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Nicotine patch for cannabis withdrawal symptom relief: a randomized controlled trial



Given that tetrahydrocannabinol (THC) and nicotine have similar effects on negative affect (NA), we hypothesized that a 7-mg nicotine patch (NP) would reduce NA-related cannabis (CAN) withdrawal symptoms in cannabis-dependent (CD) individuals who were not nicotine dependent.


We sought to determine whether NP reduces NA across 15 days of CAN abstinence in two groups: non-tobacco smokers (NTS) and light tobacco smokers (LTS).


CD participants (N = 127; aged 18–35) who used CAN at least 5 times/week for the past 12 + months were randomized to (1) NP or (2) a placebo patch (PP) and received $300 for sustained biochemically verified CAN abstinence. Of those randomly assigned, 52 of 63 NP, and 56 of 64 PP maintained biochemically verified CAN abstinence and 51 NP and 50 PP participants complied with all aspects of the study. Affect and other withdrawal symptoms were measured every 48 h across 15 days of CAN abstinence.


After controlling for age, tobacco use, baseline THC concentration, and baseline measurements of the dependent variable, NP reduced NA symptoms across the 15-day treatment relative to PP. Differences in NA and CAN withdrawal symptoms were not moderated by tobacco user status.


The findings provide the first evidence that NP may be able to attenuate NA-related withdrawal symptoms in individuals with cannabis use disorder who are not heavy users of tobacco or nicotine.

Clinical trials registry

NCT01400243 http://www.clinicaltrials.gov

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We thank Quincy Scott, our study physician, John D. Lindt, and the dozens of undergraduate and graduate research assistants who helped conduct this study, and without whom, it would have been impossible to complete.


The study was supported by NIH grant R01DA031006 awarded to David Gilbert.

Author information

The study was designed by DGG and NER. The data were acquired by DGG and NER. The analyses were conducted by DGG and JTM. The manuscript was drafted by DGG, NER, and JTM. Each author contributed to critical revisions and approval of the final version of the manuscript. Funding was obtained by DGG. Supervision of the study was done by DGG and NER.

Correspondence to David G. Gilbert.

Ethics declarations

DGG, NER, and JTM had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of interest

David Gilbert ended grant funding and all other connections with or benefits from R. J. Reynolds Tobacco Company in 1997 and has not received funding from any source other than the National Institutes of Health since that time. Prior to 2000 the first author received free nicotine and placebo patches from Glaxo-Smith Kline and received a consultation fee in 2003 and co-authorship on two manuscripts from Pfizer in 2004 and 2007 dealing with tobacco smoking withdrawal symptoms. Norka Rabinovich worked with several grant projects from R. J. Reynolds prior to the termination of funding from RJR in 1997. Justin McDaniel has no conflict of interest.

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Gilbert, D.G., Rabinovich, N.E. & McDaniel, J.T. Nicotine patch for cannabis withdrawal symptom relief: a randomized controlled trial. Psychopharmacology (2020). https://doi.org/10.1007/s00213-020-05476-1

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  • Cannabis
  • Marijuana
  • Withdrawal symptoms
  • Negative affect
  • Nicotine
  • Smoking
  • Testing effect
  • THC