Open-label pilot study of quetiapine treatment for cannabis dependence

Abstract

Background There are no efficacious pharmacotherapies for cannabis dependence. The effects of quetiapine are well matched to the symptoms of cannabis withdrawal and could be useful in the treatment of cannabis dependence. Objectives To evaluate quetiapine for the treatment of cannabis dependence and determine the optimal dosing. Methods In an eight-week open-label outpatient pilot trial, we evaluated the feasibility of quetiapine treatment for cannabis dependence in 15 outpatients. Quetiapine was gradually titrated to 600 mg or the maximum tolerated dose. Results The mean study retention was 6.5 weeks (±2.3), with 67% of participants completing all eight weeks of the trial. The mean maximum dose achieved was 197 mg/day (range: 25–600 mg/day). Only two of the 15 participants were able to achieve the target dose of 600 mg daily. There were no serious adverse events and no participants were discontinued from the trial due to adverse effects. The most common reported adverse effects were fatigue (80% of participants) and somnolence (47%). From baseline to week 8, the modeled overall decrease in daily dollar value of marijuana was 76.3% (CI: 63.4%, 84.7%). Over the eight weeks of the study, there was a 46.9% (CI: 11%, 68.3%) decrease in urine tetrahydrocannabinol-9-carboxylic acid (THCOOH) levels. Conclusions These preliminary results are promising in that quetiapine treatment was tolerated by cannabis-dependent patients and associated with decreased cannabis use. The recommended maximum target dose for cannabis-dependent patients is 300 mg daily. These preliminary data support further evaluation of quetiapine as a treatment for cannabis dependence.

Intentional Recreational Abuse of Quetiapine Compared to Other Second-generation Antipsychotics

“…28 Other studies support this, identifying a three-fold increase in prescribing over a decade, 29 an observation likely driven by the increasing popularity of quetiapine use for “off-label” indications. 2 , 3 , 16 , 29 , 30 , 31 These prescribing patterns may contribute to why quetiapine is the most commonly abused SGA in terms of absolute numbers of cases.…”

Cannabis and Mood Disorders

“…One study investigated the effect of lithium on cannabis use outcomes in an open-label trial and found improved abstinence outcomes and decreased symptoms of anxiety and depression [59]. Finally, another open label trial investigated the effects of the second generation antipsychotic quetiapine in cannabis-dependent individuals and found a significant decreased in urine THC levels [60]. Patients with co-occurring mood disorder diagnoses were not included in these open-label trials, so further research is warranted on the effects of these drugs on comorbid mood disorders with cannabis use.…”

What do we know about the pharmacotheraputic management of insomnia in cannabis withdrawal: A systematic review

“…This study involved non‐treatment seeking participants; however, authors felt this cannot explain the higher relapse among the Seroquel group. In contrast to Cooper's findings, a pilot open trial by Mariani et al showed treatment with Quetiapine was associated with a reduction in cannabis use among participants with Cannabis dependence. Therefore, the authors suggest to consider these findings preliminary until further research is available.…”