Cannabis use disorder (CUD) is a common condition with few validated treatments and, to date, no FDA- approved medications. Subsequently, providers have few options to offer treatment seekers. An expanding literature base suggests that a single treatment of excitatory repetitive Transcranial Magnetic stimulation (rTMS) applied to the dorsolateral pre-frontal cortex (DLPFC) may temporarily reduce drug cue induced craving across substance use disorders. Two recent clinical trials suggest that delivering a course of multiple rTMS treatments holds promise as a potential treatment for tobacco and cocaine use disorders. Consistent with the findings in addictions, in Major Depressive Disorder a single treatment of rTMS has little if any mood effect; however repeated treatments result in clinically meaningful improvement and remission from depression in a substantial number of depressed patients. The candidate and mentorship team recently completed a laboratory-based trial demonstrating that a single treatment of rTMS is safe, tolerable, and feasible in non-treatment seeking cannabis use disordered participants. Additionally, rTMS reduced cannabis cue-induced craving. Given these promising preliminary findings, it is possible that a full course of rTMS would have a larger effect on craving and an effect on cannabis use. In this application for a career development award, the candidate proposes to determine if a course of rTMS treatments applied to the DLPFC can result in reduced cannabis cue-induced craving (Aim1) and cue reactivity in reward structures during an fMRI paradigm (Aim2) in treatment seeking cannabis use disordered individuals. Additionally, he will determine if a course of rTMS reduces cannabis use (Exploratory Aim). Development of a novel, effective treatment for CUD would have the potential of helping the estimated one million cannabis using Americans that seek treatment each year. Of note, rTMS is a treatment with few side effects, and it may focally target CUD's pathophysiology.
More than one million Americans sought treatment for cannabis use disorder (CUD) in 2014, and since that time the number of cannabis use disordered citizens of the United States has likely increased. Despite the substantial number of treatment seekers for CUD, there are few treatments with proven efficacy. Repetitive Transcranial Magnetic Stimulation (rTMS) is a promising new technique to treat addictions; however, further research is needed to translate promising early findings to standard of care treatments. This proposal will provide the necessary training and mentorship to transition the candidate to a career in the field of brain stimulation based research in addictions. Additionally, this application will provide preliminary evidence as to whether, or not a course of prefrontal rTMS might help individuals with CUD cease using cannabis.
