Men and People With Sleep Issues Are Less Likely to Recover From Cannabis Dependency, Study Suggests

Previous research has shown that cannabis use disorder (CUD) can be treated with a combination of counseling and cannabis medicines with a 1:1 ratio of CBD and THC.

But men and people with sleep issues may benefit from additional support, new analysis suggests.

In 2019, researchers from the University of Sydney previously published the results of a randomized placebo-controlled trial of nabiximols (cannabis medicines with a 1:1 ratio of CBD and THC) for CUD, finding that the use of nabiximols alongside counseling helped to reduce the number of days in which participants (who were actively trying to quit cannabis) used cannabis during the trial period.

In a new piece of secondary analysis, published recently in the journal Substance Abuse Treatment, Prevention, and Policy, the researchers found that greater counseling attendance and the use of nabiximols were both positively associated with increased odds of significantly reducing cannabis use.

However, men were the least likely to attend counseling and those with sleep issues had worse odds of reducing their cannabis use, suggesting that these demographics may benefit from extra attention.

Cannabinoid medicines help treat cannabis dependence

The randomized controlled trial (RCT) had recruited a total of 128 participants from specialist alcohol and drug treatment services. Each participant had a cannabis dependency and were actively seeking treatment after prior treatment attempts were unsuccessful. The participants were randomized to receive either oral mucosal sprays of a nabiximol or a placebo, in addition to regular counseling appointments over a 12-week study period.

Seventeen of the 128 participants achieved complete abstinence during weeks 9-12, with a further 31 participants reporting a greater-than 50% reduction in cannabis use days compared to baseline. Overall, the researchers observed that the group given nabiximols reported significantly fewer cannabis usage days than the placebo group, and the nabiximols were well-tolerated and caused few adverse events.

“This is the first study with sufficient power to allow us to draw conclusions regarding the efficacy of cannabinoid medicines for outpatient treatment of cannabis dependence,” Nick Lintzeris, the study’s lead author and professor of addiction at the University of Sydney, told Analytical Cannabis at the time.

“The counseling and regular reviews had some benefits – but that these are enhanced when combined with active medication” he added. “This is a finding generally consistent with the evidence from other areas of health care – that combined medication and counseling is often more effective than either approach alone.”

Nabiximols increase odds of significant cannabis use reduction

The new secondary analysis sought to determine how treatment engagement was associated with participants’ characteristics at baseline, and also how these characteristics may affect various cannabis-related treatment outcomes, such as abstinence or significant reductions in cannabis use days.

The researchers found that attendance at counseling sessions was associated with reduced overall cannabis use. However, it was unclear what direction this association may be acting in. It could be that counseling gave participants the necessary skills to reduce their cannabis use, the researchers suggest, or it may be that those who reduced their use were more motivated to engage in treatment.

The researchers also found that the group given nabiximols had higher odds of attending any given counseling session than the placebo group and were at a lower hazard of dropping out of treatment. Receiving nabiximols was also associated with increased odds of reporting a greater-than 50% reduction in cannabis use days.

Some demographics may need more support

In terms of particular demographics or baseline characteristics, the researchers noted several interesting associations.

Firstly, participants who had longer lifetime durations of cannabis use were less likely to drop out of treatment and were more likely to significantly reduce their cannabis use. Similarly, those who reported using greater quantities of cannabis prior to their involvement in the study were more likely to remain in treatment and attend more counseling sessions, though they did also use higher doses of the nabiximol spray.

The researchers say these findings would suggest that individuals with more severe cannabis dependance are still likely to engage in more intensive treatment, which is encouraging.

They also observed that female and non-binary individuals were more likely to attend any given counseling session than men. Given the association between these sessions and reductions in use, the researchers suggest that an increased effort to engage with male CUD patients could help to improve treatment outcomes in clinical practice.

The analysis also revealed that individuals who reported greater pain levels at baseline were more likely to reduce their number of cannabis use days but also used higher doses of nabiximol medicines over the study period, suggesting they may be substituting their cannabis use for nabiximols. Interestingly, the same was not seen in individuals with pre-existing sleep issues (such as insomnia), who were less likely overall to reduce their cannabis use.

Treating cannabis use disorder

It is estimated that around 22 million people worldwide currently live with CUD. People with CUD often suffer from uncomfortable cravings and physical withdrawal symptoms.

In the past, it was thought that CUD generally affected recreational cannabis users, particularly recreational users with a frequent or heavy use pattern. But more recent research has shown that CUD is just as prevalent among individuals who are self-medicating for medicinal purposes.

For example, in a study published earlier this year, researchers in Australia surveyed more than 900 people who were self-medicating with illicit cannabis to treat a medical condition. They found that around one-third (32%) of respondents described their relationship with cannabis in a manner consistent with the criteria for CUD. Around 13% of the survey participants met the criteria for moderate-to-severe CUD.

In the search for an effective treatment for CUD, turning to cannabinoids might seem like an unlikely answer. But so far research into nabiximols and CBD seems to support the idea that these drugs can be used in conjunction with psychological counseling to address cannabis dependence.