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Treatment of Cannabis Use Disorder Dr. Paul Morrison Clinical Senior Lecturer Institute of Psychiatry King's College London NHS Consultant Psychiatrist The Maudsley Hospital, London

Outline Introduction to the treatment of cannabis use disorder Antipsychotic use in psychotic patients Treating non-positive psychotic symptoms

Treatment of cannabis use disorder Scant evidence base Psychological therapies May be effective for the individual Lack of convincing evidence Therapeutic relationship Focus on motivation

Treatment of cannabis use disorder Scant evidence base Psychological therapies May be effective for the individual Lack of convincing evidence Therapeutic relationship Focus on motivation

Treatment of cannabis use disorder Scant evidence base Psychological therapies May be effective for the individual Lack of convincing evidence Therapeutic relationship Focus on motivation

Treatment of cannabis use disorder Scant evidence base Psychological therapies May be effective for the individual Lack of convincing evidence Therapeutic relationship Focus on motivation

Pharmacotherapies

Very few studies: small number of participants Pharmacotherapies Very few studies: small number of participants

Very few studies: small number of participants Pharmacotherapies Very few studies: small number of participants Oral THC Can reduce withdrawal Psychotic patients? CBD Uncomplicated cannabis dependence

Very few studies: small number of participants Pharmacotherapies Very few studies: small number of participants Oral THC Can reduce withdrawal Psychotic patients? CBD Uncomplicated cannabis dependence Prud’homme, M., Cata, R., & Jutras-Aswad, D. (2015). Cannabidiol as an Intervention for Addictive Behaviors: A Systematic Review of the Evidence. Substance Abuse: Research and Treatment, 9, 33–38.

Very few studies: small number of participants Pharmacotherapies Very few studies: small number of participants Oral THC Can reduce withdrawal Psychotic patients? CBD Uncomplicated cannabis dependence Prud’homme, M., Cata, R., & Jutras-Aswad, D. (2015). Cannabidiol as an Intervention for Addictive Behaviors: A Systematic Review of the Evidence. Substance Abuse: Research and Treatment, 9, 33–38.

Antipsychotic use in psychotic patients

Use of potent cannabinoids Antipsychotics Can mitigate THC effects Sinsemilla and synthetic cannabinoids may overpower the AP Stopping antipsychotics: Common cause of relapse Use of potent cannabinoids Antipsychotics have protective effects Long-acting antipsychotics are used for repeated psychotic crisis and risk of harm

Use of potent cannabinoids Antipsychotics Can mitigate THC effects Sinsemilla and synthetic cannabinoids may overpower the AP Stopping antipsychotics: Common cause of relapse Use of potent cannabinoids Antipsychotics have protective effects Long-acting antipsychotics are used for repeated psychotic crisis and risk of harm

Use of potent cannabinoids Antipsychotics Can mitigate THC effects Sinsemilla and synthetic cannabinoids may overpower the AP Stopping antipsychotics: Common cause of relapse Use of potent cannabinoids Antipsychotics have protective effects Long-acting antipsychotics are used for repeated psychotic crisis and risk of harm

Use of potent cannabinoids Antipsychotics Can mitigate THC effects Sinsemilla and synthetic cannabinoids may overpower the AP Stopping antipsychotics: Common cause of relapse Use of potent cannabinoids Antipsychotics have protective effects Long-acting antipsychotics are used for repeated psychotic crisis and risk of harm

Emphasis: rehabilitation Withdrawal, apathy, disorganization, cognitive slowing Morrison, P. D., & Stone, J. M. (2011). Synthetic delta-9-tetrahydrocannabinol elicits schizophrenia-like negative symptoms which are distinct from sedation. Human Psychopharmacology, 26(1), 77–80.

Emphasis: rehabilitation Withdrawal, apathy, disorganization, cognitive slowing Morrison, P. D., & Stone, J. M. (2011). Synthetic delta-9-tetrahydrocannabinol elicits schizophrenia-like negative symptoms which are distinct from sedation. Human Psychopharmacology, 26(1), 77–80.

Emphasis: rehabilitation Withdrawal, apathy, disorganization, cognitive slowing Morrison, P. D., & Stone, J. M. (2011). Synthetic delta-9-tetrahydrocannabinol elicits schizophrenia-like negative symptoms which are distinct from sedation. Human Psychopharmacology, 26(1), 77–80.

No algorithms available Treatment should be personalized Art of medicine

Key Points There is scant evidence base for the treatment of cannabis use disorder CBD is being studied as potential treatment LAI antipsychotics are an option for patients who use potent cannabinoids, have psychotic symptoms and have poor treatment adherence Psychosocial interventions such as rehabilitation should be emphasized in cannabis users with non-positive psychotic symptoms

Key Points There is scant evidence base for the treatment of cannabis use disorder CBD is being studied as potential treatment LAI antipsychotics are an option for patients who use potent cannabinoids, have psychotic symptoms and have poor treatment adherence Psychosocial interventions such as rehabilitation should be emphasized in cannabis users with non-positive psychotic symptoms

Key Points There is scant evidence base for the treatment of cannabis use disorder CBD is being studied as potential treatment LAI antipsychotics are an option for patients who use potent cannabinoids, have psychotic symptoms and have poor treatment adherence Psychosocial interventions such as rehabilitation should be emphasized in cannabis users with non-positive psychotic symptoms

Key Points There is scant evidence base for the treatment of cannabis use disorder CBD is being studied as potential treatment LAI antipsychotics are an option for patients who use potent cannabinoids, have psychotic symptoms and have poor treatment adherence Psychosocial interventions such as rehabilitation should be emphasized in cannabis users with non-positive psychotic symptoms

End of presentation