Although cannabis is the most widely used illicit drug worldwide, it has only recently been recognized as a chemically addictive substance (albeit very mild) that addicts users in similar ways to harder drugs. There has been a significant increase in the rate of people seeking help for cannabis use disorders and the majority of them do not respond successfully to the treatments available.
The need for medications that can help people quit, as with some other drugs, is therefore high. There are no medications approved for helping people quit marijuana. Although some medications have shown some promise, none are properly understood or have received the scientific attention needed to properly evaluate them.
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A recent study has suggested that cannabis can alleviate the symptoms associated with addiction. This study assembles the available data on cannabis addiction, withdrawal, and the potential drugs for treating it. The results are not encouraging and there is substantial work to be done before effective therapies can be implemented.
In the United States, there are an estimated 4 million adults who are believed to have a lifetime cannabis dependence. That is twice the number of any other illicit drug. Relapse rates are comparable to other illicit addictive drugs.
The numbers of people seeking help and being diagnosed with cannabis use disorders are growing. This is partly due to increased awareness of cannabis dependence, and possibly due to the increasing use of recreational and medicinal marijuana due to legalization or decriminalization. Many drugs are addictive because they alter the way that the reward systems in the brain work.
These mechanisms involve the neurotransmitter dopamine and in some small studies, repeated THC (the psychoactive cannabinoid found in the cannabis sativa plant) administration has been shown to desensitize these dopamine circuits in a very similar way to other drugs of abuse. This suggests that a common system is used for drug addiction and that there might be drugs that can combat addiction for several drugs
The symptoms of cannabis withdrawal syndrome are not as severe as, for example, heroin or nicotine. However, they are severe enough that they stop some people from quitting. CB receptor agonists (drugs that bind to CB receptors) have been experimented with but results are mixed and none has been approved by any regulatory body.
The only successful drug was THC, which decreased withdrawal symptoms according to dose. It is psychoactive, however, and will not be useful in many cases. Some antidepressants have been shown to lessen withdrawal symptoms but have yet to be investigated further.
There are several avenues being investigated for treating cannabis dependence. The “agonist approach” is the method of using agonists, which bind to the same receptors as the addictive chemicals, but do not exert the same effects. This reduces craving because the brain is getting its cannabinoid fix and limits withdrawal symptoms the same way. Data are yet to be generated.
The antagonist approach blocks cannabinoid receptors, eliminating the pleasure patients get from the drug. It is a successful treatment for opioids; it has not been studied for cannabinoids to an acceptable level.
The mechanisms of addiction are becoming clearer, the recognition of cannabis use disorders becoming more widespread, and there is finally research ongoing into these topics. Inconclusive but hopeful.