CBD cigarettes reduced need for illegal high-THC cannabis in patient with schizophrenia

After years of treatment failure with 30 hospitalizations, introducing CBD cigarettes (<1% THC) as adjunctive therapy, combined with off-label methylphenidate, led the patient to report significantly less need for illegal high-THC cannabis. He stopped cocaine use and had no further hospitalizations.

Single clinical case report of a male patient with schizophrenia, combined personality disorder, cannabis use disorder, and cocaine use disorder, treated with CBD cigarettes and methylphenidate after exhausting conventional treatment approaches over 8 years.

Patients with co-occurring schizophrenia and substance use disorders are among the hardest to treat. This case suggests CBD cigarettes may serve as a harm reduction substitute for high-THC cannabis in patients who are unable or unwilling to stop smoking cannabis entirely.

Harm reduction approaches that accept some continued substance use while reducing the most harmful forms may be more practical than abstinence-only approaches for patients with treatment-resistant dual diagnoses.

Single case report. Cannot attribute improvement solely to CBD cigarettes given concurrent methylphenidate. Placebo effect and therapeutic relationship may play a role. No long-term follow-up data provided.