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|Issue 151||April 2019|
The report is a product of the VA/HSR&D Evidence Synthesis Program.
Pharmacotherapy for the Treatment of Cannabis Use Disorder: A Systematic Review
Social, medical, and legal acceptance of cannabis has grown dramatically over the last 15 years, and cannabis use — for medical and recreational purposes — also has increased. From 2002 to 2012, the prevalence of daily cannabis use in the United States increased from 1.3 to 2.1%. Along with an increase in the acceptance and use of cannabis, the potency of cannabis available on the market has increased dramatically. Meanwhile, the proportion of the public that perceives important harms from cannabis use has decreased; however, among regular users, cannabis use can lead to physiologic dependence, with withdrawal symptoms similar to those of other substance use disorders. Between 2.5% and 6.3% of adults are estimated to have cannabis use disorder (CUD). Nearly half those adults have moderate or severe CUD, and the risk is greatest in young adults and socioeconomically disadvantaged groups. Cannabis use disorder also is a growing concern among Veterans.
A recent national survey found that only about 1 in 5 individuals reporting any past-year cannabis use perceived addiction to be a risk associated with cannabis.
This systematic review and meta-analysis examined the benefits and risks associated with the use of various pharmacotherapies for the promotion of cessation or reduction of cannabis use, abstinence and retention among individuals with cannabis use disorder (CUD). Investigators with VA's Evidence-based Synthesis Program (ESP) Coordinating Center in Portland, OR searched electronic databases, clinical trial registries, and reference lists through July 2018 for randomized controlled trials (RCTs) directly comparing pharmacological interventions against each other, placebo, usual care, or psychotherapy in individuals with CUD. After reviewing nearly 1,000 studies, 23 RCTs were included in the final analysis.
Trials in this review examined antidepressants (i.e., escitalopram, fluoxetine, bupropion), antipsychotics (i.e, clozapine, ziprasidone), buspirone, mood stabilizers (i.e., divalproex, lithium), atomoxetine, cannabinoids, anticonvulsants (i.e., topiramate, gabapentin), N-acetylcysteine, arepitant, and oxytocin. Antidepressants were the most widely studied drug class.
Given increasing access to and use of cannabis in the general population (including Veterans), along with the high prevalence of cannabis use disorder among current cannabis users, there is an urgent need for more research to identify effective pharmacologic treatments.
Implications for VHA Policy/Practice
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ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.
This report is a product of VA/HSR&D's Evidence Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers –; and to disseminate these reports throughout VA.
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