REVIEW OF: Gilbert DG et al, Psychopharmacology (Berl) 2020;237(5):1507–1519

As more and more states legalize marijuana and the prevalence of cannabis use increases, more people will be experiencing cannabis withdrawal symptoms, which are difficult to treat. The authors of this study hypothesized that the degree of negative affect experienced in cannabis withdrawal would be mitigated by nicotine. They designed a randomized, blinded, placebo-controlled trial to test the hypothesis.

Investigators recruited 101 people with moderate cannabis use disorder between the ages of 18 and 35. Participants were paid to stop using cannabis for 2 weeks (abstinence verified by urine tetrahydrocannabinol [THC] levels). They were then split into two groups, with one group receiving a 7 mg nicotine patch (n = 51) and the other receiving a placebo patch (n = 50). Physical symptoms of cannabis withdrawal (such as restlessness, sleep difficulty, decreased appetite or weight loss, abdominal discomfort or nausea, tremor, or headache) and negative affect were measured every other day for 15 days using the Profile of Mood States scale (POMS).

The results showed that the nicotine patch was more effective than placebo in reducing negative affect associated with cannabis withdrawal after 7 days (Cohen’s d = 0.2). Perhaps most interestingly, the results applied to all patients, whether they were tobacco users or not. Disappointingly, nicotine patches did not reduce overall withdrawal symptoms, and in fact increased nausea, probably an effect of the nicotine. The authors note that use of a higher-strength patch might have improved the results.

CATR’s Take
Nicotine can attenuate symptoms of negative affect during cannabis withdrawal, but not primary withdrawal symptoms. The study didn’t evaluate whether nicotine helps maintain cannabis abstinence. As a clinician, you can try this fairly harmless approach for cannabis-addicted patients who already use nicotine, but don’t expect miracles.