Commonly used for seizures, pain, and anxiety, gabapentin shows broad spectrum effects in patients with cannabis dependence.
Cannabis dependence is responsible for a quarter of all inpatient substance use admissions globally and is associated with prominent cognitive, work, and social dysfunctions. Several medications with different mechanisms of action have been found ineffective against cannabis dependence. Researchers conducted a pilot, 12-week, randomized, placebo-controlled trial to test the efficacy of gabapentin (1200 mg, given in 3 divided doses daily) in 50 patients with long-standing, chronic cannabis dependence (mean age at first use, 14.5 years; mean daily use, 11.6 years). All participants received motivational enhancement and counseling using techniques from cognitive-behavioral therapy. The researchers’ institution has applied for a patent for this application of gabapentin.
Compared with placebo, gabapentin was associated with greater reductions in amount and days of use, withdrawal symptoms, craving, and psychological and physical problems related to use, and with greater improvements in executive cognitive dysfunction (studied in the last 38 enrollees). Groups showed no differences in adverse events. Of enrollees, 64% dropped out; at baseline, dropouts had earlier onset of use, more chronic use, greater withdrawal symptoms, and greater cognitive dysfunction.
Comment: Gabapentin, a very well-tolerated medication, may add significant benefit to drug counseling in cannabis-dependent patients, a cohort for whom there are no established medication treatments (see also JW Psychiatry Jul 2 2012). Higher doses could well improve efficacy, but the effect found in this study is impressive because gabapentin had benefits over and above those from effective counseling. The high dropout rate is typical for addiction studies. Clinicians treating patients with cannabis dependence could try this medication right now.
— Peter Roy-Byrne, MD
Published in Journal Watch Psychiatry July 2, 2012
Mason BJ et al. A proof-of-concept randomized controlled study of gabapentin: Effects on cannabis use, withdrawal and executive function deficits in cannabis-dependent adults. Neuropsychopharmacology 2012 Jun; 37:1689.
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