Correlates of treatment engagement and client outcomes: results of a randomised controlled trial of nabiximols for the treatment of cannabis use disorder

Llewellyn Mills; Adrian Dunlop; Mark Montebello; Jan Copeland; Raimondo Bruno; Meryem Jefferies; Iain Mcgregor; Nicholas Lintzeris

doi:10.1186/s13011-022-00493-z

Correlates of treatment engagement and client outcomes: results of a randomised controlled trial of nabiximols for the treatment of cannabis use disorder

Subst Abuse Treat Prev Policy. 2022 Oct 8;17(1):67. doi: 10.1186/s13011-022-00493-z.

Authors

Llewellyn Mills^{1

2

3

4}, Adrian Dunlop^{5

6

7}, Mark Montebello^{8

9

10

7}, Jan Copeland^{9

11}, Raimondo Bruno^{9

12}, Meryem Jefferies¹³, Iain Mcgregor^{14

15}, Nicholas Lintzeris^{16

8

5}

Affiliations

¹ Drug and Alcohol Services, South East Sydney Local Health District, Caringbah, NSW, Australia. llew.mills@sydney.edu.au.
² Specialty of Addiction Medicine, Faculty Medicine, and Health, University of Sydney, Camperdown, NSW, Australia. llew.mills@sydney.edu.au.
³ National Drug and Alcohol Research Centre, University of New South Wales, Kensington, NSW, Australia. llew.mills@sydney.edu.au.
⁴ NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Health, St Leonards, Australia. llew.mills@sydney.edu.au.
⁵ Drug and Alcohol Services, Hunter New England Local Health District, New Lambton, NSW, Australia.
⁶ Priority Research Centre for Brain and Mental Health, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
⁷ Drug and Alcohol Services, Northern Sydney Local Health District, Hornsby, Australia.
⁸ Specialty of Addiction Medicine, Faculty Medicine, and Health, University of Sydney, Camperdown, NSW, Australia.
⁹ National Drug and Alcohol Research Centre, University of New South Wales, Kensington, NSW, Australia.
¹⁰ NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Health, St Leonards, Australia.
¹¹ Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Sippy Downs, QLD, Australia.
¹² University of Tasmania, Hobart, TAS, Australia.
¹³ Drug Health, Western Sydney Local Health District, North Parramatta, NSW, Australia.
¹⁴ School of Psychology, University Sydney, Camperdown, NSW, Australia.
¹⁵ Lambert Initiative Cannabinoid Therapeutics, University Sydney, Camperdown, NSW, Australia.
¹⁶ Drug and Alcohol Services, South East Sydney Local Health District, Caringbah, NSW, Australia.

Abstract

Introduction and aims: There is increasing interest and evidence for the use of cannabinoid medications in the treatment of cannabis use disorder, but little examination of the correlates of successful treatment. This paper is a secondary analysis of a randomised placebo-controlled trial of nabiximols for the treatment of cannabis use disorder (CUD), aiming to identify which client and treatment characteristics impact treatment engagement and outcomes.

Method: Bayesian multiple regression models were used to examine the impact of age, gender, duration of regular cannabis use, daily quantity of cannabis, cannabis use problems, self-efficacy for quitting, sleep, mental health, pain measures, and treatment group upon treatment engagement (retention, medication dose, and counselling participation) and treatment outcomes (achieving end-of-study abstinence, and a 50% or greater reduction in cannabis use days) among the 128 clients participating in the 12-week trial.

Results: Among the treatment factors, greater counselling attendance was associated with greater odds of abstinence and ≥ 50% reduction in cannabis use; nabiximols with greater odds of ≥ 50% reduction and attending counselling, and reduced hazard of treatment dropout; and higher dose with lower odds of ≥ 50% reduction. Among the client factors, longer duration of regular use was associated with higher odds of abstinence and 50% reduction, and lower hazard of treatment dropout; greater quantity of cannabis use with reduced hazard of dropout, greater odds of attending counselling, and higher average dose; greater pain at baseline with greater odds of ≥ 50% reduction and higher average dose; and more severe sleep issues with lower odds of ≥ 50% reduction. Males had lower odds of attending counselling.

Discussions and conclusions: These findings suggest that counselling combined with agonist pharmacotherapy may provide the optimal treatment for cannabis use disorder. Younger clients, male clients, and clients with sleep issues could benefit from extra support from treatment services to improve engagement and outcomes.

Trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12616000103460) https://www.anzctr.org.au.

Keywords: Cannabis dependence; Cannabis use disorder; Treatment engagement; Treatment outcomes.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Australia
Bayes Theorem
Cannabidiol
Cannabinoids* / therapeutic use
Cannabis*
Dronabinol
Drug Combinations
Humans
Male
Marijuana Abuse* / drug therapy
Marijuana Abuse* / psychology
Pain
Substance-Related Disorders*

Substances

Cannabinoids
Drug Combinations
Cannabidiol
Dronabinol
nabiximols

Associated data

ANZCTR/ACTRN12616000103460