Brain Stimulation (rTMS) Reduced Cannabis Use Frequency in Preliminary Trial | Research

The takeaway

In a double-blind RCT of 72 people with cannabis use disorder, those receiving active repetitive transcranial magnetic stimulation used cannabis fewer days per week than those receiving sham treatment, though craving reductions were not significant.

Addiction psychiatrists, neuromodulation researchers, cannabis use disorder treatment providers

Nearly 1 fewer day/week of cannabis use with active rTMS

What the researchers found

Active rTMS (10Hz, left DLPFC, 20 sessions) did not significantly reduce craving compared to sham. However, active rTMS participants reported fewer days of cannabis use in the final two weeks of follow-up (-0.72 days/week, p = 0.02). They also had numerically more weeks of abstinence (15.5% vs 9.3%) though not statistically significant.

Why it matters

There are no FDA-approved medications for cannabis use disorder. rTMS is a non-invasive brain stimulation technique already approved for depression and OCD. This preliminary trial suggests it may have therapeutic potential for CUD, warranting larger studies.

The numbers in context

72 participants (37.5% women, mean age 30.2); 20 rTMS sessions; -0.72 fewer days/week of cannabis use (p = 0.02); 15.5% vs 9.3% weeks of abstinence (NS); no significant craving differences.

How the study worked

Two-site, phase-2, double-blind RCT. 72 treatment-seeking participants with moderate or greater CUD randomized to active or sham rTMS (20 total sessions, 2 per visit, 2 visits per week) with cannabis cues, plus 3-session motivational enhancement therapy.

What this study cannot tell us

Small sample (n=72). Short follow-up (4 weeks). Primary outcome (craving) was negative. Use frequency effect emerged only in the final two weeks. All participants also received motivational enhancement therapy.

How to read the evidence

Double-blind RCT with appropriate controls, but small sample, short follow-up, and negative primary outcome.

When this study was published

2024 publication

The bigger picture

Brain stimulation is an active area of addiction research. The finding that rTMS reduced use frequency without reducing craving suggests it may work through mechanisms other than craving reduction, possibly by enhancing prefrontal control over substance-seeking behavior.

Questions still open

Would more rTMS sessions or longer follow-up reveal stronger effects?
Does rTMS reduce cannabis use through enhanced executive control rather than craving reduction?

Common questions

Can brain stimulation help people quit cannabis?

This preliminary trial found that repetitive transcranial magnetic stimulation reduced cannabis use by about 1 fewer day per week compared to sham treatment in 72 people with CUD. However, it did not significantly reduce craving, and larger trials are needed.

Are there medical treatments for cannabis use disorder?

There are currently no FDA-approved medications for CUD. This trial of brain stimulation (rTMS) showed preliminary promise for reducing cannabis use frequency, but the evidence is early-stage and the primary outcome (craving reduction) was not met.

Read the original research

A preliminary randomized controlled trial of repetitive transcranial magnetic stimulation applied to the left dorsolateral prefrontal cortex in treatment seeking participants with cannabis use disorder.

Drug and alcohol dependence, 254, 111035

View on PubMed ↗Publisher’s paper ↗

Citation

Sahlem, Gregory L; Kim, Bohye; Baker, Nathaniel L; Wong, Brendan L; Caruso, Margaret A; Campbell, Lauren A; Kaloani, Irakli; Sherman, Brian J; Ford, Tiffany J; Musleh, Ahmad H; Kim, Jane P; Williams, Nolan R; Manett, Andrew J; Kratter, Ian H; Short, Edward B; Killeen, Terese K; George, Mark S; McRae-Clark, Aimee L. (2024). A preliminary randomized controlled trial of repetitive transcranial magnetic stimulation applied to the left dorsolateral prefrontal cortex in treatment seeking participants with cannabis use disorder.. Drug and alcohol dependence, 254, 111035. https://doi.org/10.1016/j.drugalcdep.2023.111035