Brain Stimulation Shows Early Promise for Treating Cannabis Use Disorder

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.

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 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.

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.