Evidence for effectiveness of pharmacotherapies for cannabis dependence is incomplete

Wednesday 30 September 2015

Brian McAvoy

PEARLS No.

469

Clinical question

Compared with placebo or supportive care, how effective are pharmacotherapies for reducing symptoms of cannabis withdrawal and promoting cessation or reduction of cannabis use?

Bottom line

There was incomplete evidence for all of the pharmacotherapies investigated. Antidepressants, bupropion, buspirone and atomoxetine were of little value in the treatment of cannabis dependence. Preparations containing tetrahydrocannabinol (THC) were of potential value in the treatment of cannabis dependence, but limitations in the evidence were such that this application of THC preparations should be considered still experimental. The evidence base for gabapentin and N-acetylcysteine was weak, and it was not possible to quantitatively estimate their effectiveness.

Caveat

Quantitative analysis was not possible for most of the outcomes, and was limited for most of the pharmacotherapies investigated. The quality of evidence for many of the outcomes was downgraded due to small sample size, inconsistency and risk of attrition bias.

Context

Cannabis is the most prevalent illicit drug in the world. Demand for treatment of cannabis use disorders is increasing. There are currently no pharmacotherapies approved for treatment of cannabis use disorders.

Cochrane Systematic Review

Marshall K et al. Pharmacotherapies for cannabis dependence. Cochrane Reviews, 2014, Issue 12. Art. No.: CD008940.DOI: 10.1002/14651858. CD008940.pub2. This review contains 14 studies involving 958 participants.

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