Varenicline for Comorbid Tobacco and Cannnabis Use in Veterans

烟草和大麻在退伍军人群体中通常一起使用，导致严重的发病率; 然而，到目前为止，针对这种科摩罗的药物开发进展有限。伐尼克兰， α4β2亚型的选择性烟碱nACH受体部分激动剂和α7亚型的完全激动剂， 可以说是促进戒烟最有效的药物疗法，也显示出对戒烟的希望。 酒精使用障碍的治疗。Varenicline可以通过多种方式改善大麻使用结果 机制，包括与中脑边缘多巴胺系统的相互作用，认知功能的增强， 和抑制控制的恢复。我们的试验数据还表明，伐尼克兰可能有效地改善 使用大麻和烟草的个人的结果。鉴于大麻和烟草的流行 在退伍军人使用障碍，我们建议进行为期12周，安慰剂对照试验，138人，以评估 伐尼克兰在患有这种合并症的个体中的潜在疗效。主要结局将是减少 探索性分析将审查治疗中的保留情况。

Tobacco and cannabis are commonly used together in the Veteran population and result in significant morbidity; to date, however, advancements in medication development for this comorbidity have been limited. Varenicline, a selective nicotinic nACH receptor partial agonist of the α4β2 subtype and a full agonist of the α7 subtype, is arguably the most effective pharmacotherapy for promoting tobacco abstinence and has also shown promise for the treatment of alcohol use disorder. Varenicline may improve cannabis use outcomes through multiple mechanisms, including interaction with the mesolimbic dopamine system, enhancement of cognitive functioning, and restoration of inhibitory control. Our pilot data also suggests that varenicline may be effective in improving use outcomes in individuals who use both cannabis and tobacco. Given the prevalence of cannabis and tobacco use disorder in Veterans, we propose to conduct a 12-week, placebo-controlled trial in 138 individuals to evaluate the potential efficacy of varenicline in individuals with this comorbidity. Primary outcomes will be reduction in cannabis and tobacco use, and exploratory analyses will examine retention in treatment.