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Effects of topiramate on the association between affect, cannabis craving, and cannabis use in the daily life of youth during a randomized clinical trial

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Abstract

Rationale

Topiramate is an anticonvulsant currently under study for treating substance use disorders. Topiramate is thought to reduce substance use by attenuating craving and the rewarding effects of acute substance use through its concurrent GABAergic agonism and glutamatergic antagonism. Importantly, topiramate also impacts mood states central to many models of substance use. Despite this, little previous research has examined whether topiramate attenuates the respective associations of affect and craving with substance use.

Objectives

We conducted a secondary analysis of 63 youths that exhibited heavy cannabis use, aged 15–24 years, who were randomized in a double-blinded 6-week clinical trial comparing the effects of topiramate (up to 200 mg/day) and placebo on cannabis use. Ecological momentary assessment data were leveraged to model the role positive affect, negative affect, and craving on use over the 6-week period and whether topiramate attenuated associations between these feeling states and cannabis use.

Results

Findings showed that craving was positively associated with use at the within-person level, while positive affect was negatively associated with use at the between-person level. Topiramate appears to attenuate the negative association of between-person positive affect (i.e., average) and cannabis use. Specifically, those in the placebo condition exhibited this inverse association between average positive affect and use while those in topiramate condition did not. No other significant affect or affect × medication condition interactions were observed.

Conclusions

These findings implicate craving and low positive affect as important risk factors for cannabis use in youth in treatment. Topiramate may attenuate this association for positive affect.

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Funding

This research was supported in part by grants from National Institute on Alcohol Abuse and Alcoholism (L30AA027041, PI: Emery; AA007459, MPI: Monti, Miranda; AA028414, PI: Meisel; AA026326, PI: Miranda) and the National Institute on Drug Abuse (DA026778, PI: Miranda; DA016184, PI: Rohsenow).

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Authors and Affiliations

  1. Department of Psychology, Colorado State University, Fort Collins, CO, USA

    Noah N. Emery

  2. Department of Psychological Sciences, University of Missouri St. Louis, St. Louis, MO, USA

    Ryan W. Carpenter

  3. Center for Alcohol and Addiction Studies, Brown University, Box S121-4, Providence, RI, 02912, USA

    Samuel N. Meisel & Robert Miranda Jr

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  1. Noah N. Emery
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  2. Ryan W. Carpenter
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  3. Samuel N. Meisel
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  4. Robert Miranda Jr
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Correspondence to Robert Miranda Jr.

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Some data reported in this study were presented in other published articles. Most notably, the treatment outcomes of this randomized controlled trial were published elsewhere (Miranda et al. 2017). In addition, previous versions of these analyses were presented at the Annual Collaborative Perspectives on Addiction, April 4–6, 2019, Providence, Rhode Island.

This article belongs to a Special Issue on Cannabis and Cannabinoids

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Emery, N.N., Carpenter, R.W., Meisel, S.N. et al. Effects of topiramate on the association between affect, cannabis craving, and cannabis use in the daily life of youth during a randomized clinical trial. Psychopharmacology 238, 3095–3106 (2021). https://doi.org/10.1007/s00213-021-05925-5

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