A randomized trial of clozapine vs. other antipsychotics for cannabis use disorder in patients with schizophrenia.
OBJECTIVE
Cannabis use disorder is the most common co-occurring drug use disorder in people with schizophrenia and is associated with poor outcomes. We launched a randomized controlled trial to assess the impact of clozapine compared with treatment as usual on cannabis use in patients with schizophrenia and co-occurring cannabis use disorder.


METHODS
Thirty-one patients with schizophrenia and co-occurring cannabis use disorder were randomly assigned to switch to clozapine or to stay on their current antipsychotic and were then followed weekly for 12 weeks. Blinded raters assessed participants weekly with the Timeline Follow-back for substance use and the expanded Brief Psychiatric Rating Scale for symptoms. Longitudinal random effects models were used to investigate the time-varying differences in cannabis use and other outcomes between the treatment as usual and clozapine groups.


RESULTS
The two groups differed in average intensity of cannabis use by approximately 4.5 joints/week, with lesser use in the clozapine group (t = -1.77; df = 28.5; p=.086; effect size ~ 0.6). Symptoms and functioning were not different between the two groups.


CONCLUSIONS
Clozapine may reduce cannabis use among patients with schizophrenia and co-occurring cannabis use disorder. Further controlled trials are warranted.
Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire 03755.
Mary F
MF
Brunette
Frontier Science Research and Technology, Boston, MA.
Ree
R
Dawson
Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire 03755.
Christopher D
CD
O'Keefe
Department of Psychiatry, University of South Carolina, Columbia, SC.
Meera
M
Narasimhan
Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire 03755.
Douglas L
DL
Noordsy
Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Joanne
J
Wojcik
Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire 03755.
Alan I
AI
Green
cannabis; clozapine; co-occurring; schizophrenia; substance use disorder; treatment