Karli K. Kondo, PhD; Benjamin J. Morasco, PhD; Shannon M. Nugent, PhD; Chelsea K. Ayers, MPH; Maya E. O'Neil, PhD; Michele Freeman, MPH; Devan Kansagara, MD, MCR
Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the U.S. government.
Acknowledgment: The authors thank Robin Paynter for developing the search strategy and running electronic searches, and Jessica Montgomery for assistance with data abstraction.
Financial Support: Funding for the Veterans Affairs Evidence Synthesis Program is provided by the Veterans Health Administration Health Services Research and Development Service.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1105.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement: Study protocol: See Supplement Table 1. Statistical code: Not available. Data set: Available from Dr. Kondo (e-mail, email@example.com).
Corresponding Author: Karli K. Kondo, PhD, VA Portland Health Care System, Mail Code R&D 71, 3710 Southwest U.S. Veterans Hospital Road, Portland, OR 97239; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Kondo and Kansagara and Ms. Freeman: VA Portland Health Care System, Mail Code R&D 71, 3710 Southwest U.S. Veterans Hospital Road, Portland, OR 97239.
Dr. Morasco: 3710 Southwest U.S. Veterans Hospital Road, Mail Code R&D 99, Portland, OR 97239.
Drs. Nugent and O'Neil: 3710 Southwest U.S. Veterans Hospital Road, Mail Code R&D 66, Portland, OR 97239.
Ms. Ayers: 3710 Southwest U.S. Veterans Hospital Road, Mail Code R&D 71, Portland, OR 97239.
Author Contributions: Conception and design: K.K. Kondo, B.J. Morasco, S.M. Nugent, C.K. Ayers, M.E. O'Neil, D. Kansagara.
Analysis and interpretation of the data: K.K. Kondo, B.J. Morasco, S.M. Nugent, M.E. O'Neil, M. Freeman, D. Kansagara.
Drafting of the article: K.K. Kondo, B.J. Morasco, S.M. Nugent, C.K. Ayers, M.E. O'Neil, D. Kansagara.
Critical revision for important intellectual content: K.K. Kondo, B.J. Morasco, S.M. Nugent, M.E. O'Neil, D. Kansagara.
Final approval of the article: K.K. Kondo, B.J. Morasco, S.M. Nugent, C.K. Ayers, M.E. O'Neil, M. Freeman, D. Kansagara.
Obtaining of funding: D. Kansagara.
Administrative, technical, or logistic support: C.K. Ayers.
Collection and assembly of data: K.K. Kondo, B.J. Morasco, S.M. Nugent, C.K. Ayers, M.E. O'Neil, M. Freeman, D. Kansagara.
Cannabis use disorder (CUD) is a growing concern, and evidence-based data are needed to inform treatment options.
To review the benefits and risks of pharmacotherapies for the treatment of CUD.
MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, and clinical trial registries from inception through September 2019.
Pharmacotherapy trials of adults or adolescents with CUD that targeted cannabis abstinence or reduction, treatment retention, withdrawal symptoms, and other outcomes.
Data were abstracted by 1 investigator and confirmed by a second. Study quality was dually assessed, and strength of evidence (SOE) was determined by consensus according to standard criteria.
Across 26 trials, the evidence was largely insufficient. Low-strength evidence was found that selective serotonin reuptake inhibitors (SSRIs) do not reduce cannabis use or improve treatment retention. Low- to moderate-strength evidence was found that buspirone does not improve outcomes and that cannabinoids do not increase abstinence rates (moderate SOE), reduce cannabis use (low SOE), or increase treatment retention (low SOE). Across all drug studies, no consistent evidence of increased harm was found.
Few methodologically rigorous trials have been done. Existing trials are hampered by small sample sizes, high attrition rates, and heterogeneity of concurrent interventions and outcomes assessment.
Although data on pharmacologic interventions for CUD are scarce, evidence exists that several drug classes, including cannabinoids and SSRIs, are ineffective. Because of increasing access to and use of cannabis in the general population, along with a high prevalence of CUD among current cannabis users, an urgent need exists for more research to identify effective pharmacologic treatments.
U.S. Department of Veterans Affairs. (PROSPERO: CRD42018108064)
Kondo KK, Morasco BJ, Nugent SM, et al. Pharmacotherapy for the Treatment of Cannabis Use Disorder: A Systematic Review. Ann Intern Med. 2020;172:398–412. [Epub ahead of print 3 March 2020]. doi: https://doi.org/10.7326/M19-1105
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Published: Ann Intern Med. 2020;172(6):398-412.
Published at www.annals.org on 3 March 2020
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