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2. 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

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

4. 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

5. 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

6. 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

7. 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

8. Pharmacotherapies

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

10. 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

11. 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.

12. 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.

13. Antipsychotic use in psychotic patients

14. 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

15. 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

16. 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

17. 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

18. 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.

19. 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.

20. 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.

21. No algorithms available
Treatment should be personalized
Art of medicine

22. 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

23. 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

24. 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

25. 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

26. End of presentation