Lee DC, Schlienz NJ, Herrmann ES, et al. Randomized controlled trial of zolpidem as a pharmacotherapy for cannabis use disorder. J Subst Use Addict Treat. 2024;156:209180. doi:10.1016/j.josat.2023.209180
This randomized controlled trial evaluated the utility of zolpidem-XR (AmbienÒ) as a biomedical tool for reducing sleep disturbance in cannabis users seeking abstinence. As one of the primary complaints during cannabis withdrawal is sleep disturbance, the authors sought to determine if the combination of biomedical therapy, financial incentives, and a computerized behavioral treatment platform could help. Participants were eligible to participate if they were adults, had used cannabis for more than 45 days in the previous 90 days, were interested in quitting, and either used cannabis to help them sleep or had sleep issues when they did not take cannabis (n = 127). Participants received either zolpidem-XR or a placebo for 12 weeks. All participants were asked to make weekly visits to outpatient clinics to provide urine samples and complete computerized motivational enhancement and cognitive behavioral therapy. Overall, attrition remained high for both groups (retention: placebo = 49%, zolpidem-XR = 53%), and medication adherence was low (53%). To resolve this issue, financial incentives for accurately reporting cannabis use were instated, increasing adherence to 92%. Initially, zolpidem-XR prevented the sleep disturbances seen in the placebo group once the period of abstinence began. Cannabis users abstaining from use and taking zolpidem-XR had no change in their time to fall asleep, whereas the placebo group showed a marked increase in this measure. Unfortunately, once participants stopped taking zolpidem-XR, they began experiencing sleep disturbances. Additional behavioral interventions are likely necessary to resolve sleep dysfunction in cannabis users, even after a period of absence.