Nabilone 2 mg/day did not reduce cannabis use significantly more than placebo.
Summary
Pilot RCT (n=18 adults with DSM-IV cannabis dependence); nabilone 2 mg/day vs. placebo over 10 weeks; both groups reduced cannabis use, but no significant difference between nabilone and placebo (p not significant by self-report and urine test). Nabilone well tolerated; 8 adverse events (all mild-moderate) in the nabilone group vs. 6 in the placebo group; no serious adverse events.
P
PopulationAdults with DSM-IV cannabis dependence, n=18 (completers: n=12)
I
InterventionNabilone 2 mg/day orally, 10 weeks, plus medication management
C
ControlPlacebo orally, 10 weeks, plus medication management
O
OutcomeNo statistically significant reduction in cannabis use (self-report) and no group difference between nabilone and placebo; both groups generally reported reduced use
Confidence in the evidence
Very lowLowModerateHigh
Moderate
The third of four GRADE levels, the effect estimate is probably reliable.
Downgraded for
Imprecision
Quality profile
Sample size★★★★★
BlindingDouble-blind
Effect sizeNo benefit
Citations / year★★★★★
Authors
Hill KP, Palastro MD, Gruber SA, Fitzmaurice GM, Greenfield SF, Lukas SE, Weiss RD.
<h4>Background and objectives</h4>We assessed the safety, tolerability, and preliminary efficacy of nabilone, a cannabinoid agonist, to treat cannabis dependence.<h4>Methods</h4>Eighteen adults with DSM-IV cannabis dependence were randomized to receive either 2 mg/day of nabilone (n = 10) or placebo (n = 8) for 10 weeks in addition to medication management. Twelve participants, six in each group, completed treatment. The safety and tolerability of nabilone was assessed at each visit. Any side effects from nabilone or the placebo were documented. Cannabis use outcomes were assessed via self-report of days of use and twice-weekly urine cannabinoid tests; secondary outcomes included cannabis craving and anxiety.<h4>Results</h4>We assessed safety and tolerability at each study visit. A total of eight adverse events, all mild or moderate, were reported in two participants in the nabilone group, and six events were reported in four participants in the placebo group during study treatment. A total of eight adverse events were reported in two participants in the nabilone group and six events were reported in four participants in the placebo group during study treatment. All reported adverse events were rated mild-to-moderate. There were no side effects deemed serious enough to be classified as an FDA-defined serious adverse event. In general, participants in both groups reported reduced cannabis use according to self-report over the course of the study, although these reductions were not statistically discernible. Moreover, there was no difference in cannabis use between the nabilone group and the placebo group as measured by self-report.<h4>Discussion and conclusions</h4>Nabilone pharmacotherapy was safe and well-tolerated in participants with cannabis dependence. Future studies might evaluate a higher dose of nabilone to determine its effects on cannabis use outcomes in participants with cannabis dependence.<h4>Scientific significance</h4>There remains a clear need for additional pharmacotherapy trials for cannabis dependence, and nabilone remains a candidate for such trials. (Am J Addict 2017;26:795-801).