Nabiximols (Sativex), containing both THC and CBD, is being investigated as a cannabinoid replacement therapy for cannabis dependence, similar to how methadone is used for opioid dependence.
Read this if you are struggling to quit cannabis and want to know about emerging pharmacological treatments.
Cannabinoid replacement therapy: controlled THC/CBD to manage cannabis withdrawal and craving
What the researchers found
The review outlines a novel approach to treating cannabis dependence using nabiximols (Sativex), a buccal spray containing THC and CBD. The rationale is analogous to opioid substitution therapy: providing a controlled, pharmaceutical-grade cannabinoid formulation to manage withdrawal and craving while patients engage in behavioral treatment.
The advantages of nabiximols over smoked cannabis include: controlled dosing, pharmaceutical-grade standardization, slower onset (reducing abuse potential), inclusion of CBD (which may modulate THC effects and has anxiolytic properties), and a delivery method that avoids the harms of smoking.
Recent research findings relevant to clinical practice are reviewed, though the approach remains investigational.
Why it matters
Cannabis dependence treatment currently has no FDA-approved medications. Cannabinoid replacement therapy represents a paradigm shift that applies lessons learned from opioid substitution therapy to cannabis treatment, potentially offering a new evidence-based approach.
The numbers in context
Nabiximols contains THC and CBD in approximately 1:1 ratio. Delivered as buccal spray. Approach modeled on opioid substitution therapy (methadone, buprenorphine).
How the study worked
This is a narrative review outlining the rationale and evidence for using nabiximols as a cannabinoid replacement therapy. It reviews the pharmacological basis for the approach and recent relevant research.
What this study cannot tell us
Clinical trial evidence for this approach was limited at the time of publication. The regulatory pathway for using a cannabinoid to treat cannabinoid dependence is complex. Long-term outcomes, optimal treatment duration, and appropriate patient selection criteria are unknown.
How to read the evidence
This is a narrative review proposing a novel treatment approach with limited but promising clinical evidence.
When this study was published
Published in 2015. Clinical trials of nabiximols for cannabis dependence have continued, with some positive results.
The bigger picture
The concept of using a controlled cannabinoid to treat cannabis dependence has historical parallels in the successful use of methadone and buprenorphine for opioid dependence. If effective, cannabinoid replacement therapy could fill a significant treatment gap.
Questions still open
- Would cannabinoid replacement therapy improve treatment retention? Is the CBD component essential or would THC alone suffice? What is the optimal treatment duration before tapering?
Common questions
How is this different from just using cannabis?
Is this available as a treatment?
Read the original research
Cannabinoid replacement therapy (CRT): Nabiximols (Sativex) as a novel treatment for cannabis withdrawal.
Clinical pharmacology and therapeutics, 97(6), 571-4
Citation
Allsop, D J; Lintzeris, N; Copeland, J; Dunlop, A; McGregor, I S. (2015). Cannabinoid replacement therapy (CRT): Nabiximols (Sativex) as a novel treatment for cannabis withdrawal.. Clinical pharmacology and therapeutics, 97(6), 571-4. https://doi.org/10.1002/cpt.109
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