evaluated 1- and 6-months postintervention. RESULTS Relative to assessment, both BMI + SFAS and BMI + RT were associated with significant reductions in cannabis problems and craving at 1-month follow-up, and significant reductions in anxiety at 6-month follow-up. Relative to AO, BMI + RT was associated with significant reductions in cannabis use at 1-month follow-up. There were no differences between BMI conditions. CONCLUSIONS This pilot trial was not adequately powered to conclusively evaluate relative efficacy but provides preliminary support for the short-term efficacy of both two-session interventions for reducing anxiety and cannabis-related risk among nontreatment seeking emerging adults. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- James G. Murphy
- Department of Psychology, University of Memphis, 400 Innovation Dr., Memphis, TN, 38152 United States
| | - Ashley A. Dennhardt
- Department of Psychology, University of Memphis, 400 Innovation Dr., Memphis, TN, 38152 United States
| | - Bettina Utzelmann
- Department of Psychology, University of Memphis, 400 Innovation Dr., Memphis, TN, 38152 United States
| | - Brian Borsari
- Mental Health Service (116B) San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA 94121, United States
- Department of Psychiatry and Behavioral Sciences, University of California – San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States
| | - Benjamin O. Ladd
- Department of Psychology, Washington State University Vancouver, 14204 NE Salmon Creek Ave, Vancouver, WA 98686-9600, United States
| | - Matthew P. Martens
- College of Education, University of Missouri, 118D Hill Hall, Columbia, MO 65211, United States
| | - Helene R. White
- Center of Alcohol and Substance Studies, Rutgers, the State University of New Jersey, 607 Allison Road, Piscataway, NJ 08854, United States
| | - Ali M. Yurasek
- Department of Health Education and Behavior, University of Florida, FLG16, Gainesville, FL 32611, United States
| | - Kevin W. Campbell
- Department of Psychology, University of Memphis, 400 Innovation Dr., Memphis, TN, 38152 United States
| | - Katie Witkiewitz
- Department of Psychology, Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale SE, Albuquerque, NM 87131, United States
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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.
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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
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3
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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.
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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
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Bilbao A, Spanagel R. Medical cannabinoids: a pharmacology-based systematic review and meta-analysis for all relevant medical indications. BMC Med 2022; 20:259. [PMID: 35982439 PMCID: PMC9389720 DOI: 10.1186/s12916-022-02459-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/01/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Medical cannabinoids differ in their pharmacology and may have different treatment effects. We aimed to conduct a pharmacology-based systematic review (SR) and meta-analyses of medical cannabinoids for efficacy, retention and adverse events. METHODS We systematically reviewed (registered at PROSPERO: CRD42021229932) eight databases for randomized controlled trials (RCTs) of dronabinol, nabilone, cannabidiol and nabiximols for chronic pain, spasticity, nausea /vomiting, appetite, ALS, irritable bowel syndrome, MS, Chorea Huntington, epilepsy, dystonia, Parkinsonism, glaucoma, ADHD, anorexia nervosa, anxiety, dementia, depression, schizophrenia, PTSD, sleeping disorders, SUD and Tourette. Main outcomes and measures included patient-relevant/disease-specific outcomes, retention and adverse events. Data were calculated as standardized mean difference (SMD) and ORs with confidence intervals (CI) via random effects. Evidence quality was assessed by the Cochrane Risk of Bias and GRADE tools. RESULTS In total, 152 RCTs (12,123 participants) were analysed according to the type of the cannabinoid, outcome and comparator used, resulting in 84 comparisons. Significant therapeutic effects of medical cannabinoids show a large variability in the grade of evidence that depends on the type of cannabinoid. CBD has a significant therapeutic effect for epilepsy (SMD - 0.5[CI - 0.62, - 0.38] high grade) and Parkinsonism (- 0.41[CI - 0.75, - 0.08] moderate grade). There is moderate evidence for dronabinol for chronic pain (- 0.31[CI - 0.46, - 0.15]), appetite (- 0.51[CI - 0.87, - 0.15]) and Tourette (- 1.01[CI - 1.58, - 0.44]) and moderate evidence for nabiximols on chronic pain (- 0.25[- 0.37, - 0.14]), spasticity (- 0.36[CI - 0.54, - 0.19]), sleep (- 0.24[CI - 0.35, - 0.14]) and SUDs (- 0.48[CI - 0.92, - 0.04]). All other significant therapeutic effects have either low, very low, or even no grade of evidence. Cannabinoids produce different adverse events, and there is low to moderate grade of evidence for this conclusion depending on the type of cannabinoid. CONCLUSIONS Cannabinoids are effective therapeutics for several medical indications if their specific pharmacological properties are considered. We suggest that future systematic studies in the cannabinoid field should be based upon their specific pharmacology.
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Affiliation(s)
- Ainhoa Bilbao
- Behavioral Genetics Research Group, Central Institute of Mental Health, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Rainer Spanagel
- Institute of Psychopharmacology, Central Institute of Mental Health, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
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McRae-Clark AL, Gray KM, Baker NL, Sherman BJ, Squeglia L, Sahlem GL, Wagner A, Tomko R. Varenicline as a treatment for cannabis use disorder: A placebo-controlled pilot trial. Drug Alcohol Depend 2021; 229:109111. [PMID: 34655945 PMCID: PMC8665036 DOI: 10.1016/j.drugalcdep.2021.109111] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND An efficacious pharmacotherapy for cannabis use disorder (CUD) has yet to be established. This study preliminarily evaluated the safety and efficacy of varenicline for CUD in a proof-of-concept clinical trial. METHODS Participants in this 6-week randomized, placebo-controlled pilot trial received either varenicline (n = 35) or placebo (n = 37), added to a brief motivational enhancement therapy intervention. Outcomes included cannabis withdrawal, cannabis abstinence, urine cannabinoid levels, percent cannabis use days, and cannabis sessions per day. RESULTS Both treatment groups noted significant decreases in self-reported cannabis withdrawal, percentage of days used, and use sessions per day during treatment compared to baseline. While this pilot trial was not powered to detect statistically significant between-group differences, participants randomized to varenicline evidenced numerically greater rates of self-reported abstinence at the final study visit [Week 6 intent-to-treat (ITT): Varenicline: 17.1% vs. Placebo: 5.4%; RR = 3.2 (95% CI: 0.7,14.7)]. End-of-treatment urine creatinine corrected cannabinoid levels were numerically lower in the varenicline group and higher in the placebo group compared to baseline [Change from baseline: Varenicline -1.7 ng/mg (95% CI: -4.1,0.8) vs. Placebo: 1.9 ng/mg (95% CI: -0.4,4.3); Δ = 3.5 (95% CI: 0.1,6.9)]. Adverse events related to study treatment did not reveal new safety signals. CONCLUSIONS Findings support the feasibility of conducting clinical trials of varenicline as a candidate pharmacotherapy for CUD, and indicate that a full-scale efficacy trial, powered based on effect sizes and variability yielded in this study, is warranted.
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Affiliation(s)
- Aimee L. McRae-Clark
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC,Ralph H. Johnson VA Medical Center, Charleston, SC
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Nathaniel L. Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Brian J. Sherman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Lindsay Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | | | - Amanda Wagner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Rachel Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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Breindahl T, Kimergård A, Leutscher PDC, Hindersson P. Implementation of Mathematical Models to Predict New Cannabis Use by Urine Drug Testing: It Is Time to Move Forward. J Anal Toxicol 2021; 45:e15-e19. [PMID: 33876828 PMCID: PMC8272527 DOI: 10.1093/jat/bkab037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/08/2021] [Accepted: 04/19/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Torben Breindahl
- Department Clinical Biochemistry, North Denmark Regional Hospital, DK-9800 Hjørring, Denmark
| | - Andreas Kimergård
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB London, UK
| | - Peter D C Leutscher
- Centre for Clinical Research, North Denmark Regional Hospital, DK-9800 Hjørring, Denmark.,Department of Clinical Medicine, Aalborg University, DK-9100 Aalborg, Denmark
| | - Peter Hindersson
- Department Clinical Biochemistry, North Denmark Regional Hospital, DK-9800 Hjørring, Denmark
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Spanagel R, Bilbao A. Approved cannabinoids for medical purposes - Comparative systematic review and meta-analysis for sleep and appetite. Neuropharmacology 2021; 196:108680. [PMID: 34181977 DOI: 10.1016/j.neuropharm.2021.108680] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Cannabinoids are used for numerous disease indications. However, cannabinoids can also produce adverse effects; for example, they can disturb physiological functions such as sleep and appetite. The medical use of cannabinoids refers to a wide variety of preparations and products. Approved cannabinoid products include dronabinol ((-)-trans-Δ9-tetrahydrocannabinol (THC), nabilone (a THC analogue), and cannabidiol (CBD) that differ in their pharmacology and may thus have different adverse effects on sleep and appetite. OBJECTIVES Here we ask if (i) cannabinoids decrease sleep and appetite in somatic patients or patients that suffer from mental illness and if (ii) there is a difference between THC products (nabilone, dronabinol), vs. CBD in disturbing these physiological functions. METHODS In order to answer these two questions, we performed a comparative systematic review (SR) for nabilone, dronabinol, and CBD. For the comparative SR we searched PubMed, Medline, Embase, and PsycINFO for randomized controlled trials (RCTs) and extracted information for adverse side effects or outcomes reporting a negative impact on sleep and appetite. RCT evidence was calculated as odds ratios (ORs) via fixed effects meta-analyses. Evidence quality was assessed by the Cochrane Risk of Bias and GRADE tools. This study is registered at PROSPERO (CRD42021229932). FINDINGS A total of 17 RCTs (n = 1479) and 15 RCTs (n = 1974) were included for sleep and appetite, respectively. Pharmaceutical THC (nabilone, dronabinol) does not affect sleep or appetite. In contrast, there is moderate evidence that CBD decreases appetite (OR = 2.46 [1.74:4.01] but has also no effect on sleep. INTERPRETATIONS Our comparative systematic study shows that approved cannabinoids can decrease appetite as a negative side effect - an effect that seems to be driven by CBD. Approved cannabinoid products do not negatively affect sleep in somatic and psychiatric patients. This article is part of the special Issue on "Cannabinoids".
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Affiliation(s)
- Rainer Spanagel
- Institute of Psychopharmacology, Central Institute of Mental Health, Faculty of Medicine Mannheim, University of Heidelberg, Germany.
| | - Ainhoa Bilbao
- Behavioral Genetics Research Group, Central Institute of Mental Health, Germany.
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Moral J, Hundl C, Lee D, Neuman M, Grimaldi A, Cuellar M, Stout P. Erratum To: Implementation of a Blind Quality Control Program in Blood Alcohol Analysis. J Anal Toxicol 2021; 45:e15. [PMID: 33792720 DOI: 10.1093/jat/bkab031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/31/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jackeline Moral
- Houston Forensic Science Center, 500 Jefferson Street, 13th Floor, Houston, TX 77002, USA
| | - Callan Hundl
- Houston Forensic Science Center, 500 Jefferson Street, 13th Floor, Houston, TX 77002, USA
| | - Dayong Lee
- Houston Forensic Science Center, 500 Jefferson Street, 13th Floor, Houston, TX 77002, USA
| | - Maddisen Neuman
- Houston Forensic Science Center, 500 Jefferson Street, 13th Floor, Houston, TX 77002, USA.,Center for Statistics and Applications in Forensic Evidence (CSAFE), 613 Morrill Road, Ames, IA 50011, USA
| | - Aimee Grimaldi
- Houston Forensic Science Center, 500 Jefferson Street, 13th Floor, Houston, TX 77002, USA
| | - Maria Cuellar
- University of Pennsylvania, Philadelphia, McNeil Office 554, 3718 Locust Walk, Philadelphia, PA 19104, USA
| | - Peter Stout
- Houston Forensic Science Center, 500 Jefferson Street, 13th Floor, Houston, TX 77002, USA
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Lintzeris N, Mills L, Dunlop A, Copeland J, Mcgregor I, Bruno R, Kirby A, Montebello M, Hall M, Jefferies M, Kevin R, Bhardwaj A. Cannabis use in patients 3 months after ceasing nabiximols for the treatment of cannabis dependence: Results from a placebo-controlled randomised trial. Drug Alcohol Depend 2020; 215:108220. [PMID: 32768992 DOI: 10.1016/j.drugalcdep.2020.108220] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/29/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND AIMS Previous studies suggest cannabinoid agonist treatment is effective in reducing cannabis use in dependent treatment seekers, however few studies have reported on post-treatment outcomes. We examine cannabis use outcomes 12 weeks after cessation of treatment from a randomised placebo-controlled trial of nabiximols for the treatment of cannabis dependence. METHOD 128 participants received either nabiximols (n = 61) or placebo (n = 67) for 12 weeks, in combination with psychosocial interventions. Self-reported number of days of cannabis use in the previous 28 days was measured at baseline, 4, 8, and 12 weeks (end of treatment) and again at 24 weeks (3 months after treatment ceased). Urinalysis was used to confirm self-report data at Week 24 interview. RESULTS A factorial mixed-effects model for repeated measures regression revealed that the nabiximols group used cannabis on 6.8 fewer days in the previous 28 days at week 12 (end of treatment) than the placebo group (p = 0.002, CI: 2.1,11.4), and 6.7 fewer days in the previous 28 days at the week-24 follow-up than the placebo group (p = 0.006, CI: 1.4,12.1). A significantly higher proportion of the nabiximols group (14/61; 23 %) than the placebo group (6/67; 9%) reported abstinence from cannabis in the previous 28 days at the week-24 research interview OR=3.0, CI: 1.1, 9.1; p=0.035, NNT=8, CI: 4, 71). DISCUSSIONS AND CONCLUSIONS The benefits of treatment incorporating nabiximols with psychosocial interventions in reducing cannabis use appears to persist for up to 3 months after the cessation of treatment. A stepped care model of treatment is proposed. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12616000103460) https://www.anzctr.org.au.
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Affiliation(s)
- Nicholas Lintzeris
- Drug and Alcohol Services, South East Sydney Local Health District, NSW, Australia; Division Addiction Medicine, Faculty Medicine and Health, University of Sydney, NSW, Australia; NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Australia.
| | - Llewellyn Mills
- Drug and Alcohol Services, South East Sydney Local Health District, NSW, Australia; Division Addiction Medicine, Faculty Medicine and Health, University of Sydney, NSW, Australia; NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Australia
| | - Adrian Dunlop
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Australia; Drug and Alcohol Services, Hunter New England Local Health District, NSW, Australia; Priority Research Centre for Brain and Mental Health, School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | | | - Iain Mcgregor
- Lambert Initiative Cannabinoid Therapeutics, University of Sydney, NSW, Australia
| | | | - Adrienne Kirby
- National Health and Medical Research Council, Clinical Trials Centre, Faculty Medicine and Public Health, University of Sydney, NSW, Australia
| | - Mark Montebello
- Drug and Alcohol Services, South East Sydney Local Health District, NSW, Australia; Division Addiction Medicine, Faculty Medicine and Health, University of Sydney, NSW, Australia; NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Australia; University of New South Wales, NSW, Australia
| | - Michelle Hall
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Australia; Drug and Alcohol Services, Hunter New England Local Health District, NSW, Australia
| | - Meryem Jefferies
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Australia; Drug Health, Western Sydney Local Health District, NSW, Australia
| | - Richard Kevin
- Lambert Initiative Cannabinoid Therapeutics, University of Sydney, NSW, Australia
| | - Anjali Bhardwaj
- Drug and Alcohol Services, South East Sydney Local Health District, NSW, Australia; Division Addiction Medicine, Faculty Medicine and Health, University of Sydney, NSW, Australia; National Health and Medical Research Council, Clinical Trials Centre, Faculty Medicine and Public Health, University of Sydney, NSW, Australia
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Tomko RL, Gray KM, Huestis MA, Squeglia LM, Baker NL, McClure EA. Measuring Within-Individual Cannabis Reduction in Clinical Trials: A Review of the Methodological Challenges. CURRENT ADDICTION REPORTS 2019; 6:429-436. [PMID: 32133273 DOI: 10.1007/s40429-019-00290-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose Cannabis abstinence traditionally is the primary outcome in cannabis use disorder (CUD) treatment trials. Due to the changing legality of cannabis, patient goals, and preliminary evidence that suggests individuals who reduce their cannabis use may show functional improvements, cannabis reduction is a desirable alternative outcome in CUD trials. We review challenges in measuring cannabis reduction and the evidence to support various definitions of reduction. Findings Reduction in number of cannabis use days was associated with improvements in functioning across several studies. Reductions in quantity of cannabis used was inconsistently associated with improvements in functioning, though definitions of quantity varied across studies. Different biomarkers may be used depending on the reduction outcome. Conclusions Biologically-confirmed reductions in frequency of cannabis use days may represent a viable endpoint in clinical trials for cannabis use disorder. Additional research is needed to better quantify reduction in cannabis amounts.
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Affiliation(s)
- Rachel L Tomko
- Department of Psychiatry and Behavioral Sciences, Medical university of South Carolina
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical university of South Carolina
| | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University
| | - Lindsay M Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical university of South Carolina
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, Medical university of South Carolina
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Lintzeris N, Bhardwaj A, Mills L, Dunlop A, Copeland J, McGregor I, Bruno R, Gugusheff J, Phung N, Montebello M, Chan T, Kirby A, Hall M, Jefferies M, Luksza J, Shanahan M, Kevin R, Allsop D. Nabiximols for the Treatment of Cannabis Dependence: A Randomized Clinical Trial. JAMA Intern Med 2019; 179:1242-1253. [PMID: 31305874 PMCID: PMC6632121 DOI: 10.1001/jamainternmed.2019.1993] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/22/2019] [Indexed: 01/28/2023]
Abstract
IMPORTANCE There are no effective medications for treating dependence on cannabis. OBJECTIVE To examine the safety and efficacy of nabiximols in the treatment of patients with cannabis dependence. DESIGN, SETTING, AND PARTICIPANTS This parallel double-blind randomized clinical trial comparing nabiximols with placebo in a 12-week, multisite outpatient study recruited participants from February 3, 2016, to June 14, 2017, at 4 outpatient specialist alcohol and drug treatment services in New South Wales, Australia. Participants had cannabis dependence (as defined by the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision) and were seeking treatment, were nonresponsive to prior treatment attempts, were 18 to 64 years of age, had no other substance use disorder, had no severe medical or psychiatric conditions, were not pregnant, were not mandated by a court to undergo treatment, and provided informed consent. Results for primary efficacy measures and all secondary outcomes were obtained using a modified intention-to-treat data set. INTERVENTIONS Participants received 12-week treatment involving weekly clinical reviews, structured counseling, and flexible medication doses-up to 32 sprays daily (tetrahydrocannabinol, 86.4 mg, and cannabidiol, 80 mg), dispensed weekly. MAIN OUTCOMES AND MEASURES Primary outcome was self-reported number of days using illicit cannabis during the 12-week period. Other outcomes included alternate cannabis use parameters (periods of abstinence, withdrawal, cravings, and problems), safety parameters (adverse events and aberrant medication use), health status, other substance use, and treatment retention. RESULTS A total of 128 participants (30 women and 98 men; mean [SD] age, 35.0 [10.9] years) were randomized and received at least 1 dose of study medication. Participants had used a mean (SD) of 2.3 (2.1) g of cannabis on a mean (SD) of 25.7 (4.5) days in the past 28 days. Treatment retention was comparable for the 2 groups (placebo, 30 of 67 participants [44.8%]; nabiximols, 30 of 61 participants [49.2%]), and both groups used similar mean (SD) doses (placebo, 18.5 [9.5] sprays daily; nabiximols, 17.6 [9.5] sprays daily, equivalent to a mean [SD] of 47.5 [25.7] mg of tetrahydrocannabinol and 44.0 [23.8] mg of cannabidiol). For the primary end point, the placebo group reported significantly more days using cannabis during the 12 weeks (mean [SD], 53.1 [33.0] days) than the nabiximols group (mean [SD], 35.0 [32.4] days; estimated difference, 18.6 days; 95% CI, 3.5-33.7 days; P = .02). Both groups showed comparable improvements in health status, with no substantial changes in other substance use. Medication was well tolerated with few adverse events. CONCLUSIONS AND RELEVANCE This study demonstrates that cannabinoid agonist treatment, in this case using nabiximols, in combination with psychosocial interventions is a safe approach for reducing cannabis use among individuals with cannabis dependence who are seeking treatment. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12616000103460.
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Affiliation(s)
- Nicholas Lintzeris
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, New South Wales, Australia
- Discipline Addiction Medicine, Faculty Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anjali Bhardwaj
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, New South Wales, Australia
- Discipline Addiction Medicine, Faculty Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Llewellyn Mills
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, New South Wales, Australia
- Discipline Addiction Medicine, Faculty Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Adrian Dunlop
- Drug and Alcohol Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Priority Research Centre for Brain and Mental Health, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jan Copeland
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Iain McGregor
- Lambert Initiative Cannabinoid Therapeutics, University of Sydney, Sydney, New South Wales, Australia
| | - Raimondo Bruno
- School of Psychology, University of Tasmania, Hobart, Tasmania, Australia
| | - Jessica Gugusheff
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, New South Wales, Australia
- Discipline Addiction Medicine, Faculty Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nghi Phung
- Drug Health, Western Sydney Local Health District, Parramatta, New South Wales, Australia
| | - Mark Montebello
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, New South Wales, Australia
| | - Therese Chan
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, New South Wales, Australia
| | - Adrienne Kirby
- National Health and Medical Research Council, Clinical Trials Centre, Faculty of Medicine and Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Michelle Hall
- Drug and Alcohol Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Meryem Jefferies
- Drug Health, Western Sydney Local Health District, Parramatta, New South Wales, Australia
| | - Jennifer Luksza
- Drug Health, Western Sydney Local Health District, Parramatta, New South Wales, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard Kevin
- Drug and Alcohol Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - David Allsop
- Lambert Initiative Cannabinoid Therapeutics, University of Sydney, Sydney, New South Wales, Australia
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Tomko RL, McClure EA, Squeglia LM, Treloar Padovano H, McRae-Clark AL, Baker NL, Carpenter MJ, Gray KM. Methods to reduce the incidence of false negative trial results in substance use treatment research. Curr Opin Psychol 2019; 30:35-41. [PMID: 30798020 DOI: 10.1016/j.copsyc.2019.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/10/2019] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
Abstract
Treatment development and evaluation for substance use disorders are hindered when randomized controlled trials fail to show a treatment effect when one exists. This manuscript provides an overview of addressable methodological factors that may contribute to incorrect trial results. The collection of remote, naturalistic, real-time adherence and substance use data through ambulatory assessment methods in everyday life is presented as a partial solution. Other recommendations related to participant recruitment and selection, ensuring adequate consistency/fidelity and dose of treatment, and rigorously assessing clinical outcomes are discussed. With implementation of eligibility criteria verification, treatment adherence monitoring, and remote assessment of substance use and biomarkers, ambulatory assessment may help improve clinical trial success rates by improving precision, increasing reproducibility, and reducing the impact of methodological issues that may lead to inaccurate trial results.
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Affiliation(s)
- Rachel L Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, United States.
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, United States
| | - Lindsay M Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, United States
| | | | - Aimee L McRae-Clark
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, United States
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, United States
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, United States
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, United States
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