Support for cannabis use disorder
I have a 55 year old male patient who has been smoking cannabis, roughly 2 grams per day, for essentially the past 40 years. He is now pretty motivated to stop for health reasons, mostly being more short of breath, and is wondering if there are any medical treatments to help him wean off. My understanding is that there isn't, but maybe some things have been tried off label? He has a fairly complex health history including probable bipolar disorder, active but less frequent (about weekly) crack use, diabetes, htn, asthma and chronic pain. I would love for him to take cannabis out of the picture but I don't want to destabilize his other issues.
If medications are not useful, any recommendations on resources or strategies would be greatly appreciated.
There are not any medical treatments that I am aware of. Motivational Interviewing to support his change plan may be helpful. If his main concern is shortness of breath, perhaps recommending he switch to edibles or vaporizing for now will address some of his concerns.
I would suggest treating the symptoms ie anxiety, insomnia (CBT I)
Is he very overweight? You might motivate him to cut down his cannabis use by linking it to weight gain. But the weekly crack says this fellow has likely a certain lifestyle / friends that make addiction problems more likely. He may never get off cannabis completely but 75% reduction along with exercise might drop his weight (assuming he’s overweight) and relieve his SOB.
Nabilone has an off-label use for helping people wean off cannabis.
It a can be substituted for a joint.
Start with 0.5mg BID or TID and increase as tolerated to a maximum of 6 mg OD.
Alison Arnot
Hi,
I run the Ontario Pharmacists Associations' Drug Information and Resource Centre. This is a subscription service for Ontario's pharmacists to answer questions on all sorts of medications related questions.
We are thinking about creating a service for other healthcare providers to answer these cannabis related questions. Do followers on this thread think that could be useful to others?
In the meantime, if you can send me a bit more information about your patient (what other medications is he on and what dosages), I'd be happy to have one of my drug information pharmacists take a look at possible options for you?
Mary
Hi Mary;
I would definitely find it useful.
Alison Arnot
I would also find that useful Mary.