|Titre :||Pharmacotherapies for cannabis dependence (2019)|
|Auteurs :||S. NIELSEN ; L. GOWING ; P. SABIONI ; B. LE FOLL|
|Type de document :||Article : Périodique|
|Dans :||Cochrane Database of Systematic Reviews (n°1, 2019)|
|Article en page(s) :||CD008940 ; 113 p.|
|Discipline :||TRA (Traitement et prise en charge / Treatment and care)|
Thésaurus TOXIBASECANNABIS ; DEPENDANCE ; TRAITEMENT ; PHARMACOTHERAPIE ; EFFICACITE ; TETRAHYDROCANNABINOL ; ANTIDEPRESSEURS ; ANXIOLYTIQUES ; MEDICAMENTS ; CANNABINOIDES
Background: Cannabis use is relatively common and widespread worldwide. Demand by cannabis users for treatment has been increasing in most regions of the world. Moves in some countries to decriminalise or legalise cannabis use is likely to result in this trend continuing. Currently there are no medicines specifically for the treatment of cannabis use. This review sought to assess the effectiveness and safety of medicines for the treatment of cannabis dependence.
Search date: We searched the scientific literature in March 2018.
We identified 21 randomised controlled trials (clinical studies where people are allocated at random to one of two or more treatment groups) involving 909 participants treated with active medicines, and 846 who received placebo (a pretend treatment). 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 mean age of participants in individual studies ranged from 22 to 41 years, excluding three studies that targeted young people. Most (75%) study participants were male. Most (16) of the studies were undertaken in the USA, with three occurring in Australia, one in Canada and one in Israel. The studies tested a wide range of medicines to reduce the symptoms of cannabis withdrawal and to promote cessation or reduction of cannabis use.
Four studies received study medicines from the manufacturing pharmaceutical company but none were funded by pharmaceutical companies. One study did not report funding or medicine source.
For the outcome of abstinence at the end of treatment, Delta9-tetrahydrocannabinol (THC, the major constituent in cannabis) preparations were probably ineffective; antidepressants called selective serotonin reuptake inhibitors, mixed action antidepressants, a medicine called buspirone and a medicine called N-acetylcysteine may also have been ineffective; and we are uncertain about the effect of anticonvulsants and mood stabilisers.
For the outcome of completion of the scheduled period of treatment, THC preparations, mixed action antidepressants, anticonvulsants and mood stabilisers may not have been effective, we were uncertain about the effect of SSRI antidepressants, and N-acetylcysteine probably did not support treatment completion. The use of anticonvulsants and mood stabilisers may have increased the likelihood that people left treatment early.
THC preparations and N-acetylcysteine were probably no more likely to cause side effects than placebo, mixed action antidepressants and buspirone may have been no more likely to cause side effects than placebo, and we were uncertain about SSRI antidepressants.
Based on current research, all medicines should be considered still experimental.
Quality of the evidence: The quality of the evidence for many of the outcomes in this review was low or very low because each medicine was investigated by a small number of studies (ranging from one to four), each study involved small numbers of participants, there was some inconsistency in the findings and there was a risk of bias due to study participants dropping out of treatment.
|Domaine :||Drogues illicites / Illicit drugs|
|Sous-type de document :||Revue de la littérature / Literature review|
|Affiliation :||Monash Addiction Research Centre, Monash University, Peninsula Campus, McMahons Road, Frankston, VIC, Australia|