Historique
Article de Périodique
Pharmacotherapies for cannabis dependence (2014)
Auteur(s) :
MARSHALL, K. ;
GOWING, L. ;
ALI, R. ;
LE FOLL, B.
Année
2014
Page(s) :
CD008940 ; 66 p.
Sous-type de document :
Revue de la littérature / Literature review
Langue(s) :
Anglais
Domaine :
Drogues illicites / Illicit drugs
Thésaurus mots-clés
CANNABIS
;
DEPENDANCE
;
TRAITEMENT
;
PHARMACOTHERAPIE
;
EVALUATION
;
EFFICACITE
;
MEDICAMENTS
;
TETRAHYDROCANNABINOL
;
SEVRAGE
;
REDUCTION DE CONSOMMATION
Résumé :
Background: Cannabis is the most common illicit drug in the world. Demand by cannabis users for treatment has been increasing in most regions of the world. Currently there are nomedications specifically for the treatment of cannabis use. This review sought to assess the effectiveness and safety of medications for the treatment of cannabis dependence.
Search date: We searched the scientific literature in February and March 2014.
Study characteristics: We identified 14 randomised controlled trials (clinical studies where people are allocated at random to one of two or more treatment groups) involving 958 cannabis-dependent participants. Key features of dependent drug use are compulsive use, loss of control over use, and withdrawal symptoms on cessation of drug use. This review included studies where participants were described as dependent or were likely to be dependent based on cannabis use occurring several days a week, or daily. The average age of participants was 33 years, excluding two studies that targeted young people. Most (80%) study participants were male. Most (10) of the studies were undertaken in the USA, with three occurring in Australia and one in Israel. The studies involved a wide range of medications to reduce the symptoms of cannabis withdrawal and to promote cessation or reduction of cannabis use. Two studies received study medications from the manufacturing pharmaceutical company but none were funded by pharmaceutical companies.
Key results: The effects for many of the medicines we evaluated in this review were uncertain. Based on the available evidence, antidepressants, bupropion, buspirone and atomoxetine are probably of little value in the treatment of cannabis dependence. Preparations containing tetrahydrocannabinol (THC), the main psychoactive ingredient of cannabis, are of potential value in the treatment of cannabis dependence, but limitations in the evidence are such that this application of THC preparations should be considered still experimental. Available evidence on gabapentin and N-acetylcysteine suggest that these medications may be worth further investigation, but at this time it is not possible to assess their effectiveness.
Quality of the evidence:
The quality of the evidence for many of the outcomes in this review was downgraded because each medication was investigated by only one or two studies, each study involved small numbers of participants, there was some inconsistency in the findings, and a risk of bias due to study participants dropping out of treatment.
Search date: We searched the scientific literature in February and March 2014.
Study characteristics: We identified 14 randomised controlled trials (clinical studies where people are allocated at random to one of two or more treatment groups) involving 958 cannabis-dependent participants. Key features of dependent drug use are compulsive use, loss of control over use, and withdrawal symptoms on cessation of drug use. This review included studies where participants were described as dependent or were likely to be dependent based on cannabis use occurring several days a week, or daily. The average age of participants was 33 years, excluding two studies that targeted young people. Most (80%) study participants were male. Most (10) of the studies were undertaken in the USA, with three occurring in Australia and one in Israel. The studies involved a wide range of medications to reduce the symptoms of cannabis withdrawal and to promote cessation or reduction of cannabis use. Two studies received study medications from the manufacturing pharmaceutical company but none were funded by pharmaceutical companies.
Key results: The effects for many of the medicines we evaluated in this review were uncertain. Based on the available evidence, antidepressants, bupropion, buspirone and atomoxetine are probably of little value in the treatment of cannabis dependence. Preparations containing tetrahydrocannabinol (THC), the main psychoactive ingredient of cannabis, are of potential value in the treatment of cannabis dependence, but limitations in the evidence are such that this application of THC preparations should be considered still experimental. Available evidence on gabapentin and N-acetylcysteine suggest that these medications may be worth further investigation, but at this time it is not possible to assess their effectiveness.
Quality of the evidence:
The quality of the evidence for many of the outcomes in this review was downgraded because each medication was investigated by only one or two studies, each study involved small numbers of participants, there was some inconsistency in the findings, and a risk of bias due to study participants dropping out of treatment.
Affiliation :
Discipline of Pharmacology, University of Adelaide, Adelaide, Australia