A Phase II Multi-Site, Double-Blind, Randomized, Sham-Controlled, Clinical Trial of Repetitive Transcranial Magnetic Stimulation for Cannabis Use Disorder

Addiction to cannabis, or cannabis use disorder (CUD), is a rapidly growing clinical problem, given the increasing numbers of people with frequent and heavy cannabis use. CUD is associated with harm to mental and physical health and impairments in day-to-day function. It has even greater harm for young people and those who are already marginalized. Currently, there are no approved treatments for CUD. The disorder is driven by dysfunctional brain circuits that lead to symptoms of cannabis craving and compulsive use, which may be modifiable through a method of non-invasive focal magnetic stimulation called repetitive transcranial magnetic stimulation (rTMS). We propose that by stimulating regions of the frontal cortex involved in cognitive control of craving and compulsive drug use, rTMS can be an effective treatment for CUD. Current rTMS devices are highly expensive and difficult to implement in routine clinical settings. We propose using a novel circular coil (the MagVenture MMC-140) that is designed to be low-cost, easy to self-position and avoid needing technician staff and uses a low-intensity device that could be developed into an at-home coil in the future. Our team consists of experts in clinical trials, addiction, rTMS, and cannabis treatment. We are supported by pilot data showing the feasibility of this approach, and here, we propose a randomized controlled trial across two sites (Toronto and Hamilton, ON) using this rTMS coil compared to sham stimulation to explore the efficacy and safety in patients with CUD. Participants will receive rTMS or sham for a 4-week treatment course and be assessed for changes in the quantity and frequency of cannabis use, cannabis craving, mood, and cognitive functioning. This study aims to estimate the effect of this treatment to potentially advance to a larger, definitive, multi-site clinical trial. This study could pave the way for the first brain-based intervention in CUD that could be widely adopted into clinical care.