Abstract
Cannabis use has been continuously increasing, and cannabis use disorder (CUD) has become a public health issue. Some psychosocial interventions have demonstrated the ability to reduce cannabis use; however, there are no pharmacotherapies approved for the treatment of CUD. Some drugs have shown limited positive effects on use and withdrawal symptoms, but no controlled studies have been able to show strong and persistent effects on clinically meaningful outcomes. The aim of this review is to synthesize the evidence from the available literature regarding the effectiveness of psychosocial and pharmacological treatments for CUD among adults (that is, 18 years old or older). An analysis of the evidence shows that the current best psychosocial intervention to reduce cannabis use is the combination of motivational enhancement therapy and cognitive-behavioral therapy, preferably accompanied by a contingency management approach. In regard to pharmacological interventions, there are mostly unclear findings. Some drugs, such as CB1 agonists, gabapentin, and N-acetylcysteine, have been shown to produce improvements in some symptoms of CUD in single studies, but these have not been replicated. Other classes of medications, including antidepressants and antipsychotics, have been unsuccessful in producing such effects. There is an imminent need for more clinical trials to develop more effective treatments for CUD.
Highlights
Cannabis is one of the most commonly used drugs at the global level, and an estimated 183 million people used cannabis in 2014
The rewarding effects of cannabis are directly associated with the actions of Δ9-tetrahydrocannabinol (THC) on cannabinoid CB1 receptors in the brain[2,3]
It is estimated that about 8% to 9% of people who have used cannabis in their lifetime will develop cannabis dependence, corresponding to the most severe form of cannabis use disorder (CUD)[5,6]
Summary
Cannabis is one of the most commonly used drugs at the global level, and an estimated 183 million people used cannabis in 2014. Cannabis use has increased in North America over the past few years, most notably in jurisdictions that have legalized access. In Colorado, cannabis use among young adults (18–25 years old) increased from 20% to 31% between 2000 and 20144. The increase in treatment demand is partially due to the availability of new high-potency strains of cannabis and synthetic cannabinoids[8,9]. THC levels have increased to as much as 20–25% over the past few years, whereas cannabis concentrate or synthetic cannabinoid products can contain up to 80–90% THC or more potent cannabinoid agonists[10,11,12,13]
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