A Randomized Trial of Clozapine Versus Other Antipsychotics for Cannabis Use Disorder in Patients With Schizophrenia

Brunette, Mary F.; Dawson, Ree; O'Keefe, Christopher; Narasimhan, Meera; Noordsy, Douglas L.; Wojcik, Joanne; Green, Alan I.

doi:10.1080/15504263.2011.570118

Cited by 48 publications

(27 citation statements)

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“…The largest study included 95 patients with schizophrenia and comorbid substance use disorder in early remission, followed up to a decade, and found lower relapse rates for substance use in individuals treated with clozapine ( n = 25, 8%) than in those treated with other antipsychotics ( n = 70, 40%) ( P = 0.003) . A small randomized controlled trial in patients with comorbid schizophrenia and cannabis use disorder ( n = 31) showed a reduction in cannabis use among individuals randomized to clozapine for 12 weeks compared to other antipsychotics, equivalent to an effect size of 0.6 which did not reach statistical significance ( P = 0.086) .…”

Section: State Of the Artmentioning

confidence: 99%

How and when to use clozapine

Rubio

Kane

2019

Acta Psychiatr Scand

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Objective Clozapine is the only approved strategy for treatment‐resistant schizophrenia, although it is highly underutilized. We aim to generate practical and actionable evidence‐based recommendations for the use of this drug considering prescription barriers. Method Narrative review. Results A consistent body of evidence supports the efficacy of clozapine reducing morbidity and mortality in schizophrenia. The main obstacles to its use are the lack of experience by prescribers and perceived treatment burden. Systematic screening of eligibility, utilization of available resources for consultation, developing a professional network with other stakeholders, as well as optimizing how clozapine is presented to patients is discussed. Furthermore, specific evidence‐based recommendations for initiation, maintenance, and safety monitoring with clozapine are provided. Conclusion Clozapine prescription is one of the areas in psychiatry with the greatest mismatch between efficacy and utilization in clinical practice. Although multiple barriers to the use of clozapine exist, some of these may be overcome by updates of routine clinical practice.

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Section: State Of the Artmentioning

confidence: 99%

How and when to use clozapine

Rubio

Kane

2019

Acta Psychiatr Scand

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“…Given tokens for cannabis‐free urine tests is currently under trial. The only pharmacological treatment that has had any success is clozapine: a double‐blind trial showed it to have a useful effect in diminishing craving for cannabis.…”

Section: Outcome and Treatmentmentioning

confidence: 99%

Traditional marijuana, high‐potency cannabis and synthetic cannabinoids: increasing risk for psychosis

et al. 2016

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Epidemiological evidence demonstrates that cannabis use is associated with an increased risk of psychotic outcomes, and confirms a doseresponse relationship between the level of use and the risk of later psychosis. High-potency cannabis and synthetic cannabinoids carry the greatest risk. Experimental administration of tetrahydrocannabinol, the active ingredient of cannabis, induces transient psychosis in normal subjects, but this effect can be ameliorated by co-administration of cannabidiol. This latter is a constituent of traditional hashish, but is largely absent from modern high-potency forms of cannabis. Argument continues over the extent to which genetic predisposition is correlated to, or interacts with, cannabis use, and what proportion of psychosis could be prevented by minimizing heavy use. As yet, there is not convincing evidence that cannabis use increases risk of other psychiatric disorders, but there are no such doubts concerning its detrimental effect on cognitive function. All of the negative aspects are magnified if use starts in early adolescence. Irrespective of whether use of cannabis is decriminalized or legalized, the evidence that it is a component cause of psychosis is now sufficient for public health messages outlining the risk, especially of regular use of high-potency cannabis and synthetic cannabinoids.Key words: Cannabis, psychosis, marijuana, synthetic cannabinoids, cognitive function, brain structure, genetic predisposition, early adolescence (World Psychiatry 2016;15:195-204) The use of cannabis has been illegal in most countries since the 1930s, but this has not deterred use 1 . Currently, cannabis is used by around 180 million people globally 2 . The tensions produced by this unsatisfactory situation have resulted in much attention being paid to the legal status of cannabis.Possession of the drug in small quantities has been decriminalized officially in countries such as Portugal and the Netherlands, and unofficially in many more. In 2013, Uruguay became the first nation to legalize the sale, cultivation and distribution of cannabis 3 . Four US states have also legalized recreational use, and another twenty-five US states as well as Canada permit so-called "medicinal marijuana". While Uruguay has strict rules concerning access, laws vary state by state in the US, with policy being increasingly driven by entrepreneurs in search of profit, and law makers in search of taxes.Given the above, it seems likely that consumption of cannabis will increase rather than decrease. This makes it imperative to understand the possible adverse consequences of use, even if they only affect a minority of users. In this paper we start by reviewing cannabinoids and the endocannabinoid system. We then focus on cannabis use and risk of psychiatric disorder, particularly psychosis, before touching on the effects on cognition and brain structure. CANNABINOIDS AND THE ENDOCANNABINOID SYSTEMCannabis contains over one hundred cannabinoids 4 , the most important of which are tetrahydrocannabinol (THC) and ...

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“…7 Furthermore, there is a need to examine the use of antipsychotic medication and investigate if some medications are particularly useful for patients with psychotic disorders who intend to continue to use cannabis. In a randomised trial comparing the effects of different antipsychotics, 8 clozapine seemed to stand out in reducing craving for cannabis, a finding that is in need of replication. Previous research has shown that stopping cannabis use after a first episode of psychosis has beneficial outcomes compared with continued use.…”

Section: Jorun Rugkåsamentioning

confidence: 99%