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Levin FR, Mariani JJ, Choi CJ, Basaraba C, Brooks DJ, Brezing CA, Pavlicova M. Non-abstinent treatment outcomes for cannabis use disorder. Drug Alcohol Depend 2021; 225:108765. [PMID: 34087745 PMCID: PMC8282674 DOI: 10.1016/j.drugalcdep.2021.108765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Abstinence remains a standard outcome for potential treatment interventions for Cannabis Use Disorder (CUD). However, there needs to be validation of non-abstinent outcomes. This study explores reductions in self-reported days of use as another viable outcome measure using data from three completed randomized placebo-controlled clinical trials of pharmacological interventions for CUD. METHODS The three trials tested the effect of quetiapine (QTP, n = 113); dronabinol (DRO, n = 156); and lofexidine + dronabinol (LFD, n = 122). Self-reported cannabis use was categorized into three use-groups/week: heavy (5-7 days/week), moderate (2-4 days/week) and light use (0-1 days/week). Multinomial logistic regressions analyzed the treatment by time effect on the likelihood of light and moderate use compared to heavy use in each study. RESULTS Across the three trials, there was no significant overall time-by-treatment interaction (QTP: p = .06; DRO: p = .15; LFD: p = .21). However, the odds of moderate compared to heavy use were significantly higher in treatment than in placebo groups starting around the midpoint of each trial. No treatment differences were found between the odds of light compared to heavy use. CONCLUSIONS While study-end abstinence rates have been a standard treatment outcome for CUD trials, reduction from heavy to moderate use has not been standardly assessed. During the last several weeks of each trial, those on active medication were more likely to move from heavy to moderate use, which suggests that certain medications may be more impactful than previously assessed. Future studies should determine if this pattern is associated with less CUD severity and/or improved quality of life.
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Affiliation(s)
- Frances R. Levin
- New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, New York, NY 10032 USA,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032 USA,Address correspondence to: Frances R. Levin, M.D., 1051 Riverside Drive, Unit 66, New York, New York 10032 USA, Telephone: (646) 774-6137 FAX: (212) 543-6018,
| | - John J. Mariani
- New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, New York, NY 10032 USA,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032 USA
| | - C. Jean Choi
- New York State Psychiatric Institute, Division of Mental Health Data Science, 1051 Riverside Drive, New York, NY 10032 USA
| | - Cale Basaraba
- New York State Psychiatric Institute, Division of Mental Health Data Science, 1051 Riverside Drive, New York, NY 10032 USA
| | - Daniel J. Brooks
- New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, New York, NY 10032 USA
| | - Christina A. Brezing
- New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, New York, NY 10032 USA,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032 USA
| | - Martina Pavlicova
- Department of Biostatistics, Columbia University, 722 West 168th Street, New York, NY 10032 USA
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Skryabin VY, Vinnikova MA, Ezhkova EV, Titkov MS, Bulatova RA. Atypical antipsychotics in the treatment of patients with a dual diagnosis of schizophrenia spectrum disorders and substance use disorders: the results of a randomized comparative study. J Addict Dis 2021; 39:513-525. [PMID: 33832406 DOI: 10.1080/10550887.2021.1905589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The article presents the results of a randomized comparative study of Aripiprazole and Quetiapine in the treatment of patients with a dual diagnosis: schizophrenia and substance use disorders. During the study, 90 of the 266 male patients were screened. Among them, 54 individuals (60%) had a previously established diagnosis of mental disorder and 36 patients (40%) had no established psychiatric diagnosis. They were randomly randomized into three groups of 30 patients, each receiving an antipsychotic: Aripiprazole at a dose of up to 20 mg daily, Quetiapine at a dose of up to 600 mg daily, or Haloperidol at a dose of up to 30 mg daily. The efficacy of Aripiprazole and Quetiapine was evaluated using the following scales: PANSS, BPRS, VAS, and Substance Craving Scale (SCS). Drug safety was assessed by the development of adverse events, serious adverse events, or adverse reactions. Study results demonstrated the efficacy of atypical antipsychotics in the three groups. Analysis of independent variables showed significant differences between Aripiprazole and Haloperidol in PANSS and BPRS scores by Visit 4, in VAS scores by Visit 3, and in SCS scores by Visit 2. Intergroup analysis of independent variables showed significant differences between Quetiapine and Haloperidol in PANSS, VAS, and SCS scores by Visit 4. Intergroup analysis of independent variables showed significant differences between Aripiprazole and Quetiapine in the VAS and SCS scores. The correlation analysis allowed drawing conclusions about the close connection of the symptoms of schizophrenia and substance use disorders in patients with a dual diagnosis.
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Affiliation(s)
- V Yu Skryabin
- Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - M A Vinnikova
- Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia.,Scientific Department, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - E V Ezhkova
- Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - M S Titkov
- Psychiatry and Psychotherapy Division, European Medical Centre, Moscow, Russia
| | - R A Bulatova
- Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
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Mariani JJ, Pavlicova M, Jean Choi C, Basaraba C, Carpenter KM, Mahony AL, Brooks DJ, Bisaga A, Naqvi N, Nunes EV, Levin FR. Quetiapine treatment for cannabis use disorder. Drug Alcohol Depend 2021; 218:108366. [PMID: 33153828 DOI: 10.1016/j.drugalcdep.2020.108366] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/31/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
BACKROUND Pharmacotherapy for cannabis use disorder (CUD) is an important unmet public health need. METHODS In a 12-week randomized double-blind placebo-controlled trial, the efficacy of quetiapine (300 mg nightly) for the treatment of CUD was tested in 130 outpatients. Weekly cannabis use was categorized into three groups: heavy use (5-7 days), moderate use (2-4 days) and light use (0-1 days). RESULTS At baseline both groups were considered heavy users (using days per week: median = 7.0; interquartile range (IQR): 6.5-7.0; daily dollar value: median = $121.4; IQR: 73.8-206.3). The week-by-treatment interaction was marginally significant (χ2(2) = 5.56, P = .06). With each week, the odds of moderate compared to heavy use significantly increased in the quetiapine group (OR=1.17, P < .0001), but not significantly in the placebo group (OR=1.05, P = .16). The odds of light versus heavy use did not significantly differ over time (P = .12). Treatment was also associated with reduced cannabis withdrawal symptoms by 10.4% each week (95% CI: 8.9-11.8). No serious adverse events occurred during the study and no evidence of development of a movement disorder was detected. Adverse effects were not significantly different between the quetiapine and placebo treatment arms. CONCLUSIONS The use of quetiapine to treat CUD was associated with an increased likelihood of heavy frequency use transitioning to moderate use, but not light use. The clinical significance of reductions in cannabis use, short of abstinence warrants further study.
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Affiliation(s)
- John J Mariani
- New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, New York, NY, 10032, USA; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th Street, New York, NY, 10032, USA.
| | - Martina Pavlicova
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th Street, New York, NY, 10032, USA
| | - C Jean Choi
- New York State Psychiatric Institute, Division of Mental Health Data Science, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Cale Basaraba
- New York State Psychiatric Institute, Division of Mental Health Data Science, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Kenneth M Carpenter
- New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, New York, NY, 10032, USA; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th Street, New York, NY, 10032, USA
| | - Amy L Mahony
- New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Daniel J Brooks
- New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Adam Bisaga
- New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, New York, NY, 10032, USA; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th Street, New York, NY, 10032, USA
| | - Nasir Naqvi
- New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, New York, NY, 10032, USA; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th Street, New York, NY, 10032, USA
| | - Edward V Nunes
- New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, New York, NY, 10032, USA; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th Street, New York, NY, 10032, USA
| | - Frances R Levin
- New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, New York, NY, 10032, USA; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th Street, New York, NY, 10032, USA
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Ivanets NN, Vinnikova MA, Ezhkova EV, Titkov MS, Bulatova RA. [Aripiprazole and quetiapine in the treatment of patients with 'dual diagnosis' of schizophrenia and drug addiction]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 119:52-61. [PMID: 31626219 DOI: 10.17116/jnevro201911909152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIM The randomized comparative study of aripiprazole and quetiapine in the treatment of patients with 'dual diagnosis' of schizophrenia and drug addiction. MATERIAL AND METHODS Intra-group analysis of dependent variables on the scales PANSS, BPRS, VAS, SACS showed significant differences in the dinamics of the therapy in all groups. A comparative randomized study included 90 men admitted to an inpatient addiction unit. Of these, 54 (60%) had a previously established psychiatric diagnosis and 36 patients (40%) did not have an established psychiatric diagnosis. They were randomized into 3 groups of 30 patients each: group 1 received aripiprazole at a dose of up to 20 mg/day, group 2 received quetiapine at a dose of up to 600 mg/day and group 3 (controls) was treated with haloperidol at a dose of up to 30 mg/day. Treatment duration was 21 days. The efficacy of aripiprazole and quetiapine was evaluated with PANSS, BPRS, VAS and SACS on 10th, 14th and 21st day (visits 2-4). Drug safety was evaluated by recording adverse events or side-effects. RESULTS AND CONCLUSION An analysis of independent variables showed significant differences between aripiprazole and haloperidol in PANSS and BPRS scores at visit 4, in VAS scores at visit 3, and in SACS scores at visit 2. An intergroup analysis of independent variables showed significant differences between quetiapine and haloperidol in PANSS, VAS and SACS scores at visit 4 and between aripiprazole and quetiapine in VAS and SACS scores. According to the results of the correlation analisys it has been concluded that presenting features of schizophrenia are closely correlated with drug addiction (craving).
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Affiliation(s)
- N N Ivanets
- Sechenov First Moscow State Medical University of the Russian Federation Moscow, Russia
| | - M A Vinnikova
- Sechenov First Moscow State Medical University of the Russian Federation Moscow, Russia; Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - E V Ezhkova
- Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - M S Titkov
- European Medicine Centre, Moscow, Russia
| | - R A Bulatova
- Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
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Aldemir E, Berk G, Coşkunol H. The Effects of the Addiction Programme of Probation on Treatment Motivation, Abstinence and Quality of Life: a Comparative Study with Motivational Interviewing and Individual Intervention. ACTA ACUST UNITED AC 2018; 55:261-270. [PMID: 30224874 DOI: 10.5152/npa.2017.19440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 06/12/2017] [Indexed: 11/22/2022]
Abstract
Introduction The aim of this study is to evaluate the effectiveness of Addiction Programme of Probation (APP) created by the Substance Abuse Treatment Commission of Ministry of Health. Methods The sample was consisted of probationers who were referred to Ege University by probation offices in February 2010. Literate probationers aged above 18, who fulfilled the SCID-I criteria for substance dependence, or had positive urine sample for illegal drugs were included. The probationers were allocated respectively to three treatment groups: APP (n=28); Motivational Interviewing (MI; n=30); Individual Intervention (II; n=30). The effectiveness of the treatment modalities was assessed by the State Anxiety Inventory; the WHO Quality of Life-Brief form; the Treatment Motivation Questionnaire. Visual analogue and Likert-type scales were used to assess the sense of the importance and the readiness of quitting drugs also the levels of craving. Urine toxicological analyses were performed fortnightly. Results The APP increased the readiness of quitting drugs. The MI increased both the sense of importance and readiness of quitting drugs, decreased the frequency and severity of craving. The II improved the mental and physical health, increased the confidence in treatment also readiness of quitting drugs. Additionally, II decreased the level of anxiety, the severity, frequency and duration of craving. There was a significant decrease in positive urine samples of all groups. Conclusion Because of changing only "the level of being ready to quit substance abuse", APP is considered as an inadequate program compared with MI and II.
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Affiliation(s)
- Ebru Aldemir
- Ege University Institute on Drug Abuse, Toxicology and Pharmaceutical Science, İzmir, Turkey
| | - Güneş Berk
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridgeshire, England
| | - Hakan Coşkunol
- Department of Psychiatry, Ege University Faculty of Medicine, İzmir, Turkey
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6
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Aldemir E, Berk G, Coşkunol H. The Effects of the Addiction Programme of Probation on Treatment Motivation, Abstinence and Quality of Life: a Comparative Study with Motivational Interviewing and Individual Intervention. Noro Psikiyatr Ars 2018. [PMID: 30224874 DOI: 10.5152/npa.2017.19440)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The aim of this study is to evaluate the effectiveness of Addiction Programme of Probation (APP) created by the Substance Abuse Treatment Commission of Ministry of Health. METHODS The sample was consisted of probationers who were referred to Ege University by probation offices in February 2010. Literate probationers aged above 18, who fulfilled the SCID-I criteria for substance dependence, or had positive urine sample for illegal drugs were included. The probationers were allocated respectively to three treatment groups: APP (n=28); Motivational Interviewing (MI; n=30); Individual Intervention (II; n=30). The effectiveness of the treatment modalities was assessed by the State Anxiety Inventory; the WHO Quality of Life-Brief form; the Treatment Motivation Questionnaire. Visual analogue and Likert-type scales were used to assess the sense of the importance and the readiness of quitting drugs also the levels of craving. Urine toxicological analyses were performed fortnightly. RESULTS The APP increased the readiness of quitting drugs. The MI increased both the sense of importance and readiness of quitting drugs, decreased the frequency and severity of craving. The II improved the mental and physical health, increased the confidence in treatment also readiness of quitting drugs. Additionally, II decreased the level of anxiety, the severity, frequency and duration of craving. There was a significant decrease in positive urine samples of all groups. CONCLUSION Because of changing only "the level of being ready to quit substance abuse", APP is considered as an inadequate program compared with MI and II.
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Affiliation(s)
- Ebru Aldemir
- Ege University Institute on Drug Abuse, Toxicology and Pharmaceutical Science, İzmir, Turkey
| | - Güneş Berk
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridgeshire, England
| | - Hakan Coşkunol
- Department of Psychiatry, Ege University Faculty of Medicine, İzmir, Turkey
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Zhand N, Milin R. What do we know about the pharmacotheraputic management of insomnia in cannabis withdrawal: A systematic review. Am J Addict 2018; 27:453-464. [PMID: 30113101 DOI: 10.1111/ajad.12783] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/04/2018] [Accepted: 07/22/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Sleep disturbance is one of the hallmarks of cannabis withdrawal. Studies have indicated that treatment of this key symptom may facilitate abstinence. In the present paper we aim to provide a systematic review of the extant literature on pharmacological management of sleep disturbance associated with cannabis withdrawal. METHOD We conducted a systematic literature search across five electronic databases including PubMed, Psycinfo, MEDLINE, Cochrane review and Embase. Human studies using a pharmacological treatment for sleep disturbances associated with cannabis withdrawal were included. Review articles, case-series, open trials, posters, and editorials were excluded. RESULTS Seventeen publications, involving 562 participants, were included in this review. Major limitations involved small sample size, high dropout rate, methodological limitations, and heterogeneity of participants. Most of the studies were at high risk of bias, further downgrading the level of evidence. A meta-analysis was not performed due to lack of quantitative data, marked heterogeneity and low quality of the included studies. CONCLUSION There is not sufficient evidence for any of the reviewed treatment options. Methodological limitations in a majority of the studies rendered their findings preliminary. Of the twelve investigated pharmacological agents, Gabapentin, Lofexidine, Mirtazapine, Quetiapine, and Zolpidem showed some primary benefits for treatment of sleep difficulties associated with cannabis withdrawal; however, future prospective studies are required to confirm such results. SCIENTIFIC SIGNIFICANCE This review examines the current evidence for potential pharmacological options for treatment of cannabis withdrawal and associated sleep disturbance. It furthers our knowledge and provides groundwork for future research. (Am J Addict 2018;27:453-464).
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Affiliation(s)
- Naista Zhand
- Department of Psychiatry, University of Ottawa, Ontario, Canada
| | - Robert Milin
- Department of Psychiatry, University of Ottawa, Ontario, Canada.,Head, Division of Addiction and Mental Health, Department of Psychiatry, University of Ottawa, Ontario, Canada
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Abstract
Purpose of review The present review will provide an overview of the neurobiology, epidemiology, clinical impact, and treatment of cannabis use disorder (CUD) in mood disorders. Recent findings Patients with mood disorders including major depressive disorder (MDD) and bipolar disorder (BD) have higher rates of cannabis use, and CUD compared to the general population. Reasons for this association are not clear, nor are the putative therapeutic effects of cannabis use, or its components delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), in these illnesses. The evidence surrounding treatments for patients with this comorbidity is lacking, with more support for psychotherapeutic treatments compared with pharmacological treatments. Summary Cannabis use may be associated mood disorders, but more research is needed to increase our understanding of the mechanisms for this association, and to develop more effective treatments for this comorbidity.
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The Current State of Pharmacological Treatments for Cannabis Use Disorder and Withdrawal. Neuropsychopharmacology 2018; 43:173-194. [PMID: 28875989 PMCID: PMC5719115 DOI: 10.1038/npp.2017.212] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/31/2017] [Accepted: 08/31/2017] [Indexed: 02/07/2023]
Abstract
Cannabis use disorder (CUD) commonly occurs and carries a notable economic and functional burden at both individual and societal levels. While there are no clearly efficacious medication treatments for CUD, 20 years of committed and high-quality research in the human laboratory and clinical settings have resulted in medications with demonstrated effectiveness in the treatment of cannabis withdrawal, the ability to reduce cannabis use, and results that point to promising future work. The current state of pharmacology research for CUD highlights the need to consider particular characteristics of patients, such as gender, impulsivity, and severity of cannabis use, when selecting a medication in the off-label treatment of CUD or cannabis withdrawal. As a field, the body of work also exposes some areas in need of improvement in study design, selection of outcome measures, interpretation of results, and the overall process of evaluating candidate medications. Coming to a consensus as a field and addressing these gaps in future research will likely lend itself to further advances in improving the lives of patients with CUD.
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Abstract
The cannabis withdrawal syndrome (CWS) is a criterion of cannabis use disorders (CUDs) (Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition) and cannabis dependence (International Classification of Diseases [ICD]-10). Several lines of evidence from animal and human studies indicate that cessation from long-term and regular cannabis use precipitates a specific withdrawal syndrome with mainly mood and behavioral symptoms of light to moderate intensity, which can usually be treated in an outpatient setting. Regular cannabis intake is related to a desensitization and downregulation of human brain cannabinoid 1 (CB1) receptors. This starts to reverse within the first 2 days of abstinence and the receptors return to normal functioning within 4 weeks of abstinence, which could constitute a neurobiological time frame for the duration of CWS, not taking into account cellular and synaptic long-term neuroplasticity elicited by long-term cannabis use before cessation, for example, being possibly responsible for cannabis craving. The CWS severity is dependent on the amount of cannabis used pre-cessation, gender, and heritable and several environmental factors. Therefore, naturalistic severity of CWS highly varies. Women reported a stronger CWS than men including physical symptoms, such as nausea and stomach pain. Comorbidity with mental or somatic disorders, severe CUD, and low social functioning may require an inpatient treatment (preferably qualified detox) and post-acute rehabilitation. There are promising results with gabapentin and delta-9-tetrahydrocannabinol analogs in the treatment of CWS. Mirtazapine can be beneficial to treat CWS insomnia. According to small studies, venlafaxine can worsen the CWS, whereas other antidepressants, atomoxetine, lithium, buspirone, and divalproex had no relevant effect. Certainly, further research is required with respect to the impact of the CWS treatment setting on long-term CUD prognosis and with respect to psychopharmacological or behavioral approaches, such as aerobic exercise therapy or psychoeducation, in the treatment of CWS. The up-to-date ICD-11 Beta Draft is recommended to be expanded by physical CWS symptoms, the specification of CWS intensity and duration as well as gender effects.
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Affiliation(s)
- Udo Bonnet
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Castrop-Rauxel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen
| | - Ulrich W Preuss
- Vitos-Klinik Psychiatrie und Psychotherapie Herborn, Herborn
- Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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11
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Juel A, Kristiansen CB, Madsen NJ, Munk-Jørgensen P, Hjorth P. Interventions to improve lifestyle and quality-of-life in patients with concurrent mental illness and substance use. Nord J Psychiatry 2017; 71:197-204. [PMID: 27834103 DOI: 10.1080/08039488.2016.1251610] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Patients with co-existence of psychiatric disorders and substance use have an increased risk of premature death. This is attributable to a higher prevalence of physical comorbidities and a lifestyle related to substance use. Furthermore, they experience low quality-of-life (QoL). Studies addressing lifestyle interventions for these patients are warranted. AIMS To investigate the physical health and QoL in patients with co-existence of psychiatric disorders and substance use, and to analyse for changes in their (a) health, (b) substance use, and (c) QoL after a 24-month health-promotion programme. Further aims were to investigate associations between (a) QoL and number of interventions, (b) QoL and patient characteristics, and (c) QoL and length of participation in the intervention. METHODS In this naturalistic cohort study, 64 non-selected patients were engaged in health-promoting interventions added to contemporary treatments. QoL and clinical variables were measured at the beginning of and continuously during the programme by means of the WHOQoL-Bref questionnaire. RESULTS At enrolment, the patients' intake of cannabis and alcohol was high. During follow-up, patients consumed significantly fewer caffeinated beverages (p = .038) and fast-food meals (p = .018), and slept significantly less (p = .032). The average dose of antipsychotic medication increased significantly (p = .015). QoL was low at enrolment, but improved significantly overall (p = .009) and in the psychological (p = .020) and environmental domains (p = .012) at follow-up. The difference in total QoL was positively associated with the number of interventions attended. CONCLUSION This programme shows promise in addressing health promotion for these patients and can easily be integrated into contemporary treatments.
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Affiliation(s)
- Anette Juel
- a Department of Affective Disorders, Aarhus University Hospital , Risskov , Denmark
| | | | | | - Povl Munk-Jørgensen
- d Department of Psychiatry Odense , University Function, Southern University of Denmark , Odense , Denmark
| | - Peter Hjorth
- e Mental health Center, Psychiatric Hospital , Randers , Denmark
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Klein L, Bangh S, Cole JB. Intentional Recreational Abuse of Quetiapine Compared to Other Second-generation Antipsychotics. West J Emerg Med 2016; 18:243-250. [PMID: 28210359 PMCID: PMC5305132 DOI: 10.5811/westjem.2016.10.32322] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 09/30/2016] [Accepted: 10/15/2016] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Case reports and poison center data have demonstrated that the second-generation antipsychotic quetiapine is being obtained and used for recreational abuse. The purpose of this study was to describe the relative rates of single-substance abuse for different atypical antipsychotics and compare their demographic and clinical features. METHODS We conducted a 10-year retrospective analysis of the National Poison Data System (NPDS) database (2003 - 2013). Trained nurses and pharmacists with specialty training in toxicology prospectively collect all NPDS data at poison control centers around the United States. We queried the NPDS for all cases of single-substance second-generation antipsychotic exposures coded as "intentional abuse." The data provided by the NPDS regarding rates and clinical features of quetiapine abuse and the abuse of all other second-generation antipsychotics were compared and described descriptively. RESULTS During the study period, 2,118 cases of quetiapine abuse and 1,379 cases of other second-generation antipsychotic abuse were identified. Quetiapine abuse was more common than the abuse of other second-generation antipsychotics, compromising 60.6% of all abuse cases during the study period. After quetiapine, the next most frequently abused medications were risperidone (530 cases, 15.2%) and olanzapine (246 cases, 7.0%). For all second-generation antipsychotics including quetiapine, central nervous system clinical effects were most common, including drowsiness, confusion, and agitation. Other serious clinical effects observed with second-generation antipsychotic abuse included hypotension, respiratory depression, and seizures. CONCLUSION Quetiapine abuse is relatively common, and is abused far more often than any other second-generation antipsychotic. Emergency physicians should be aware of the clinical effects that may occur after second-generation antipsychotic abuse.
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Affiliation(s)
- Lauren Klein
- Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota
| | - Stacey Bangh
- Minnesota Poison Control System, Minneapolis, Minnesota
| | - Jon B Cole
- Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota; Minnesota Poison Control System, Minneapolis, Minnesota
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Halah MP, Zochniak MP, Barr MS, George TP. Cannabis Use and Psychiatric Disorders: Implications for Mental Health and Addiction Treatment. CURRENT ADDICTION REPORTS 2016. [DOI: 10.1007/s40429-016-0128-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mason BL, Mustafa A, Filbey F, Brown ES. Novel Pharmacotherapeutic Interventions for Cannabis Use Disorder. CURRENT ADDICTION REPORTS 2016. [DOI: 10.1007/s40429-016-0094-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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