A preliminary randomized controlled trial of repetitive transcranial magnetic stimulation applied to the left dorsolateral prefrontal cortex in treatment seeking participants with cannabis use disorder.

Background: Cannabis use disorder (CUD) is a common and consequential disorder. When applied to the dorsolateral prefrontal cortex (DLPFC), repetitive transcranial magnetic stimulation (rTMS) reduces craving across substance use disorders and may have therapeutic clinical effects when applied in serial-sessions. The present study sought to preliminarily determine whether serial-sessions of rTMS applied to the DLPFC had a therapeutic effect in CUD.
Methods: This study was a two-site, phase-2, double-blind, randomized-controlled-trial. Seventy-two treatment-seeking participants (37.5% Women, mean age 30.2±9.9SD) with ≥moderate-CUD were randomized to active or sham rTMS (Beam-F3, 10Hz, 20-total-sessions, two-sessions-per-visit, two-visits-per-week, with cannabis cues) while undergoing a three-session motivational enhancement therapy intervention. The primary outcome was the change in craving between pre- and post- treatment (Marijuana Craving Questionnaire Short-Form-MCQ-SF). Secondary outcomes included the number of weeks of abstinence and the number of days-per-week of cannabis use during 4-weeks of follow-up.
Results: There were no significant differences in craving between conditions. Participants who received active-rTMS reported numerically, but not significantly, more weeks of abstinence in the follow-up period than those who received sham-rTMS (15.5%-Active; 9.3%-Sham; rate ratio = 1.66 [95% CI: 0.84, 3.28]; p=0.14). Participants who received active-rTMS reported fewer days-per-week of cannabis use over the final two-weeks of the follow-up period than those receiving sham-rTMS (Active vs. Sham: -0.72; Z=-2.33, p=0.02).
Conclusions: This trial suggests rTMS is safe and feasible in individuals with CUD and may have a therapeutic effect on frequency of cannabis use, though further study is needed with additional rTMS-sessions and a longer follow-up period.
Competing Interests: Declaration of Competing Interest GLS has collaborated with MagVenture and MECTA as part of investigator-initiated trials. He additionally consults for and has equity in the company Trial Catalyst. TJF is employed by Magnus Medical and holds stock/equity options. NRW is a named inventor on Stanford-owned intellectual property relating to accelerated TMS pulse pattern sequences and neuroimaging-based TMS targeting; he has served on scientific advisory boards for Otsuka, NeuraWell, Magnus Medical, and Nooma as a paid advisor; and he has equity/stock options in Magnus Medical, NeuraWell, and Nooma. EBS is a paid consultant for Neuronetics and is an equity holder of Bodhi Neurotech. MSG has the following disclosures; Babystrong (patent co-holder), Brainsway (unpaid consultant, research grant, donated equipment for research trials), Magnus Medical (unpaid scientific Advisor), Magstim (unpaid consultant, donated equipment for research trials), MECTA (unpaid consultant, research grant, donated equipment for research grant), Microtransponder (DSMB member), Neuronetics (unpaid consultant, research grant, donated equipment for research), NeoSync (unpaid consultant, DSMB member), Neuralief (scientific advisory board, research grant, and Sooma (scientific advisory board), and he is an editor of the Elsevier journal Brain Stimulation. ALM has received research support from PleoPharma. None of the other authors have any relevant conflicts to disclose.
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