title: Dronabinol for the treatment of cannabis dependence: a randomized, double-blind, placebo-controlled trial.
abstract: Cannabis dependence is a substantial public health problem. Behavioral treatments have shown promise, but there are no effective medications for cannabis dependence. The purpose of this study was to evaluate the safety and efficacy of dronabinol, a synthetic form of delta-9-tetrahydrocannabinol, a naturally occurring pharmacologically active component of marijuana, in treating cannabis dependence. 156 cannabis-dependent adults were enrolled in a randomized, double-blind, placebo-controlled, 12-week trial. After a 1-week placebo lead-in phase, participants were randomized to receive dronabinol 20mg twice a day or placebo. Doses were maintained until the end of week 8 and then tapered off over 2 weeks. All participants received weekly motivational enhancement and relapse prevention therapy. Marijuana use was assessed using the timeline follow back method. There was no significant difference between treatment groups in the proportion of participants who achieved 2 weeks of abstinence at the end of the maintenance phase (dronabinol: 17.7%; placebo: 15.6%). Although both groups showed a reduction in marijuana use over time, there were no differences between the groups. Treatment retention was significantly higher at the end of the maintenance phase on dronabinol (77%), compared to placebo (61%) (P=.02), and withdrawal symptoms were significantly lower on dronabinol than placebo (P=.02). This is the first trial using an agonist substitution strategy for treatment of cannabis dependence. Dronabinol showed promise, it was well-tolerated, and improved treatment retention and withdrawal symptoms. Future trials might test higher doses, combinations of dronabinol with other medications with complementary mechanisms, or with more potent behavioral interventions.
authors.affiliation: New York State Psychiatric Institute, Division of Substance Abuse, New York, NY 10032, USA. frl2@columbia.edu
authors.forename: Frances R
authors.initials: FR
authors.lastname: Levin
authors.forename: John J
authors.initials: JJ
authors.lastname: Mariani
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Brooks
authors.forename: Martina
authors.initials: M
authors.lastname: Pavlicova
authors.forename: Wendy
authors.initials: W
authors.lastname: Cheng
authors.forename: Edward V
authors.initials: EV
authors.lastname: Nunes
mesh_terms: D000328:Adult; D016739:Behavior, Addictive / Q000188:drug therapy*; D002186:Cannabinoids / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D004311:Double-Blind Method; D013759:Dronabinol / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000188:drug therapy*; D008385:Marijuana Smoking / Q000517:prevention & control*; D008875:Middle Aged; D010919:Placebos; D011613:Psychotherapy; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology
chemical_list: D002186:Cannabinoids; D010919:Placebos; D011619:Psychotropic Drugs; D013759:Dronabinol