Using Cannabinoid Medications to Treat Addiction: What the Clinical Trials Actually Show
THC-containing medications (dronabinol, nabiximols) are effective for cannabis withdrawal, dronabinol may help with opioid withdrawal, and rimonabant showed promise for smoking cessation but was pulled for psychiatric side effects.
Quick Facts
What This Study Found
This review examined randomized controlled trial evidence for cannabinoid-based medications across different addictions.
For cannabis use disorder: THC-containing medications like dronabinol and nabiximols (Sativex) effectively reduced withdrawal symptoms. This agonist substitution approach parallels how methadone is used for opioid dependence. Dronabinol may also help reduce opioid withdrawal symptoms.
For tobacco: The CB1 inverse agonist rimonabant showed promising smoking cessation effects in clinical trials, but its psychiatric side effects (depression, anxiety, suicidal ideation) led to removal from the market. It was never approved in the United States.
For alcohol: Very few trials had investigated cannabinoid medications for alcohol use disorder at the time of this review, representing a significant gap.
The review highlighted emerging approaches: FAAH inhibitors (which boost anandamide) and neutral CB1 antagonists (which lack the psychiatric side effects of inverse agonists like rimonabant) as promising future options.
Key Numbers
Dronabinol and nabiximols: effective for cannabis withdrawal (RCT evidence). Dronabinol: may reduce opioid withdrawal. Rimonabant: effective for smoking cessation but removed from market. Few RCTs for alcohol use disorder.
How They Did This
Narrative review of randomized controlled trials evaluating cannabinergic medications for substance use disorders, including cannabis, opioid, tobacco, and alcohol use disorders.
Why This Research Matters
Addiction treatment options remain limited, and the endocannabinoid system's involvement in reward and dependence makes it a logical therapeutic target. This review provides a practical summary of what works, what failed, and what is coming next in cannabinoid-based addiction treatment.
The Bigger Picture
The failure of rimonabant did not end the story of targeting the endocannabinoid system for addiction. Instead, it redirected research toward approaches that avoid brain CB1 blockade: peripheral antagonists, neutral antagonists, FAAH inhibitors, and agonist substitution strategies. The endocannabinoid system remains one of the most promising targets for developing new addiction medications.
What This Study Doesn't Tell Us
Narrative review without systematic search methodology. The evidence base for cannabinoid medications in addiction is still relatively small, with most RCTs having modest sample sizes. The review does not cover newer compounds that have entered clinical testing since publication.
Questions This Raises
- ?Will FAAH inhibitors or neutral CB1 antagonists prove effective for addiction without psychiatric side effects?
- ?Could nabiximols become a standard treatment for cannabis use disorder?
- ?Why has so little research addressed cannabinoid medications for alcohol use disorder?
Trust & Context
- Key Stat:
- Dronabinol and nabiximols reduced cannabis withdrawal symptoms in RCTs; rimonabant helped smoking cessation but caused psychiatric side effects
- Evidence Grade:
- Moderate evidence from a review of existing RCTs, though the underlying trial evidence is still limited in size.
- Study Age:
- Published in 2017. Novel cannabinoid-based addiction medications continue to be developed.
- Original Title:
- The endocannabinoid system as a target for addiction treatment: Trials and tribulations.
- Published In:
- Neuropharmacology, 124, 73-83 (2017)
- Authors:
- Sloan, Matthew E(7), Gowin, Joshua L(4), Ramchandani, Vijay A(2), Hurd, Yasmin L, Le Foll, Bernard
- Database ID:
- RTHC-01522
Evidence Hierarchy
Summarizes existing research on a topic.
What do these levels mean? →Frequently Asked Questions
Can cannabinoid medications help people quit cannabis?
Yes. Clinical trials have shown that THC-containing medications like dronabinol and nabiximols effectively reduce cannabis withdrawal symptoms. This is similar to how nicotine patches help with nicotine withdrawal or methadone helps with opioid withdrawal, using a controlled medical substitute.
Why was rimonabant taken off the market if it helped with smoking cessation?
Rimonabant blocked CB1 receptors throughout the brain, including in mood-regulating circuits. While it effectively reduced smoking, it also caused depression, anxiety, and suicidal ideation in some users. The psychiatric risks outweighed the smoking cessation benefits, and it was withdrawn from the European market in 2009.
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Cite This Study
https://rethinkthc.com/research/RTHC-01522APA
Sloan, Matthew E; Gowin, Joshua L; Ramchandani, Vijay A; Hurd, Yasmin L; Le Foll, Bernard. (2017). The endocannabinoid system as a target for addiction treatment: Trials and tribulations.. Neuropharmacology, 124, 73-83. https://doi.org/10.1016/j.neuropharm.2017.05.031
MLA
Sloan, Matthew E, et al. "The endocannabinoid system as a target for addiction treatment: Trials and tribulations.." Neuropharmacology, 2017. https://doi.org/10.1016/j.neuropharm.2017.05.031
RethinkTHC
RethinkTHC Research Database. "The endocannabinoid system as a target for addiction treatme..." RTHC-01522. Retrieved from https://rethinkthc.com/research/sloan-2017-the-endocannabinoid-system-as
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.