Sleep medication helped cannabis users sleep during early withdrawal but did not significantly boost quit rates | Research

The takeaway

In a 12-week trial of 127 adults seeking cannabis cessation, zolpidem prevented early withdrawal sleep disturbance but did not significantly increase abstinence rates (27% vs 15% on placebo), with high dropout in both groups.

Addiction medicine specialists, sleep researchers, and cannabis cessation program designers

27% vs 15% abstinence (not significant); 50% dropout

What the researchers found

Placebo participants but not zolpidem-XR participants showed significant sleep disturbance during week 1 of cannabis cessation. Abstinence rates were numerically higher with zolpidem-XR (27% vs 15%) but not statistically significant. Sleep disturbance emerged in the medication group after treatment stopped. Treatment retention was poor (about 50% dropout in both groups).

Why it matters

Sleep disturbance is one of the most common reasons people relapse when trying to quit cannabis. This trial provides important evidence that pharmacological sleep support can help during early withdrawal.

The numbers in context

127 participants; 27% abstinent on zolpidem-XR vs 15% on placebo (not significant); ~50% dropout in both groups; sleep disturbance prevented during medication but emerged after stopping; objective polysomnography used

How the study worked

Twelve-week randomized, double-blind, placebo-controlled trial of 127 adults with cannabis use disorder. All received computerized behavioral therapy and abstinence-based contingency management. Zolpidem-XR or placebo was provided during treatment. In-home ambulatory polysomnography measured sleep objectively.

What this study cannot tell us

Not powered to detect significant differences in abstinence; high dropout rate reduces interpretability; medication adherence was challenging; sleep medication stopped at end of treatment causing rebound; unclear optimal treatment duration

How to read the evidence

Well-designed RCT with objective sleep measurement, but underpowered for the primary outcome and hampered by high attrition.

When this study was published

2024 study

The bigger picture

The rebound sleep disturbance after stopping zolpidem suggests that simply delaying withdrawal symptoms is insufficient. Longer or different approaches to managing cannabis withdrawal sleep problems may be needed.

Questions still open

Would a longer course of sleep medication improve cannabis cessation? Would non-pharmacological sleep interventions (CBT-I) provide more durable benefits? Is sleep disturbance a mediator or just a correlate of cannabis relapse?

Common questions

Did sleep medication help people quit cannabis?

It helped with sleep but not significantly with quitting. Zolpidem-XR prevented the sleep problems that typically occur in the first week of cannabis cessation, and numerically more participants quit (27% vs 15%), but the difference was not statistically significant.

What happened when the medication stopped?

Sleep disturbance that was prevented during medication treatment emerged after zolpidem-XR was discontinued, suggesting the medication delayed rather than resolved withdrawal-related sleep problems. About half of participants in both groups dropped out before completing the trial.

Read the original research

Randomized controlled trial of zolpidem as a pharmacotherapy for cannabis use disorder.

Journal of substance use and addiction treatment, 156, 209180

View on PubMed ↗Publisher’s paper ↗

Citation

Lee, Dustin C; Schlienz, Nicolas J; Herrmann, Evan S; Martin, Erin L; Leoutsakos, Jeannie; Budney, Alan J; Smith, Michael T; Tompkins, D Andrew; Hampson, Aidan J; Vandrey, Ryan. (2024). Randomized controlled trial of zolpidem as a pharmacotherapy for cannabis use disorder.. Journal of substance use and addiction treatment, 156, 209180. https://doi.org/10.1016/j.josat.2023.209180