Tags

Type your tag names separated by a space and hit enter

Nabiximols for the Treatment of Cannabis Dependence: A Randomized Clinical Trial.
JAMA Intern Med. 2019 Sep 01; 179(9):1242-1253.JIM

Abstract

Importance

There are no effective medications for treating dependence on cannabis.

Objective

To examine the safety and efficacy of nabiximols in the treatment of patients with cannabis dependence.

Design, Setting, and Participants

This parallel double-blind randomized clinical trial comparing nabiximols with placebo in a 12-week, multisite outpatient study recruited participants from February 3, 2016, to June 14, 2017, at 4 outpatient specialist alcohol and drug treatment services in New South Wales, Australia. Participants had cannabis dependence (as defined by the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision) and were seeking treatment, were nonresponsive to prior treatment attempts, were 18 to 64 years of age, had no other substance use disorder, had no severe medical or psychiatric conditions, were not pregnant, were not mandated by a court to undergo treatment, and provided informed consent. Results for primary efficacy measures and all secondary outcomes were obtained using a modified intention-to-treat data set.

Interventions

Participants received 12-week treatment involving weekly clinical reviews, structured counseling, and flexible medication doses-up to 32 sprays daily (tetrahydrocannabinol, 86.4 mg, and cannabidiol, 80 mg), dispensed weekly.

Main Outcomes and Measures

Primary outcome was self-reported number of days using illicit cannabis during the 12-week period. Other outcomes included alternate cannabis use parameters (periods of abstinence, withdrawal, cravings, and problems), safety parameters (adverse events and aberrant medication use), health status, other substance use, and treatment retention.

Results

A total of 128 participants (30 women and 98 men; mean [SD] age, 35.0 [10.9] years) were randomized and received at least 1 dose of study medication. Participants had used a mean (SD) of 2.3 (2.1) g of cannabis on a mean (SD) of 25.7 (4.5) days in the past 28 days. Treatment retention was comparable for the 2 groups (placebo, 30 of 67 participants [44.8%]; nabiximols, 30 of 61 participants [49.2%]), and both groups used similar mean (SD) doses (placebo, 18.5 [9.5] sprays daily; nabiximols, 17.6 [9.5] sprays daily, equivalent to a mean [SD] of 47.5 [25.7] mg of tetrahydrocannabinol and 44.0 [23.8] mg of cannabidiol). For the primary end point, the placebo group reported significantly more days using cannabis during the 12 weeks (mean [SD], 53.1 [33.0] days) than the nabiximols group (mean [SD], 35.0 [32.4] days; estimated difference, 18.6 days; 95% CI, 3.5-33.7 days; P = .02). Both groups showed comparable improvements in health status, with no substantial changes in other substance use. Medication was well tolerated with few adverse events.

Conclusions and Relevance

This study demonstrates that cannabinoid agonist treatment, in this case using nabiximols, in combination with psychosocial interventions is a safe approach for reducing cannabis use among individuals with cannabis dependence who are seeking treatment.

Trial Registration

anzctr.org.au Identifier: ACTRN12616000103460.

Authors+Show Affiliations

Drug and Alcohol Services, South East Sydney Local Health District, Sydney, New South Wales, Australia. Discipline Addiction Medicine, Faculty Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.Drug and Alcohol Services, South East Sydney Local Health District, Sydney, New South Wales, Australia. Discipline Addiction Medicine, Faculty Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.Drug and Alcohol Services, South East Sydney Local Health District, Sydney, New South Wales, Australia. Discipline Addiction Medicine, Faculty Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.Drug and Alcohol Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia. Priority Research Centre for Brain and Mental Health, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.Lambert Initiative Cannabinoid Therapeutics, University of Sydney, Sydney, New South Wales, Australia.School of Psychology, University of Tasmania, Hobart, Tasmania, Australia.Drug and Alcohol Services, South East Sydney Local Health District, Sydney, New South Wales, Australia. Discipline Addiction Medicine, Faculty Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.Drug Health, Western Sydney Local Health District, Parramatta, New South Wales, Australia.Drug and Alcohol Services, South East Sydney Local Health District, Sydney, New South Wales, Australia.Drug and Alcohol Services, South East Sydney Local Health District, Sydney, New South Wales, Australia.National Health and Medical Research Council, Clinical Trials Centre, Faculty of Medicine and Public Health, University of Sydney, Sydney, New South Wales, Australia.Drug and Alcohol Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia.Drug Health, Western Sydney Local Health District, Parramatta, New South Wales, Australia.Drug Health, Western Sydney Local Health District, Parramatta, New South Wales, Australia.National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.Drug and Alcohol Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia.Lambert Initiative Cannabinoid Therapeutics, University of Sydney, Sydney, New South Wales, Australia.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31305874

Citation

Lintzeris, Nicholas, et al. "Nabiximols for the Treatment of Cannabis Dependence: a Randomized Clinical Trial." JAMA Internal Medicine, vol. 179, no. 9, 2019, pp. 1242-1253.
Lintzeris N, Bhardwaj A, Mills L, et al. Nabiximols for the Treatment of Cannabis Dependence: A Randomized Clinical Trial. JAMA Intern Med. 2019;179(9):1242-1253.
Lintzeris, N., Bhardwaj, A., Mills, L., Dunlop, A., Copeland, J., McGregor, I., Bruno, R., Gugusheff, J., Phung, N., Montebello, M., Chan, T., Kirby, A., Hall, M., Jefferies, M., Luksza, J., Shanahan, M., Kevin, R., & Allsop, D. (2019). Nabiximols for the Treatment of Cannabis Dependence: A Randomized Clinical Trial. JAMA Internal Medicine, 179(9), 1242-1253. https://doi.org/10.1001/jamainternmed.2019.1993
Lintzeris N, et al. Nabiximols for the Treatment of Cannabis Dependence: a Randomized Clinical Trial. JAMA Intern Med. 2019 Sep 1;179(9):1242-1253. PubMed PMID: 31305874.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nabiximols for the Treatment of Cannabis Dependence: A Randomized Clinical Trial. AU - Lintzeris,Nicholas, AU - Bhardwaj,Anjali, AU - Mills,Llewellyn, AU - Dunlop,Adrian, AU - Copeland,Jan, AU - McGregor,Iain, AU - Bruno,Raimondo, AU - Gugusheff,Jessica, AU - Phung,Nghi, AU - Montebello,Mark, AU - Chan,Therese, AU - Kirby,Adrienne, AU - Hall,Michelle, AU - Jefferies,Meryem, AU - Luksza,Jennifer, AU - Shanahan,Marian, AU - Kevin,Richard, AU - Allsop,David, AU - ,, PY - 2019/7/16/pubmed PY - 2019/7/16/medline PY - 2019/7/16/entrez SP - 1242 EP - 1253 JF - JAMA internal medicine JO - JAMA Intern Med VL - 179 IS - 9 N2 - Importance: There are no effective medications for treating dependence on cannabis. Objective: To examine the safety and efficacy of nabiximols in the treatment of patients with cannabis dependence. Design, Setting, and Participants: This parallel double-blind randomized clinical trial comparing nabiximols with placebo in a 12-week, multisite outpatient study recruited participants from February 3, 2016, to June 14, 2017, at 4 outpatient specialist alcohol and drug treatment services in New South Wales, Australia. Participants had cannabis dependence (as defined by the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision) and were seeking treatment, were nonresponsive to prior treatment attempts, were 18 to 64 years of age, had no other substance use disorder, had no severe medical or psychiatric conditions, were not pregnant, were not mandated by a court to undergo treatment, and provided informed consent. Results for primary efficacy measures and all secondary outcomes were obtained using a modified intention-to-treat data set. Interventions: Participants received 12-week treatment involving weekly clinical reviews, structured counseling, and flexible medication doses-up to 32 sprays daily (tetrahydrocannabinol, 86.4 mg, and cannabidiol, 80 mg), dispensed weekly. Main Outcomes and Measures: Primary outcome was self-reported number of days using illicit cannabis during the 12-week period. Other outcomes included alternate cannabis use parameters (periods of abstinence, withdrawal, cravings, and problems), safety parameters (adverse events and aberrant medication use), health status, other substance use, and treatment retention. Results: A total of 128 participants (30 women and 98 men; mean [SD] age, 35.0 [10.9] years) were randomized and received at least 1 dose of study medication. Participants had used a mean (SD) of 2.3 (2.1) g of cannabis on a mean (SD) of 25.7 (4.5) days in the past 28 days. Treatment retention was comparable for the 2 groups (placebo, 30 of 67 participants [44.8%]; nabiximols, 30 of 61 participants [49.2%]), and both groups used similar mean (SD) doses (placebo, 18.5 [9.5] sprays daily; nabiximols, 17.6 [9.5] sprays daily, equivalent to a mean [SD] of 47.5 [25.7] mg of tetrahydrocannabinol and 44.0 [23.8] mg of cannabidiol). For the primary end point, the placebo group reported significantly more days using cannabis during the 12 weeks (mean [SD], 53.1 [33.0] days) than the nabiximols group (mean [SD], 35.0 [32.4] days; estimated difference, 18.6 days; 95% CI, 3.5-33.7 days; P = .02). Both groups showed comparable improvements in health status, with no substantial changes in other substance use. Medication was well tolerated with few adverse events. Conclusions and Relevance: This study demonstrates that cannabinoid agonist treatment, in this case using nabiximols, in combination with psychosocial interventions is a safe approach for reducing cannabis use among individuals with cannabis dependence who are seeking treatment. Trial Registration: anzctr.org.au Identifier: ACTRN12616000103460. SN - 2168-6114 UR - https://www.unboundmedicine.com/medline/citation/31305874/Nabiximols_for_the_Treatment_of_Cannabis_Dependence:_A_Randomized_Clinical_Trial_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2019.1993 DB - PRIME DP - Unbound Medicine ER -