Cannabis Use Disorders in Primary Care: Screening and Treatment Suggestions
Main Article Content
Abstract
Objective: To review, through case-based learning, the screening for and treatment of cannabis use disorders in primary care. Harm reduction modalities as it pertains to cannabis use are also reviewed.
Methods: PubMed was searched for studies on cannabis use disorders with a specific focus on screening and treatment modalities. The literature cited was reviewed for those relevant studies identified through PubMed.
Results: Problematic cannabis use can be screened for with a single question. A positive screening question can lead to more intensive screening with a validated questionnaire. A high score on a validated questionnaire may lead to examination of the DSMV criteria. Withdrawal symptoms can be treated with synthetic cannabinoids. Maintenance may involve cannabinoids or other medications but the evidence is more mixed for this setting. Harm reduction techniques may be useful in those that are not interested in cutting down or in those that are willing to reduce but not stop cannabis consumption. Brief intervention may be effective in the primary care setting. There are patients who should not use cannabis.
Conclusion: Primary care providers should screen for cannabis use disorders with a single question in those patients presenting with problems that could be related to substance use. More in-depth screening is triggered by a positive response. Withdrawal management, maintenance therapy and harm reduction are all within the scope of primary care providers and should be explored with the patients. If these interventions are unsuccessful, the patient can be referred to an addiction medicine specialist.Article Details
How to Cite
TURNER, Suzanne D.; NADER, Maya; GRAVES, Lisa.
Cannabis Use Disorders in Primary Care: Screening and Treatment Suggestions.
Medical Research Archives, [S.l.], v. 5, n. 7, july 2017.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/1309>. Date accessed: 23 nov. 2024.
Keywords
Cannabis, marijuana, cannabis use disorder, and addiction
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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Gieringer, DH. Cannabis “Vaporization”. Journal Of Cannabis Therapeutics 2001; 1(3): 153-170.
Cascini F, Aiello C, Di Tanna G. Increasing delta-9-tetrahydrocannabinol (Δ-9-THC) content in herbal cannabis over time: systematic review and meta-analysis. Curr Drug Abuse Rev. 2012 Mar;5(1): 32-40.
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Popova L, McDonald EA, Sidhu S, Barry R, Richers Maruyama TA, Sheon NM, Ling PM. Perceived harms and benefits of tobacco, marijuana, and electronic vaporizers among young adults in Colorado: Implications for health education and research. Addiction. 2017 Apr 27. doi: 10.1111/add.13854. [Epub ahead of print]
Freeman TP, Winstock AR.Examining the profile of high-potency cannabis and its association with severity of cannabis dependence. Psychol Med. 2015 Nov;45(15):3181-9.
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Mannucci C, Navarra M, Calapai F, Spagnolo EV, Busardò FP, Da Cas R, Ippolito FM, Calapai G.Neurological aspects of medical use of cannabidiol. CNS Neurol Disord Drug Targets. 2017.
Budney AJ, Roffman R, Stephens RS, Walker D. Marijuana dependence and its treatment. Addict Sci Clin Pract. 2007 Dec; 4(1): 4–16.
Hall W, Pacula RL. Cannabis Use and Dependence. Cambridge: Cambridge University Press; 2003.
Hasin DS, Tulshi DS, Kerridge BT, Goldstein RB, Chou SP, Zhang H. Prevalence of marijuana use disorders in the United States between 2001-2002 and 2012-2013. JAMA Psychiatry. 2015;72(12):1235-1242.
Substance Abuse and Mental Health Services Administration. Substance Use Disorders. [cited 2017 Apr 28]. http://www.ccsa.ca/Eng/topics/Marijuana/Pages/default.aspx. Accessed April 1, 2017.
Hasin DS, Tulshi DS, Kerridge BT, Goldstein RB, Chou SP, Zhang H. Prevalence of marijuana use disorders in the United States between 2001-2002 and 2012-2013.
JAMA Psychiatry. 2015;72(12):1235-1242
Budney AJ, Hughes JR. The cannabis withdrawal syndrome. Curr Opin Psychiatry. 2006 May;19(3):233-8.
Allsop DJ, Bartlett DJ, Johnston J, Helliwell D, Winstock A, McGregor IS, Lintzeris N. The effects of lithium carbonate supplemented with nitrazepam on sleep disturbance during cannabis abstinence. J Clin Sleep Med 2015;11(10):1153 –1162 .
Budney AJ, Roffman R, Stephens RS, Walker D. Marijuana dependence and its treatment. Addict Sci Clin Pract. 2007 Dec; 4(1): 4–16.
Hermann ES, Weerts EM, Vandrey R. Sex differences in cannabis withdrawal in treatment-seeking cannabis users. Exp Clin Psychopharmacol. 2015 December ; 23(6): 415-421.
Hughes JR, Naud S, Budney AJ, FIngar JR, Callas PW. Attempts to Stop or Reduce Daily Cannabis Use: An Intensive Natural History Study. Psychol Addict Behav 2016 May; 30(3): 389-397.
Blankers M, Frijns T, Belackova V, Rossi C, Svensson B, et al. (2014) Predicting Cannabis Abuse Screening Test (CAST) Scores: A Recursive Partitioning Analysis Using Survey Data from Czech Republic, Italy, the Netherlands and Sweden. PLoS ONE 9(9): e108298.
Piontek D, Kraus L, Klempova D. Short scales to assess cannabis-related problems: a review of psychometric properties. Substance Abuse Treatment, Prevention, and Policy 2008, 3:25.
Adamson SJ, Sellman JD. A prototype screening instrument for cannabis use disorder: the Cannabis Use Disorders Identification Test (CUDIT) in an alcohol-dependent clinical sample. Drug and Alcohol Review 2003, 22, 309 – 315.
Adamson SJ, Kay-Lambdin FJ, Baker AL, Lewin TJ, Thornton L, Kelly BJ, Sellman JD. An improved brief measure of cannabis misuse: The Cannabis Use Disorders Identification Test-Revised (CUDIT-R). Drug and Alcohol Dependence 2010; 110: 137–143.
Williams R, Vinson DC. Validation of a single screening question for problem drinking. Journal of Family Practice 2001; 307.
Seale JP, Boltri JM, Shellenberger S, Velasquez MM, Cornelius M, Guyinn M, Okosun I, Sumner H. Primary Care Validation of a Single Screening Question for Drinkers. Journal of Studies on Alcohol. 2006; 67(5), 778–784.
Taj N, Devera-Sales A, Vinson DC. Screening for problem drinking: does a single question work? J Fam Pract. 1998 Apr;46(4):328-35.
Blankers M, Frijns T, Belackova V, Rossi C, Svensson B, et al. (2014) Predicting Cannabis Abuse Screening Test (CAST) Scores: A Recursive Partitioning Analysis Using Survey Data from Czech Republic, Italy, the Netherlands and Sweden. PLoS ONE 9(9): e108298.
Turner SD, Spithoff S, Kahan M. Approach to cannabis use disorder in primary care: focus on youth and other high-risk users. Can Fam Physician. 2014 Sep;60(9):801-8.
American Society of Addiction Medicine. Definition of Addiction [cited 2017 Apr 28]. Available from: http://www.asam.org/quality-practice/definition-of-addiction.
Piontek D1, Kraus L, Klempova D. Short scales to assess cannabis-related problems: a review of psychometric properties. Subst Abuse Treat Prev Policy. 2008 Dec 2;3:25. doi: 10.1186/1747-597X-3-25.
Adamson SJ, Kay-Lambkin FJ, Baker AL, Lewin TJ, Thornton L, Kelly BJ, Sellman JD. An improved brief measure of cannabis misuse: the Cannabis Use Disorders Identification Test-Revised (CUDIT-R). Drug Alcohol Depend. 2010 Jul 1;110(1-2):137-43.
Piontek D1, Kraus L, Klempova D. Short scales to assess cannabis-related problems: a review of psychometric properties. Subst Abuse Treat Prev Policy. 2008 Dec 2;3:25. doi: 10.1186/1747-597X-3-25.
Hasin DS1, O'Brien CP, Auriacombe M, Borges G, Bucholz K, Budney A, Compton WM, Crowley T, Ling W, Petry NM, Schuckit M, Grant BF. DSM-5 criteria for substance use disorders: recommendations and rationale.Am J Psychiatry. 2013 Aug 1; 170(8): 834–851.
Substance Abuse and Mental Health Services Administration. Screening, brief intervention and referral to treatment (SBIRT) [cited 2017 Apr 30]. Available from: https://www.samhsa.gov/sbirt.
Fleming M, Miller WR. Brief Intervention [cited 2017 Apr 27]. Evidenced-based practices for substance use disorders. Available from: http://lib.adai.washington.edu/dbtw-wpd/exec/dbtwpub.dll?BU=http%3A//lib.adai.washington.edu/ebpsearch.htm&TN=EBP&QY=Find+AccessNo=5&RF=Full+Display&DF=Full+Display&NP=3&RL=1&DL=0&XC=/dbtw-wpd/exec/dbtwpub.dll&AC=QBE_QUERY&CS=0.
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Robinson SM, Sobell LC, Sobell MB, Leo GI. Reliability of the Timeline Followback for cocaine, cannabis, and cigarette use. Psychol Addict Behav. 2014 Mar;28(1):154-62.
Hjorthøj CR1, Hjorthøj AR, Nordentoft M. Validity of Timeline Follow-Back for self-reported use of cannabis and other illicit substances--systematic review and meta-analysis. Addict Behav. 2012 Mar;37(3):225-33.
Fischer B, Jeffries V, Hall W, Room R, Goldner E, Rehm J. Lower Risk Cannabis use Guidelines for Canada (LRCUG): a narrative review of evidence and recommendations. Can J Public Health. 2011 Sep-Oct;102(5):324-7.
College of Family Physicians of Canada. Authorizing Dried Cannabis for Chronic Pain or Anxiety: Preliminary Guidance from the College of Family Physicians of Canada. Mississauga, On: College of Family Physicians of Canada; 2014
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Marshall K, Gowing L, Ali R, Le Foll B. Pharmacotherapies for cannabis dependence. Cochrane Database Syst Rev. 2014 December 17; 12: CD008940.
Haney M, Hart CL, Vosburg SK, Nasser J, Bennett A, Zubaran C, Foltin RW. Marijuana withdrawal in humans: effects of oral THC or divalproex. Neuropsychopharmacology. 2004 Jan;29(1):158-70.
Budney AJ, Roffman R, Stephens RS, Walker D. Marijuana dependence and its treatment. Addict Sci Clin Pract. 2007 Dec; 4(1): 4–16.
Trigo JM, Lagzdins D, Rehm J, Selby P, Gamaleddin I, Fischer B, Barnes AJ, Huestis MA, Le Foll B.Effects of fixed or self-titrated dosages of Sativex on cannabis withdrawal and cravings. Drug Alcohol Depend. 2016 Apr 1;161:298-306.
Frewen AR, Baillie AJ, Montebello ME. Are cannabis users who participate in a randomized clinical trial different from other treatment seekers? J Subst Abuse Treat. 2009 Apr;36(3):339-44.
Vandrey R, Smith MT, McCann UD, Budney AJ, Curran EM. Sleep disturbance and the effects of extended-release zolpidem during cannabis withdrawal. Drug Alcohol Depend. 2011 Aug 1;117(1):38-44.
Allsop DJ, Bartlett DJ, Johnston J, Helliwell D, Winstock A, McGregor IS, Lintzeris N. The effects of lithium carbonate supplemented with nitrazepam on sleep disturbance during cannabis abstinence. J Clin Sleep Med 2015;11(10):1153 –1162 .
Mason, B.J., et al., A proof-of-concept randomized controlled study of gabapentin: effects on cannabis use, withdrawal and executive function deficits in cannabis-dependent adults. Neuropsychopharmacology, 2012. 37(7): p. 1689-98.
Gray KM, Carpenter MJ, Baker NL, DeSantis SM, Kryway E, Hartwell KJ, McRae-Clark AL, Brady KT. A double-blind randomized controlled trial of N-acetylcysteine in cannabis-dependent adolescents. Am J Psychiatry. 2012 Aug;169(8):805-12.
Marshall K, Gowing L, Ali R, Le Foll B. Pharmacotherapies for cannabis dependence. Cochrane Database Syst Rev. 2014 December 17; 12: CD008940.
Quello, SB, Brady, KT, Sonne, SC. Mood Disorders and Substance Use Disorder: A Complex Comorbidity. Sci Pract Perspect. 2005 Dec; 3(1): 13–21.
Hart CL1, Ward AS, Haney M, Comer SD, Foltin RW, Fischman MW.
Comparison of smoked marijuana and oral Delta(9)-tetrahydrocannabinol in humans. Psychopharmacology (Berl). 2002 Dec;164(4):407-15.
Hart CL1, Haney M, Ward AS, Fischman MW, Foltin RW. Effects of oral THC maintenance on smoked marijuana self-administration. Drug Alcohol Depend. 2002 Aug 1;67(3):301-9.
Levin FR, Mariani JJ, Brooks DJ, Pavlicova M, Cheng W, Nunes EV. Dronabinol for the treatment of cannabis dependence: a randomized, double-blind, placebo-controlled trial. Drug Alcohol Depend. 2011 Jul 1;116(1-3):142-50.
McRae-Clark AL, Carter RE, Killeen TK, Carpenter MJ, Whalquist AE, Simpson SA, Brady KT. A Placebo-Controlled Trial of Buspirone for the Treatment of Marijuana Dependence. Drug Alcohol Depend. 2009 Nov 1; 105(1-2): 132–138.
Levin FR, Mariani JJ, Pavlicova M, Brooks D, Glass A, Mahony A, et al. Dronabinol and Lofexidine for Cannabis Use Disorder: A Randomized, Double-Blind, Placebo-Controlled Trial. Drug Alcohol Depend._2016 February 1; 159: 53-60.
Marshall K, Gowing L, Ali R, Le Foll B. Pharmacotherapies for cannabis dependence. Cochrane Database Syst Rev. 2014 December 17; 12: CD008940.
Substance Abuse and Mental Health Services Administration. Substance Use Disorders. [cited 2017 Apr 28]. http://www.ccsa.ca/Eng/topics/Marijuana/Pages/default.aspx. Accessed April 1, 2017.
Copeland J. Cannabis use and its associated disorders: clinical care. Australian Family Physician. 2016 Dec. 45 (12): 874-877.
Gieringer, DH. Cannabis “Vaporization”. Journal Of Cannabis Therapeutics 2001; 1(3): 153-170.
Cascini F, Aiello C, Di Tanna G. Increasing delta-9-tetrahydrocannabinol (Δ-9-THC) content in herbal cannabis over time: systematic review and meta-analysis. Curr Drug Abuse Rev. 2012 Mar;5(1): 32-40.
American Chemical Society. Legalizing marijuana and the new science of weed. 2015 Mar 23 [cited Apr 30, 2017]. Available from: https://www.acs.org/content/acs/en/pressroom/newsreleases/2015/march/legalizing-marijuana-and-the-new-science-of-weed-video.html.
Popova L, McDonald EA, Sidhu S, Barry R, Richers Maruyama TA, Sheon NM, Ling PM. Perceived harms and benefits of tobacco, marijuana, and electronic vaporizers among young adults in Colorado: Implications for health education and research. Addiction. 2017 Apr 27. doi: 10.1111/add.13854. [Epub ahead of print]
Freeman TP, Winstock AR.Examining the profile of high-potency cannabis and its association with severity of cannabis dependence. Psychol Med. 2015 Nov;45(15):3181-9.
Government of Canada. About cannabis. [cited 2017 Apr 30]. Available from: https://www.canada.ca/en/health-canada/services/substance-abuse/controlled-illegal-drugs/about-marijuana.html#s3.
Iversen LL. The science of marijuana. 2nd ed. New York, NY: Oxford University Press; 2008.
Mannucci C, Navarra M, Calapai F, Spagnolo EV, Busardò FP, Da Cas R, Ippolito FM, Calapai G.Neurological aspects of medical use of cannabidiol. CNS Neurol Disord Drug Targets. 2017.
Budney AJ, Roffman R, Stephens RS, Walker D. Marijuana dependence and its treatment. Addict Sci Clin Pract. 2007 Dec; 4(1): 4–16.
Hall W, Pacula RL. Cannabis Use and Dependence. Cambridge: Cambridge University Press; 2003.
Hasin DS, Tulshi DS, Kerridge BT, Goldstein RB, Chou SP, Zhang H. Prevalence of marijuana use disorders in the United States between 2001-2002 and 2012-2013. JAMA Psychiatry. 2015;72(12):1235-1242.
Substance Abuse and Mental Health Services Administration. Substance Use Disorders. [cited 2017 Apr 28]. http://www.ccsa.ca/Eng/topics/Marijuana/Pages/default.aspx. Accessed April 1, 2017.
Hasin DS, Tulshi DS, Kerridge BT, Goldstein RB, Chou SP, Zhang H. Prevalence of marijuana use disorders in the United States between 2001-2002 and 2012-2013.
JAMA Psychiatry. 2015;72(12):1235-1242
Budney AJ, Hughes JR. The cannabis withdrawal syndrome. Curr Opin Psychiatry. 2006 May;19(3):233-8.
Allsop DJ, Bartlett DJ, Johnston J, Helliwell D, Winstock A, McGregor IS, Lintzeris N. The effects of lithium carbonate supplemented with nitrazepam on sleep disturbance during cannabis abstinence. J Clin Sleep Med 2015;11(10):1153 –1162 .
Budney AJ, Roffman R, Stephens RS, Walker D. Marijuana dependence and its treatment. Addict Sci Clin Pract. 2007 Dec; 4(1): 4–16.
Hermann ES, Weerts EM, Vandrey R. Sex differences in cannabis withdrawal in treatment-seeking cannabis users. Exp Clin Psychopharmacol. 2015 December ; 23(6): 415-421.
Hughes JR, Naud S, Budney AJ, FIngar JR, Callas PW. Attempts to Stop or Reduce Daily Cannabis Use: An Intensive Natural History Study. Psychol Addict Behav 2016 May; 30(3): 389-397.
Blankers M, Frijns T, Belackova V, Rossi C, Svensson B, et al. (2014) Predicting Cannabis Abuse Screening Test (CAST) Scores: A Recursive Partitioning Analysis Using Survey Data from Czech Republic, Italy, the Netherlands and Sweden. PLoS ONE 9(9): e108298.
Piontek D, Kraus L, Klempova D. Short scales to assess cannabis-related problems: a review of psychometric properties. Substance Abuse Treatment, Prevention, and Policy 2008, 3:25.
Adamson SJ, Sellman JD. A prototype screening instrument for cannabis use disorder: the Cannabis Use Disorders Identification Test (CUDIT) in an alcohol-dependent clinical sample. Drug and Alcohol Review 2003, 22, 309 – 315.
Adamson SJ, Kay-Lambdin FJ, Baker AL, Lewin TJ, Thornton L, Kelly BJ, Sellman JD. An improved brief measure of cannabis misuse: The Cannabis Use Disorders Identification Test-Revised (CUDIT-R). Drug and Alcohol Dependence 2010; 110: 137–143.
Williams R, Vinson DC. Validation of a single screening question for problem drinking. Journal of Family Practice 2001; 307.
Seale JP, Boltri JM, Shellenberger S, Velasquez MM, Cornelius M, Guyinn M, Okosun I, Sumner H. Primary Care Validation of a Single Screening Question for Drinkers. Journal of Studies on Alcohol. 2006; 67(5), 778–784.
Taj N, Devera-Sales A, Vinson DC. Screening for problem drinking: does a single question work? J Fam Pract. 1998 Apr;46(4):328-35.
Blankers M, Frijns T, Belackova V, Rossi C, Svensson B, et al. (2014) Predicting Cannabis Abuse Screening Test (CAST) Scores: A Recursive Partitioning Analysis Using Survey Data from Czech Republic, Italy, the Netherlands and Sweden. PLoS ONE 9(9): e108298.
Turner SD, Spithoff S, Kahan M. Approach to cannabis use disorder in primary care: focus on youth and other high-risk users. Can Fam Physician. 2014 Sep;60(9):801-8.
American Society of Addiction Medicine. Definition of Addiction [cited 2017 Apr 28]. Available from: http://www.asam.org/quality-practice/definition-of-addiction.
Piontek D1, Kraus L, Klempova D. Short scales to assess cannabis-related problems: a review of psychometric properties. Subst Abuse Treat Prev Policy. 2008 Dec 2;3:25. doi: 10.1186/1747-597X-3-25.
Adamson SJ, Kay-Lambkin FJ, Baker AL, Lewin TJ, Thornton L, Kelly BJ, Sellman JD. An improved brief measure of cannabis misuse: the Cannabis Use Disorders Identification Test-Revised (CUDIT-R). Drug Alcohol Depend. 2010 Jul 1;110(1-2):137-43.
Piontek D1, Kraus L, Klempova D. Short scales to assess cannabis-related problems: a review of psychometric properties. Subst Abuse Treat Prev Policy. 2008 Dec 2;3:25. doi: 10.1186/1747-597X-3-25.
Hasin DS1, O'Brien CP, Auriacombe M, Borges G, Bucholz K, Budney A, Compton WM, Crowley T, Ling W, Petry NM, Schuckit M, Grant BF. DSM-5 criteria for substance use disorders: recommendations and rationale.Am J Psychiatry. 2013 Aug 1; 170(8): 834–851.
Substance Abuse and Mental Health Services Administration. Screening, brief intervention and referral to treatment (SBIRT) [cited 2017 Apr 30]. Available from: https://www.samhsa.gov/sbirt.
Fleming M, Miller WR. Brief Intervention [cited 2017 Apr 27]. Evidenced-based practices for substance use disorders. Available from: http://lib.adai.washington.edu/dbtw-wpd/exec/dbtwpub.dll?BU=http%3A//lib.adai.washington.edu/ebpsearch.htm&TN=EBP&QY=Find+AccessNo=5&RF=Full+Display&DF=Full+Display&NP=3&RL=1&DL=0&XC=/dbtw-wpd/exec/dbtwpub.dll&AC=QBE_QUERY&CS=0.
National Institute on Drug Abuse. Time-line Follow-back Sample Form. Available from: https://cde.drugabuse.gov/sites/nida_cde/files/TimeLineFollowBack_2014Mar24.pdf
Robinson SM, Sobell LC, Sobell MB, Leo GI. Reliability of the Timeline Followback for cocaine, cannabis, and cigarette use. Psychol Addict Behav. 2014 Mar;28(1):154-62.
Hjorthøj CR1, Hjorthøj AR, Nordentoft M. Validity of Timeline Follow-Back for self-reported use of cannabis and other illicit substances--systematic review and meta-analysis. Addict Behav. 2012 Mar;37(3):225-33.
Fischer B, Jeffries V, Hall W, Room R, Goldner E, Rehm J. Lower Risk Cannabis use Guidelines for Canada (LRCUG): a narrative review of evidence and recommendations. Can J Public Health. 2011 Sep-Oct;102(5):324-7.
College of Family Physicians of Canada. Authorizing Dried Cannabis for Chronic Pain or Anxiety: Preliminary Guidance from the College of Family Physicians of Canada. Mississauga, On: College of Family Physicians of Canada; 2014
Centre for Addiction and Mental Health. Cannabis Policy Framework [cited 2017 Apr 28]. Available from: https://www.camh.ca/en/hospital/about_camh/influencing_public_policy/documents/camhcannabispolicyframework.pdf
Marshall K, Gowing L, Ali R, Le Foll B. Pharmacotherapies for cannabis dependence. Cochrane Database Syst Rev. 2014 December 17; 12: CD008940.
Haney M, Hart CL, Vosburg SK, Nasser J, Bennett A, Zubaran C, Foltin RW. Marijuana withdrawal in humans: effects of oral THC or divalproex. Neuropsychopharmacology. 2004 Jan;29(1):158-70.
Budney AJ, Roffman R, Stephens RS, Walker D. Marijuana dependence and its treatment. Addict Sci Clin Pract. 2007 Dec; 4(1): 4–16.
Trigo JM, Lagzdins D, Rehm J, Selby P, Gamaleddin I, Fischer B, Barnes AJ, Huestis MA, Le Foll B.Effects of fixed or self-titrated dosages of Sativex on cannabis withdrawal and cravings. Drug Alcohol Depend. 2016 Apr 1;161:298-306.
Frewen AR, Baillie AJ, Montebello ME. Are cannabis users who participate in a randomized clinical trial different from other treatment seekers? J Subst Abuse Treat. 2009 Apr;36(3):339-44.
Vandrey R, Smith MT, McCann UD, Budney AJ, Curran EM. Sleep disturbance and the effects of extended-release zolpidem during cannabis withdrawal. Drug Alcohol Depend. 2011 Aug 1;117(1):38-44.
Allsop DJ, Bartlett DJ, Johnston J, Helliwell D, Winstock A, McGregor IS, Lintzeris N. The effects of lithium carbonate supplemented with nitrazepam on sleep disturbance during cannabis abstinence. J Clin Sleep Med 2015;11(10):1153 –1162 .
Mason, B.J., et al., A proof-of-concept randomized controlled study of gabapentin: effects on cannabis use, withdrawal and executive function deficits in cannabis-dependent adults. Neuropsychopharmacology, 2012. 37(7): p. 1689-98.
Gray KM, Carpenter MJ, Baker NL, DeSantis SM, Kryway E, Hartwell KJ, McRae-Clark AL, Brady KT. A double-blind randomized controlled trial of N-acetylcysteine in cannabis-dependent adolescents. Am J Psychiatry. 2012 Aug;169(8):805-12.
Marshall K, Gowing L, Ali R, Le Foll B. Pharmacotherapies for cannabis dependence. Cochrane Database Syst Rev. 2014 December 17; 12: CD008940.
Quello, SB, Brady, KT, Sonne, SC. Mood Disorders and Substance Use Disorder: A Complex Comorbidity. Sci Pract Perspect. 2005 Dec; 3(1): 13–21.
Hart CL1, Ward AS, Haney M, Comer SD, Foltin RW, Fischman MW.
Comparison of smoked marijuana and oral Delta(9)-tetrahydrocannabinol in humans. Psychopharmacology (Berl). 2002 Dec;164(4):407-15.
Hart CL1, Haney M, Ward AS, Fischman MW, Foltin RW. Effects of oral THC maintenance on smoked marijuana self-administration. Drug Alcohol Depend. 2002 Aug 1;67(3):301-9.
Levin FR, Mariani JJ, Brooks DJ, Pavlicova M, Cheng W, Nunes EV. Dronabinol for the treatment of cannabis dependence: a randomized, double-blind, placebo-controlled trial. Drug Alcohol Depend. 2011 Jul 1;116(1-3):142-50.
McRae-Clark AL, Carter RE, Killeen TK, Carpenter MJ, Whalquist AE, Simpson SA, Brady KT. A Placebo-Controlled Trial of Buspirone for the Treatment of Marijuana Dependence. Drug Alcohol Depend. 2009 Nov 1; 105(1-2): 132–138.
Levin FR, Mariani JJ, Pavlicova M, Brooks D, Glass A, Mahony A, et al. Dronabinol and Lofexidine for Cannabis Use Disorder: A Randomized, Double-Blind, Placebo-Controlled Trial. Drug Alcohol Depend._2016 February 1; 159: 53-60.
Marshall K, Gowing L, Ali R, Le Foll B. Pharmacotherapies for cannabis dependence. Cochrane Database Syst Rev. 2014 December 17; 12: CD008940.