Guanfacine showed trends toward improving mood during cannabis withdrawal but didn't significantly reduce symptoms
In a small pilot study of 7 cannabis-dependent volunteers, guanfacine did not significantly improve withdrawal symptoms, craving, or sleep compared to placebo, though trends toward improved positive mood and reduced compulsive craving were observed.
Quick Facts
What This Study Found
Guanfacine (3 mg/day) showed no significant effects on cannabis withdrawal, craving, or sleep compared to placebo. Trends were observed for increased positive mood symptoms and decreased craving-associated compulsivity. The authors note their subjects had early onset and severe cannabis use, potentially increasing treatment resistance.
Key Numbers
7 participants. Guanfacine 3 mg/day vs placebo, 8 days each. No significant effects on withdrawal, craving, or sleep. Trends for positive mood improvement and decreased compulsive craving. Early onset, long-duration cannabis use in subjects.
How They Did This
Within-subjects crossover pilot study with 7 non-treatment-seeking volunteers meeting DSM-IV criteria for cannabis use disorder. Two 8-day inpatient periods (guanfacine 3 mg/day vs placebo) following standardized abstinence onset (30 mg synthetic THC on day 1).
Why This Research Matters
No medications are FDA-approved for cannabis use disorder. Even negative results from pilot studies contribute to the field by ruling out approaches and identifying potential signals worth pursuing in larger trials.
The Bigger Picture
The difficulty of treating cannabis use disorder pharmacologically is underscored by this and other negative pilot studies. The noradrenergic approach (guanfacine targets alpha-2A receptors) may not be sufficient alone, though the mood improvement trends suggest the pathway is worth exploring in combination approaches.
What This Study Doesn't Tell Us
Very small sample (n=7). Non-treatment-seeking participants. Short 8-day treatment period. Within-subjects design may have carryover effects. Subjects had severe cannabis use histories that may increase treatment resistance.
Questions This Raises
- ?Would guanfacine work in less severe cannabis users?
- ?Could combining guanfacine with behavioral treatment improve outcomes?
- ?Would higher doses or longer treatment periods show significant effects?
Trust & Context
- Key Stat:
- No FDA-approved medications for cannabis use disorder; guanfacine showed only trend-level improvements
- Evidence Grade:
- Preliminary: very small pilot study (n=7) with non-significant primary outcomes.
- Study Age:
- Published in 2019.
- Original Title:
- Use of Guanfacine for Cannabis Use Disorder and Related Symptomology.
- Published In:
- The American journal on addictions, 28(6), 455-464 (2019)
- Authors:
- Holst, Manuela, Mathai, David S, Patel, Marguerite M, Rodgman, Christopher, Keller, Jake, Hussain, Mariyah Z, De La Garza, Richard, Kosten, Thomas R, Verrico, Christopher D
- Database ID:
- RTHC-02075
Evidence Hierarchy
A small preliminary study to test whether a larger study is feasible.
What do these levels mean? →Frequently Asked Questions
Are there medications to help quit cannabis?
None are FDA-approved. This study tested guanfacine, a blood pressure medication, but found no significant improvement in cannabis withdrawal or craving. The search for effective pharmacotherapy continues.
Why is it so hard to find cannabis withdrawal medications?
Cannabis use disorder involves complex brain pathways. The seven participants in this study had particularly severe, early-onset use, which may have increased treatment resistance. Different medications may work better for less severe cases.
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Cite This Study
https://rethinkthc.com/research/RTHC-02075APA
Holst, Manuela; Mathai, David S; Patel, Marguerite M; Rodgman, Christopher; Keller, Jake; Hussain, Mariyah Z; De La Garza, Richard; Kosten, Thomas R; Verrico, Christopher D. (2019). Use of Guanfacine for Cannabis Use Disorder and Related Symptomology.. The American journal on addictions, 28(6), 455-464. https://doi.org/10.1111/ajad.12959
MLA
Holst, Manuela, et al. "Use of Guanfacine for Cannabis Use Disorder and Related Symptomology.." The American journal on addictions, 2019. https://doi.org/10.1111/ajad.12959
RethinkTHC
RethinkTHC Research Database. "Use of Guanfacine for Cannabis Use Disorder and Related Symp..." RTHC-02075. Retrieved from https://rethinkthc.com/research/holst-2019-use-of-guanfacine-for
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.