Study register · detailSystematische Review · Addiction · 2020
Pharmacotherapy for the Treatment of Cannabis Use Disorder: A Systematic Review.
Kondo et al.·Annals of Internal MedicineImpact 4.3
No benefit demonstratedGRADEHigh57 citations
Samplek = 26 Studien
ControlPlacebo or active comparators
EndpointCannabis…
Blindingunklar
DesignSystematische Review
”Key finding
None of the investigated drug classes (SSRIs, buspirone, cannabinoids) showed consistent efficacy in the treatment of CUD.
Summary
Systematic review (k=26 trials, PROSPERO CRD42018108064) on pharmacotherapy of cannabis use disorder: moderate evidence that cannabinoids do NOT increase abstinence rate (moderate SOE); low evidence that cannabinoids do not reduce consumption (low SOE) and do not improve treatment retention (low SOE). SSRIs: low-SOE evidence for lack of efficacy; buspirone: no improvement in outcomes. No consistent evidence of increased harm across all substance classes.
P
PopulationAdults and adolescents with cannabis use disorder (CUD)
I
InterventionPharmacotherapies for CUD (cannabinoids, SSRIs, buspirone, among others)
C
ControlPlacebo or active comparators (depending on individual study)
O
OutcomeEvidence predominantly insufficient; low evidence against efficacy of SSRIs; low to moderate evidence against efficacy of buspirone; moderate evidence that cannabinoids do not increase abstinence rate
Confidence in the evidence
Very lowLowModerateHigh
High
The highest of four GRADE levels, the effect estimate is very reliable.
Quality profile
Sample size★★★★★
Blinding—
Effect sizeNo benefit
Citations / year★★★★★
Authors
Kondo KK, Morasco BJ, Nugent SM, Ayers CK, O'Neil ME, Freeman M, Kansagara D.
<h4>Background</h4>Cannabis use disorder (CUD) is a growing concern, and evidence-based data are needed to inform treatment options.<h4>Purpose</h4>To review the benefits and risks of pharmacotherapies for the treatment of CUD.<h4>Data sources</h4>MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, and clinical trial registries from inception through September 2019.<h4>Study selection</h4>Pharmacotherapy trials of adults or adolescents with CUD that targeted cannabis abstinence or reduction, treatment retention, withdrawal symptoms, and other outcomes.<h4>Data extraction</h4>Data were abstracted by 1 investigator and confirmed by a second. Study quality was dually assessed, and strength of evidence (SOE) was determined by consensus according to standard criteria.<h4>Data synthesis</h4>Across 26 trials, the evidence was largely insufficient. Low-strength evidence was found that selective serotonin reuptake inhibitors (SSRIs) do not reduce cannabis use or improve treatment retention. Low- to moderate-strength evidence was found that buspirone does not improve outcomes and that cannabinoids do not increase abstinence rates (moderate SOE), reduce cannabis use (low SOE), or increase treatment retention (low SOE). Across all drug studies, no consistent evidence of increased harm was found.<h4>Limitations</h4>Few methodologically rigorous trials have been done. Existing trials are hampered by small sample sizes, high attrition rates, and heterogeneity of concurrent interventions and outcomes assessment.<h4>Conclusion</h4>Although data on pharmacologic interventions for CUD are scarce, evidence exists that several drug classes, including cannabinoids and SSRIs, are ineffective. Because of increasing access to and use of cannabis in the general population, along with a high prevalence of CUD among current cannabis users, an urgent need exists for more research to identify effective pharmacologic treatments.<h4>Primary funding source</h4>U.S. Department of Veterans Affairs. (PROSPERO: CRD42018108064).