Addressing the stimulant treatment gap: A call to investigate the therapeutic benefits potential of cannabinoids for crack-cocaine use.
Crack-cocaine use is prevalent in numerous countries, yet concentrated primarily - largely within urban contexts - in the Northern and Southern regions of the Americas. It is associated with a variety of behavioral, physical and mental health and social problems which gravely affect users and their environments. Few evidence-based treatments for crack-cocaine use exist and are available to users in the reality of street drug use. Numerous pharmacological treatments have been investigated but with largely disappointing results. An important therapeutic potential for crack-cocaine use may rest in cannabinoids, which have recently seen a general resurgence for varied possible therapeutic usages for different neurological diseases. Distinct potential therapeutic benefits for crack-cocaine use and common related adverse symptoms may come specifically from cannabidiol (CBD) - one of the numerous cannabinoid components found in cannabis - with its demonstrated anxiolytic, anti-psychotic, anti-convulsant effects and potential benefits for sleep and appetite problems. The possible therapeutic prospects of cannabinoids are corroborated by observational studies from different contexts documenting crack-cocaine users' 'self-medication' efforts towards coping with crack-cocaine-related problems, including withdrawal and craving, impulsivity and paranoia. Cannabinoid therapeutics offer further benefits of being available in multiple formulations, are low in adverse risk potential, and may easily be offered in community-based settings which may add to their feasibility as interventions for - predominantly marginalized - crack-cocaine user populations. Supported by the dearth of current therapeutic options for crack-cocaine use, we are advocating for the implementation of a rigorous research program investigating the potential therapeutic benefits of cannabinoids for crack-cocaine use. Given the high prevalence of this grave substance use problem in the Americas, opportunities for such research should urgently be created and facilitated there.
Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada; Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A8, Canada; Institute of Medical Science (IMS), University of Toronto, Toronto, ON M5S 1A8, Canada. Electronic address: benedikt.fischer@utoronto.ca.
Benedikt
B
Fischer
Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada.
Sharan
S
Kuganesan
Program on Health Sciences and Health Technologies & Center of Drugs and Associated Vulnerabilities, Faculty of Ceilanda, Universidade de Brasilia, Brasilia, DF 70910-900, Brazil.
Andrea
A
Gallassi
Department of Physiological Sciences, Universidade de Brasilia, Brasilia, DF 70910-900, Brazil.
Renato
R
Malcher-Lopes
Academic Medical Centre, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; Amsterdam Institute for Addiction Research, 1100 DD Amsterdam, The Netherlands.
Wim
W
van den Brink
Urban Health Research Initiative, St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada; Division of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
Evan
E
Wood
D002186:Cannabinoids / Q000627:therapeutic use*; D000697:Central Nervous System Stimulants / Q000009:adverse effects; D019970:Cocaine-Related Disorders / Q000188:drug therapy*; D016578:Crack Cocaine / Q000009:adverse effects*; D006801:Humans
D002186:Cannabinoids; D000697:Central Nervous System Stimulants; D016578:Crack Cocaine
Americas; Cannabidiol; Cannabinoids; Crack-cocaine; Pharmacotherapy; Treatment