Alleviation of opioid withdrawal by cannabis and delta-9-tetrahydrocannabinol: A systematic review of observational and experimental human studies.
Alleviation of opioid withdrawal by cannabis and delta-9-tetrahydrocannabinol: A systematic review of observational and experimental human studies.
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DOI：
10.1016/j.drugalcdep.2022.109702
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发表时间：
2022-12-01
影响因子：
4.2
通讯作者：
Sofuoglu, Mehmet
中科院分区：
文献类型：
--
作者：
De Aquino, Joao P.;Bahji, Anees;Gomez, Oscar;Sofuoglu, Mehmet
虽然美国六个州已经正式授权大麻素替代阿片类药物并治疗阿片类药物使用障碍，但大麻素的治疗益处仍不清楚，特别是在权衡其不良影响时。我们对研究阿片类药物戒断与大麻使用或δ-9-四氢大麻酚（THC）给药之间关系的研究进行了系统回顾。我们检索了从成立到2022年7月30日的多个数据库，并评估了研究质量。确定了11项研究，共有5330名参与者，其中64%为男性。9项观察性研究研究了大麻使用与阿片类药物戒断之间的关系。两项随机、安慰剂对照临床试验（RCT）研究了屈大麻酚（一种合成形式的THC）的戒断缓解作用。四项观察性研究发现大麻使用与阿片类药物戒断症状缓解之间存在关联;一项报告阿片类药物戒断症状加重;四项报告无关联。随机对照试验报告说，THC减轻阿片类药物戒断，尽管滥用倾向，烦躁不安和心动过速的措施呈剂量依赖性增加。基线时阿片类药物戒断和阿片类药物类型和剂量的测量结果具有高度异质性。虽然有初步证据表明大麻及其主要精神活性成分THC可能会减轻阿片类药物戒断，但这些作用可能会有一个狭窄的治疗窗口。此外，大麻素缓解阿片类药物戒断的潜力是由患者特征和药理学因素之间的复杂相互作用决定的。总的来说，这些发现对大麻素使用期间治疗阿片类药物戒断以及使用非阿片类药物治疗缓解阿片类药物戒断的努力具有临床，方法和机制意义。
While six U.S. states have already officially authorized cannabinoids to substitute opioids and treat opioid use disorder, the therapeutic benefits of cannabinoids remain unclear, especially when weighted against their adverse effects. We conducted a systematic review of studies examining the association between opioid withdrawal and cannabis use or delta-9-tetrahydrocannabinol (THC) administration. We searched multiple databases from inception to July 30, 2022, and assessed study quality. Eleven studies were identified, with a total of 5330 participants, of whom 64% were male. Nine observational studies examined the association between cannabis use and opioid withdrawal. Two randomized, placebo-controlled clinical trials (RCTs) investigated the withdrawal-alleviating effects of dronabinol, a synthetic form of THC. Four observational studies found an association between cannabis use and the alleviation of opioid withdrawal; one reported exacerbation of opioid withdrawal symptoms; and four reported no association. RCTs reported that THC alleviated opioid withdrawal, albeit with dose-dependent increases in measures of abuse liability, dysphoria, and tachycardia. There was high heterogeneity in measurements of opioid withdrawal and the type and dose of opioid at baseline. Although there is preliminary evidence that cannabis and its main psychoactive constituent, THC, may alleviate opioid withdrawal, these effects are likely to have a narrow therapeutic window. Further, the potential of cannabinoids to alleviate opioid withdrawal is determined by complex interactions between patient characteristics and pharmacological factors. Collectively, these findings have clinical, methodological, and mechanistic implications for treating opioid withdrawal during cannabinoid use, and for efforts to alleviate opioid withdrawal using non-opioid therapeutics.
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影响因子：
4.2
作者：
Gamage, Thomas F.;Ignatowska-Jankowsa, Bogna M.;Muldoon, Pretal P.;Cravatt, Benjamin F.;Damaj, M. Imad;Lichtman, Aron H.
通讯作者：
Lichtman, Aron H.
影响因子：
4.2
作者：
Coloma-Carmona, Ainhoa;Carballo, Jose L.;Perez-Carbonell, Ana
通讯作者：
Perez-Carbonell, Ana
影响因子：
3.9
作者：
Evans, Elizabeth A.;Yoo, Caroline;Hser, Yih-Ing
通讯作者：
Hser, Yih-Ing
影响因子：
7.2
作者：
Hausner, Elke;Guddat, Charlotte;Waffenschmidt, Siw
通讯作者：
Waffenschmidt, Siw
影响因子：
4.2
作者：
DeWorsop, David;Creatura, Gina;D'Souza, Deepak Cyril
通讯作者：
D'Souza, Deepak Cyril