Brain Stimulation Shows Early Promise for Treating Cannabis Use Disorder | Research

The takeaway

A pilot trial of deep brain stimulation (H4 dTMS) found the treatment was feasible and tolerable for people with moderate-to-severe cannabis use disorder — the first test of this approach for CUD.

Addiction researchers exploring neuromodulation treatments, clinicians treating cannabis use disorder, patients interested in non-pharmacological treatment options.

What the researchers found

This phase 1 pilot study tested whether deep repetitive transcranial magnetic stimulation (dTMS) using the H4 coil — already approved for tobacco use disorder — could be safely applied to adults with moderate-to-severe cannabis use disorder who were seeking treatment.

Participants received 18 sessions over four weeks (five sessions per week for three weeks, then three sessions in week four), with each session delivering electromagnetic pulses to the lateral prefrontal cortex and anterior insula — brain regions implicated in addiction.

The primary findings focused on feasibility and tolerability: treatment completion rates (indicating feasibility), attainment of therapeutic dose (≥90% of resting motor threshold), and adverse event profiles (indicating tolerability). The study also collected exploratory data on cannabis use (measured in standard 5 mg THC units), CUD symptoms, cravings, cannabis reinforcing value, self-efficacy, internalizing symptoms, and neuropsychological performance.

As a phase 1 open-label study without a control group, the results speak to whether this treatment can be delivered safely rather than whether it works — an essential first step before controlled efficacy trials.

Why it matters

No medication has received regulatory approval for cannabis use disorder — a condition affecting a growing number of people as cannabis becomes more potent and widely available. The H4 coil's existing approval for tobacco use disorder provides a logical basis for testing it in CUD, since both conditions involve the same prefrontal and insular brain circuits implicated in addiction. This pilot establishes whether the approach is practical enough to test in larger controlled trials.

The numbers in context

18 dTMS sessions over 4 weeks (5/week for 3 weeks, 3 in week 4). H4 coil targeting lateral prefrontal cortex and anterior insula. Therapeutic dose threshold: ≥90% resting motor threshold. Cannabis use measured in standard 5 mg THC units.

How the study worked

Phase 1 open-label pilot study. Adults with moderate-to-severe CUD received 18 sessions of H4 deep TMS targeting the lateral prefrontal cortex and anterior insula. Primary outcomes: treatment completion (feasibility) and adverse events (tolerability). Exploratory outcomes: cannabis use in standard THC units, CUD symptoms, cravings, self-efficacy, and neuropsychological performance.

Who was studied

N=11 adults aged 18-65, 64% female, seeking treatment for moderate-to-severe cannabis use disorder.

What this study cannot tell us

Phase 1 open-label design with no control group — cannot determine whether any improvement is due to the stimulation or to placebo effects, standard care, or natural recovery. Small sample size limits generalizability. The intensive schedule (18 sessions in 4 weeks) may be burdensome for patients. Long-term effects and relapse rates are unknown.

How to read the evidence

Open-label pilot study without controls — establishes feasibility and safety but cannot speak to efficacy. Designed to justify subsequent controlled trials.

When this study was published

Published in 2026, representing an early-stage investigation of a novel treatment approach for CUD.

The bigger picture

The absence of FDA-approved medications for CUD is a gap that growing cannabis potency makes increasingly urgent. This brain stimulation approach represents a different therapeutic pathway than the pharmacological approaches (like CBD, tested in other contexts) or the behavioral interventions that currently constitute standard care. The H4 coil targets brain circuits where addiction-related decision-making occurs — connecting to the neuroscience of cannabis dependence explored in the tolerance (RTHC-00249) and withdrawal (RTHC-00037) literature.

Replication

Not stated in abstract.

Funding

Not reported in abstract.

Conflicts of interest

Not reported in abstract.

Questions still open

Will the exploratory clinical outcomes justify a phase 2 randomized controlled trial? Can the treatment schedule be optimized for better patient adherence? Would combining dTMS with pharmacotherapy or enhanced behavioral interventions improve outcomes?

Read the original research

Phase 1 Open-Label Pilot Trial of H4 Deep Repetitive Transcranial Magnetic Stimulation for Adults With Moderate-to-Severe Cannabis Use Disorder.

Neuromodulation : journal of the International Neuromodulation Society

Neuromodulation is a peer-reviewed journal focusing on the field of neuromodulation and its applications in treating various disorders.

View on PubMed ↗Publisher’s paper ↗

Citation

MacKillop, James; McIntyre-Wood, Carly; Vandehei, Emily; Yaya, Horodjei; Di Passa, Anne-Marie; Prokop-Millar, Shelby; Fein, Allan; Yang, Andrew; Elsayed, Mahmoud; Schwartzmann, Benjamin; Farzan, Faranak; MacKillop, Emily; Duarte, Dante. (2026). Phase 1 Open-Label Pilot Trial of H4 Deep Repetitive Transcranial Magnetic Stimulation for Adults With Moderate-to-Severe Cannabis Use Disorder.. Neuromodulation : journal of the International Neuromodulation Society. https://doi.org/10.1016/j.neurom.2026.01.003