Anticonvulsants to Treat Cannabis Use Disorder
The purpose of this chapter is to review the evidence for the efficacy and safety of anticonvulsants for reducing cannabis use and withdrawal symptoms, compared to placebo. A comprehensive literature search of PubMed and related databases and reference lists of obtained publications was performed. The search yielded four completed prospective pilot studies evaluating divalproex sodium (Depakote), gabapentin (Neurontin), and topiramate (Topamax) for therapeutic potential in cannabis use disorder. For three studies the average age was 30.1 years; one study targeted youth. About 78% of study participants were male. Studies were double-blind, placebo-controlled with random assignment to treatments. Cannabis use was measured by both urine toxicology and self-report. Medication adherence was verified by drug plasma level. Divalproex and topiramate generally did not show efficacy for reducing cannabis use and were poorly tolerated. Both drugs were associated with adverse drug reactions involving neurocognitive impairment and symptoms of negative affect such as depression, anxiety, and irritability. Gabapentin showed benefits over placebo in decreasing cannabis use and withdrawal symptoms, including cannabis craving, negative affect, and sleep disturbance, and was well-tolerated. Findings support further evaluation of gabapentin as a treatment for cannabis use disorder.
KeywordsAnticonvulsants Cannabis abuse Cannabis dependence Cannabis use disorder Cannabis withdrawal Divalproex Gabapentin Pharmacotherapy Topiramate Valproate
Appreciation is expressed to Sam Reed for his editorial assistance in the preparation of this chapter.
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