Evidence from Human Studies for Utilising Cannabinoids for the Treatment of Substance-Use Disorders: A Scoping Review with a Systematic Approach

Abstract

Substance-use disorders are pervasive, comorbid with a plethora of disease and possess limited treatment options. Medicinal cannabinoids have been proposed as a novel potential treatment based on preclinical/animal trials. The objective of this study was to examine the efficacy and safety of potential therapeutics targeting the endocannabinoid system in the treatment of substance-use disorders. We performed a scoping review using a systematic approach of systematic reviews, narrative reviews, and randomised control trials that utilised cannabinoids as treatment for substance-use disorders. For this scoping review we used the PRISMA guidelines, a framework for systematic reviews and meta-analyses, to inform our methodology. We conducted a manual search of Medline, Embase, and Scopus databases in July 2022. Of the 253 results returned by the databases, 25 studies including reviews were identified as relevant, from which 29 randomised controlled trials were derived and analysed via a primary study decomposition. This review captured a small volume of highly heterogenous primary literature investing the therapeutic effect of cannabinoids for substance-use disorders. The most promising findings appeared to be for cannabis-use disorder. Cannabidiol appeared to be the cannabinoid showing the most promise for the treatment of multiple-substance-use disorders.

The Role of Medicinal Cannabis as an Emerging Therapy for Opioid Use Disorder

“…Despite cannabis-based interventions showing promise in certain areas such as pain management, anxiety and epilepsy treatment, limitations still remain surrounding their use in MOUD [ 34 , 81 , 82 ]. Evidence and preliminary research findings suggesting their role, effectiveness and safety in MOUD use are very limited, with most studies conducted in small human populations, with a lack of contextual and cultural diversity and over time frames that are lacking in sufficient length [ 14 , 56 ]. Cannabis use has been reported to be associated with an increased likelihood of relapse at the 6-month follow-up, with post-discharge cannabis use significantly increasing the risk of first use of any substance and reducing the likelihood of stable remission from use of any substance [ 83 ].…”

“…The Therapeutic Goods Administration and Poisons Standards of Australia categorises medicinal cannabis products based on the CBD and THC content, with products having higher THC content subjected to stricter prescribing and storage requirements. The variations in regulations and inconsistency in quality control standards create challenges in the production, distribution for therapeutic use and integration into mainstream medical practice [ 14 , 58 , 83 ]. They hinder the integration of cannabis use into formalised treatment protocols and trials for MOUD and make it difficult for patients to access high-quality cannabis products [ 14 , 58 ].…”

“…The variations in regulations and inconsistency in quality control standards create challenges in the production, distribution for therapeutic use and integration into mainstream medical practice [ 14 , 58 , 83 ]. They hinder the integration of cannabis use into formalised treatment protocols and trials for MOUD and make it difficult for patients to access high-quality cannabis products [ 14 , 58 ]. With prescribers currently requiring specific certifications and permit applications to prescribe evidence-based MOUD, the prescribing of CBD or THC can be expected to be just as difficult, if not more [ 93 ].…”

“…A growing field of evidence has highlighted the role of the endocannabinoid system−and therefore medicinal cannabis—in substance use disorders [ 14 ]. Interestingly, in certain states of the Unites States (US) that have legalised medicinal cannabis, there is a reported 25% reduction in mean annual opioid overdose mortality [ 15 ].…”

Cannabidiol prevents the locomotor sensitization induced by cocaine and caffeine and upregulates genes of extracellular matrix and anti-inflammatory pathways in the nucleus accumbens: a transcriptome-wide analysis

“…In the last years cannabidiol (CBD) has generated promising perspectives as a pharmacotherapy for substance use disorders (SUDs) (Chye et al, 2019; Gharbi et al, 2023; Navarrete et al, 2021; Paulus et al, 2022). CBD is the most abundant non-psychotomimetic phytocannabinoid of the plant Cannabis sativa L (Echeverry et al, 2021b).…”