Approximately 1.2 million Americans were admitted to treatment for cannabis use disorders last year. Clinical trials indicate that a majority of those who enter treatment for cannabis problems relapse, and relapse rates are comparable to those observed for other drugs of abuse. Currently, there are no accepted pharmacotherapies to aid the treatment of cannabis use disorders. Disturbed sleep is one of the most prominent symptoms of the cannabis withdrawal syndrome, and recent laboratory research has demonstrated that heavy cannabis users experience clinically significant sleep problems following abrupt cessation of use. Specifically, data from clinical surveys and prospective laboratory studies suggest that sleep disturbance during abstinence can precipitate relapse to cannabis use, and heavy cannabis users exhibit disruptions in sleep architecture and continuity during abstinence that meet benchmark criteria for a diagnosis of insomnia. Similar abstinence induced effects on sleep and sleep-related risk of relapse are known to occur during withdrawal from other drugs of abuse, and, importantly, research has shown that adding sleep improvement interventions to alcohol treatment programs can significantly improve clinical outcomes. This suggests that sleep improvement interventions could reduce relapse among cannabis users trying to quit. The proposed project aims to address two important gaps in understanding the relationship between sleep and cannabis use: 1) abstinence-induced sleep disturbance has not been assessed prospectively or objectively in cannabis users seeking treatment, thus, the external validity of retrospective surveys and laboratory studies is uncertain and 2) it is unclear if amelioration of sleep disturbance during a quit attempt will result in improved clinical outcomes (e.g. relapse prevention). The proposed study will be a double blind outpatient clinical trial in which eligible participants will receive one of two 12-week treatment interventions: 1) psychosocial therapy (MET/CBT) + 12.5 mg extended-release zolpidem, or 2) MET/CBT + placebo. Objective and subjective measures of sleep quality and architecture will be obtained throughout the study while participants attempt to quit use of cannabis in their home environment. Sleep assessments include polysomnography (intake, treatment weeks 1, 6, 10, and 12, and 3 month follow- up), actigraphy (daily) and sleep diaries (daily). Participants will complete MET/CBT therapy modules once per week, complete assessments and provide observed urine specimens for toxicological testing twice weekly, and self-administer study medication nightly during treatment. The mechanism by which we believe extended- release zolpidem will benefit study participants is an improvement in sleep. The relationship between sleep and cannabis use outcomes will be determined via planned mediation analysis. Outcomes from this study will help inform the treatment of cannabis use disorders, will extend the scientifi understanding of the interrelationship of cannabis use and sleep, and will help guide future pharmacotherapy research.

Public Health Relevance

The number of people seeking treatment for marijuana-related problems is on the rise, yet there is no currently accepted medication proven to help them quit. Frequent marijuana users have reported that they have trouble sleeping when they try to quit, and that the loss of sleep can lead to relapse. This research is designed to measure the severity of sleep problems in people as they are trying to quit heavy use of marijuana, and to investigate the ability of an FDA approved sleep medication, extended-release zolpidem (Ambien CR(R)), to improve quit rates among people trying to stop using marijuana.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01DA031784-04
Application #
8877469
Study Section
Risk, Prevention and Intervention for Addictions Study Section (RPIA)
Program Officer
Biswas, Jamie
Project Start
2012-07-01
Project End
2017-06-30
Budget Start
2015-07-01
Budget End
2016-06-30
Support Year
4
Fiscal Year
2015
Total Cost
$597,297
Indirect Cost
$222,100
Name
Johns Hopkins University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21205
Chakravorty, Subhajit; Vandrey, Ryan G; He, Sean et al. (2018) Sleep Management Among Patients with Substance Use Disorders. Med Clin North Am 102:733-743
Schlienz, Nicolas J; Budney, Alan J; Lee, Dustin C et al. (2017) Cannabis Withdrawal: A Review of Neurobiological Mechanisms and Sex Differences. Curr Addict Rep 4:75-81
Pacek, Lauren R; Herrmann, Evan S; Smith, Michael T et al. (2017) Sleep continuity, architecture and quality among treatment-seeking cannabis users: An in-home, unattended polysomnographic study. Exp Clin Psychopharmacol 25:295-302
Schuster, Randi Melissa; Hanly, Ailish; Gilman, Jodi et al. (2016) A contingency management method for 30-days abstinence in non-treatment seeking young adult cannabis users. Drug Alcohol Depend 167:199-206
Herrmann, Evan S; Weerts, Elise M; Vandrey, Ryan (2015) Sex differences in cannabis withdrawal symptoms among treatment-seeking cannabis users. Exp Clin Psychopharmacol 23:415-21
Babson, Kimberly A; Ramo, Danielle E; Baldini, Lisa et al. (2015) Mobile App-Delivered Cognitive Behavioral Therapy for Insomnia: Feasibility and Initial Efficacy Among Veterans With Cannabis Use Disorders. JMIR Res Protoc 4:e87
Vandrey, Ryan; Babson, Kimberly A; Herrmann, Evan S et al. (2014) Interactions between disordered sleep, post-traumatic stress disorder, and substance use disorders. Int Rev Psychiatry 26:237-47
Pacek, Lauren R; Vandrey, Ryan (2014) Cannabis use history and characteristics of quit attempts: a comparison study of treatment-seeking and non-treatment-seeking cannabis users. Exp Clin Psychopharmacol 22:517-23
Bonn-Miller, Marcel O; Babson, Kimberly A; Vandrey, Ryan (2014) Using cannabis to help you sleep: heightened frequency of medical cannabis use among those with PTSD. Drug Alcohol Depend 136:162-5
Vandrey, Ryan; Johnson, Matthew W; Johnson, Patrick S et al. (2013) Novel Drugs of Abuse: A Snapshot of an Evolving Marketplace. Adolesc Psychiatry (Hilversum) 3:123-134