Cannabidiol for cannabis cessation shows positive results

In the first, randomised clinical trial of cannabidiol (CBD) for cannabis use disorder, CBD 400 mg and 800 mg were safe and more efficacious than placebo in reducing cannabis use. CBD also showed some potential for reducing anxiety, depression, cannabis withdrawal symptoms, and tobacco use. CBD has the potential to address a substantial unmet clinical need [1,2].

Addiction to cannabis has seen a large rise over the last decade and has emerged as the primary reason for first-time admission to drug addiction treatment, according to Dr Tom Freeman (University of Bath, UK). This rise mirrors the increasing potency of cannabis in Europe, which has made it more harmful and addictive. Cannabis use disorder affects about 22% of cannabis users and is characterised by a problematic pattern of use with clinically significant impairment or distress, such as craving, tolerance, and inability to control use.

A phase 2, double-blind, placebo-controlled adaptive Bayesian trial was designed to evaluate the most efficacious dose of CBD for reducing cannabis use (NCT02044809). The first primary endpoint was biological reduction (i.e. reduced urinary THC-COOH:creatinine ratio), and the second was self-reported reduction (i.e. days of abstinence). The 48 participants underwent motivational interviewing and were randomised to placebo (n=12), CBD 200 mg (n=12), CBD 400 mg (n=12), or CBD 800 mg (n=12). At interim analysis, after 24 weeks, CBD 200 mg was found to be inefficacious and was eliminated from the trial. In the second stage, an additional 34 participants were randomised to placebo (n=11), CBD 400 mg (n=12), or CBD 800 mg (n=11).

At final analysis, CBD 400 mg and 800 mg met both primary endpoints. For urinary THC-COOH:creatinine ratio, the probability of being the most efficacious dose versus placebo had a high certainty of 0.9995 for CBD 400 mg and 0.9965 for 800 mg. When abstinent from cannabis, this probability was 0.9966 and 0.9247, respectively. Furthermore, some evidence was found for reduction in cannabis withdrawal symptoms, tobacco use, and depression and anxiety symptoms following CBD compared with placebo. Safety and compliance were both excellent. Dr Freeman warned that these results should not be generalised to CBD wellness products.

1. Freeman TP. Cannabidiol: a novel treatment for cannabis cessation? S.16.03, ECNP 2021 Congress, 2–5 October.
2. Freeman TP, et al. Lancet Psychiatry. 2020;7(10):865–74.

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Posted on 26 November 202117 May 2024