Pharmaceuticals to Cure Marijuana Dependence and Abuse? You've Got to Be Kidding

Researchers looking for a drug to treat "marijuana dependence and abuse" may have found one, but the cure could be worse than the disease.

A team of scientists at Brown University conducted a pilot study to determine whether topiramate, an epilepsy drug marketed as Topamax, could be combined with motivational enhancement therapy to make MET more effective in reducing marijuana consumption.

Researchers seem to hope Topamax can be a silver bullet addiction cure. Scientists, including a member of the Brown team, have studied it as a potential treatment for alcohol and nicotine dependence and cocaine addiction, and now they are turning their sights on weed.

The pilot study consisted of 66 volunteers aged 15 to 24 who smoked at least twice weekly but who were interested in receiving both psychological and drug treatment. Some participants got Topamax alone and some got placebos, while all got MET counseling. The researchers found that participants who got Topamax didn't smoke less often, but they did smoke less. They called the findings statistically significant, even though the amount of decrease was 0.2 grams per use session, little more than a couple of healthy tokes.

“The positive news is it did seem to have some effect and that effect seemed to really be focused on helping people reduce how much they smoke when they smoke,” said Robert Miranda, Jr., lead author of the study in the journal Addiction Biology and member of the Center for Alcohol and Addiction Studies in the Brown University School of Public Health. “It’s promising in the sense that it suggests that medications can help, but it asks questions about for whom it might be most effective because many people can’t tolerate the medication.” 

Well, yes, there are some pesky side-effects. In fact, they're so nasty that more than half the subjects taking Topamax dropped out of the study, with two-thirds of them citing side effects like depression, anxiety, trouble with coordination and balance, weight loss, and "unusual sensations."

Maybe they're better off smoking pot. The subjects in the study certainly voted with their feet when it came to staying with Topamax.

Or maybe, despite volunteering for the study, they weren't really dependent on marijuana, especially since the study accepted subjects whose dependence could be based on smoking pot as infrequently as twice a week.

Indeed, only half the participants even met the DSM-V clinical criteria for cannabis use disorder, "a problematic pattern of cannabis use leading to clinically significant impairment or distress," whose markers include smoking more pot than you think you should and wanting to smoke pot, as well as getting too high too regularly to do the things you need to do, smoking pot even though you know it makes you crazy, and getting into work, legal or relationship trouble because of marijuana use. 

And the DSM-V is pretty straight-laced. It considers being high ("cannabis intoxication") to be a "cannabis-related disorder" (code 292.89).

There are substance abuse disorders and there are substance abuse disorders. It may be worth pondering whether relatively benign marijuana dependency merits being attacked with pharmaceutical drugs. So far, the cure has been worse than the disease. 

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