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Sativex Associated With Behavioral-Relapse Prevention Strategy as Treatment for Cannabis Dependence

A Case Series

Trigo, Jose M. PhD; Soliman, Alexandra PhD; Staios, Gregory MSc; Quilty, Lena PhD; Fischer, Benedikt PhD; George, Tony P. MD; Rehm, Jürgen PhD; Selby, Peter MBBS; Barnes, Allan J. BSc; Huestis, Marilyn A. PhD, MS; Le Foll, Bernard MD, PhD

doi: 10.1097/ADM.0000000000000229
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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, Δ9-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.

Translational Addiction Research Laboratory, Campbell Family Mental Health, Research Institute (JMT, AS, GS, BLF); Clinical Research (LQ); Social and Epidemiological Research Department (BF, JR); Schizophrenia Division and Complex Mental Illness Program, Centre for Addiction and Mental Health (CAMH), Toronto, Canada (TPG); Addiction Policy, Dalla Lana School of Public Health (JR); Institute of Medical Science, University of Toronto, Faculty of Medicine (BF, JR); Department of Psychiatry, University of Toronto, Toronto, Canada (BF, TPG, JR, PS); Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany (JR); Addictions Division, CAMH (PS, BLF); Department of Family and Community Medicine, University of Toronto, Toronto (PS); Centre for Applied Research in Mental Health & Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada (BF); and Chemistry and Drug Metabolism, National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), Baltimore, MD (AJB, MAH).

Send correspondence and reprint requests to Bernard Le Foll, PhD, Centre for Addiction and Mental Health, Canada. E-mail: bernard.lefoll@camh.ca.

Received 13 November, 2015

Accepted 21 March, 2016

Funding: Research reported in this publication was supported by the National Institute On Drug Abuse of the National Institutes of Health under Award Number R21DA031906 (to Dr Le Foll) and in part by Intramural Research Program of National Institute on Drug Abuse, NIH, DHHS.

Disclosure: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The authors report no conflicts of interest.

© 2016 American Society of Addiction Medicine