大麻和 Δ9-四氢大麻酚缓解阿片类药物戒断：观察性和实验性人体研究的系统评价。
Alleviation of opioid withdrawal by cannabis and delta-9-tetrahydrocannabinol: A systematic review of observational and experimental human studies.
机构信息
Yale University School of Medicine, Department of Psychiatry, 300 George St., New Haven, CT 06511, USA; VA Connecticut Healthcare System, 950 Campbell Avenue (151D), West Haven, CT 06516, USA; Clinical Neuroscience Research Unit (CNRU), Conneticut Mental Health Center, 34 Park St, 3rd Floor, New Haven, CT, 06519.
Cumming School of Medicine, University of Calgary, Department of Psychiatry, 2500 University Drive NW, Calgary, Alb., Canada.
出版信息
Drug Alcohol Depend. 2022 Dec 1;241:109702. doi: 10.1016/j.drugalcdep.2022.109702. Epub 2022 Nov 18.
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
背景
尽管美国有六个州已经正式批准使用大麻素来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，尤其是在权衡其不良反应时。
方法
我们对研究大麻素与阿片类药物戒断和 delta-9-四氢大麻酚（THC）使用之间关联的研究进行了系统回顾。我们从研究开始到 2022 年 7 月 30 日搜索了多个数据库，并评估了研究质量。
结果
确定了 11 项研究，共有 5330 名参与者，其中 64%为男性。9 项观察性研究调查了大麻使用与阿片类药物戒断之间的关联。两项随机、安慰剂对照临床试验（RCT）研究了合成形式的 THC（dronabinol）对戒断缓解的作用。四项观察性研究发现大麻使用与阿片类药物戒断缓解之间存在关联；一项报告了阿片类药物戒断症状恶化；四项报告没有关联。RCT 报告称，THC 缓解了阿片类药物戒断，尽管随着滥用倾向、抑郁和心动过速等指标的剂量依赖性增加，其效果也会增加。阿片类药物戒断的测量以及基线时阿片类药物的类型和剂量存在高度异质性。
结论
尽管有初步证据表明大麻及其主要精神活性成分 THC 可能缓解阿片类药物戒断，但这些效果可能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取决于患者特征和药理学因素之间的复杂相互作用。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来缓解阿片类药物戒断具有临床、方法学和机制意义。
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