Pharmacotherapy for Marijuana Dependence: A Double-blind, Placebo-controlled Pilot Study of Divalproex Sodium. Levin FR, McDowell D, Evans SM, Nunes E, Akerele E, Donovan S, Vosburg SK. American J Addiction 2004 13:21-32
Dear Colleagues,
Negative research findings can be just as important as positive ones. This is especially so in well conducted placebo-controlled, randomised intervention trials. A recently published trial from the group at Columbia University in Manhattan has shown no significant effects using a mood-stabilising anti-convulsant, divalproex, in cannabis withdrawal subjects.
Despite finding no effect from the drug treated group, for some reason these veteran researchers do not say as much in their abstract. One has to read this sentence in the abstract to glean the important message of the article: “Regardless of treatment group, patients reported a significant reduction in their frequency and amount of marijuana use as well as a reduction in irritability.”
These researchers stress their positive findings, corroborating other reports regarding cannabis: (1) There are many members of western communities who perceive that they have cannabis dependency, (2) many such citizens are interested in treatment options, (3) such subjects will attend and comply well with recommended treatment and (4) most will reduce (or cease) their drug consumption during such interventions, regardless of their nature.
Any drug used to counteract cravings or withdrawals must have a safety profile which is in measure with the safety profile of the drug of dependence being treated. As well as such safety, such a drug must also be effective. This trial shows convincingly that divalproex, although a drug with some promise for cocaine withdrawals, is not a useful drug for symptoms of cannabis withdrawal. Cannabis is a harmful drug, causing dependence in a proportion of users and causing damage to the upper respiratory tract if smoked. The scope for harm appears to be low for most users, and is much lower than the harm which occurs in the ‘average’ tobacco smoker.
These authors (or the journal’s editors) use the lay term marijuana for some reason, only rarely using the correct scientific term, cannabis, in their text.
There is also a problem with the formal DSM criteria for cannabis dependency in the USA. The definitions (304.30 and 305.20) involve (1) the time spent acquiring the drug, (2) interference with family, schooling, work or 'recreation' (sic!) and (3) legal consequences of possession and consumption of the drug. Thus some of the subjects in this trial, if given access to cheap, unadulterated cannabis as in Holland, may not have satisfied the same criteria and thus been categorized as having cannabis ‘problems’ rather than cannabis ‘dependency’.
Levin FR, McDowell D, Evans SM, Nunes E, Akerele E, Donovan S, Vosburg SK. Pharmacotherapy for Marijuana Dependence: A Double-blind, Placebo-controlled Pilot Study of Divalproex Sodium. American J Addiction (2004)13:21-32
comments by Andrew Byrne ..
