Sativex Associated With Behavioral-Relapse Prevention Strategy as Treatment for Cannabis Dependence: A Case Series

Abstract

Objectives: Cannabis is the most commonly used illicit drug; a substantial minority of users develop dependence. The current lack of pharmacological treatments for cannabis dependence warrants the use of novel approaches and further investigation of promising pharmacotherapy. In this case series, we assessed the use of self-titrated dosages of Sativex (1:1, Δ-tetrahydrocannabinol [THC]/cannabidiol [CBD] combination) and motivational enhancement therapy and cognitive behavioral therapy (MET/CBT) for the treatment of cannabis dependence among 5 treatment-seeking community-recruited cannabis-dependent subjects.

Methods: Participants underwent a 3-month open-label self-titration phase with Sativex (up to 113.4 of THC/105 mg of CBD) and weekly MET/CBT, with a 3-month follow-up.

Results: Sativex was well-tolerated by all participants (average dosage 77.5 THC/71.7 mg CBD). The combination of Sativex and MET/CBT reduced the amount of cannabis use and progressively reduced craving and withdrawal scores. THC/CBD metabolite concentration indicated reduced cannabis use and compliance with medication.

Conclusions: In summary, this pilot study found that with Sativex in combination with MET/CBT reduced cannabis use while preventing increases in craving and withdrawal in the 4 participants completing the study. Further systematic exploration of Sativex as a pharmacological treatment option for cannabis dependence should be performed.

Figure 1. Effects of Sativex and Motivational Enhancement Therapy / Cognitive Behavioral Therapy (MET/CBT) intervention on cannabis dependence

Columns represent average values (+SEM) for the four participants completing treatment and follow-up phases: a) cannabis intake (g) per week as reported on the timeline followback (TLFB), b) Sativex self-titration (sprays/week) as reported in the smoking diary, c) craving for cannabis was determined using the Cannabis Craving Questionnaire (CCQ), d) cannabis withdrawal was measured using the Cannabis Withdrawal Checklist (CWC). Cannabinoids of interest in urine were quantified using a two-dimensional gas chromatography-mass spectrometry method (2D-GCMS), e) creatinine-normalized urine ∆9-tetrahydrocannabinol (THC) concentrations, f) creatinine-normalized urine cannabidiol (CBD) concentrations. * (p<0.05), ** (p<0.01) vs baseline. Repeated measures ANOVA followed by pairwise comparisons.