Dronabinol Treatment for Cannabis Dependence

Frances R Levin, John J Mariani
European Psychiatric Review, 2010;3(1):62-64
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Abstract

No clearly effective pharmacotherapy for cannabis dependence has yet been developed. Pharmacotherapy research for cannabis-related disorders has been limited, although a variety of psychosocial interventions have been found to be effective. Delta-9-tetrahydrocannainol (THC) is the primary cannabinoid responsible for the psychoactive effects related to cannabis use. THC acts as a partial agonist at cannabinoid receptors. Dronabinol is a synthetic form of THC available for prescription in the US and other countries. Given the effectiveness of agonist replacement pharmacotherapy for other substance use disorders, such as opioid and nicotine dependence, dronabinol is a promising treatment for cannabis dependence.
Keywords
Cannabis dependence, marijuana, dronabinol
Disclosure The authors have no conflicts of interest to declare.
Received: March 24, 2009 Accepted August 20, 2009
Correspondence: John J Mariani, New York State Psychiatric Institute (NYSPI)—Division on Substance Abuse, 1051 Riverside Drive, Unit 66, New York, NY 10032, US. E: jm2330@columbia.edu

Cannabis use disorders are more prevalent than any other illicit drug use disorder in the US, yet no clearly efficacious pharmacotherapy has been identified, leaving treatment options limited to psychosocial interventions. Approximately 14.4 million people in the US reported pastmonth use of marijuana in 2007.1 Approximately 10% of first-time users,2 50% of daily users3 and more than two-thirds of those with cannabis abuse4 are estimated to develop cannabis dependence. The past-year prevalence of cannabis dependence in the US is estimated to be 0.32%.5 Furthermore, marijuana is the most common substance, after alcohol, for which individuals sought treatment in 2007,1 indicating that the development of effective treatments for cannabis use disorders is an important public health need. In a recent study of daily marijuana users who wanted to quit or reduce their use on their own, over a period of one month most were able to reduce or abstain for at least 50% of the days they attempted, but only 21% were able to reduce for at least one week and only 10% completely abstained for one week.6 Thus, similar to other drugs of abuse, cannabis-dependent individuals have difficulty quitting even when they are motivated to do so.

A variety of psychosocial interventions have been studied for the treatment of cannabis dependence and found to be effective in reducing cannabis use, promoting abstinence and improving quality of life.7 When studied under randomised, controlled conditions, voucher incentives and behavioural skills training resulted in a 35% abstinence rate.8 The Cannabis Youth Treatment study,9 the largest cannabis use disorder treatment trial to date, evaluated five shortterm outpatient psychosocial interventions and reported rates of ‘recovery’ (no drug use in the past 30 days and other criteria) of up to 34%. The Marijuana Treatment Project, which evaluated two brief psychosocial interventions for cannabis dependence, reported rates of abstinence up to 22.6%.10 While the development of effective psychotherapy is an important step in developing a comprehensive treatment approach for cannabis use disorders, significant gaps in the treatment armamentarium remain. Given the availability of effective pharmacotherapies for other substance use disorders, such as alcohol, opioid and nicotine dependence, the development of effective pharmacotherapy for cannabis use disorders is a logical way to further improve treatment outcomes.

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