Emerging pharmacological strategies for the treatment of cannabis use disorder

Cannabis use disorder (CUD) is a growing global health concern, with limited pharmacological treatments currently available despite increasing prevalence and legalization trends. This review explores the landscape of pharmacotherapies for CUD, including both repurposed agents and emerging investigational compounds. We summarize findings from recent systematic reviews and meta-analyses, with attention to mechanisms of action and clinical relevance. Agents discussed include gabapentin, N-acetylcysteine, synthetic cannabinoids, fatty acid amide hydrolase (FAAH) inhibitors, orexin receptor antagonists, and psychedelics. A narrative approach was used, informed by targeted searches of PubMed, Google Scholar, and clinical trial registries from 2000 to 2025, focusing on human studies, randomized trials, and meta-analyses relevant to pharmacologic management of CUD. The pharmacologic treatment of CUD is in its early stages, with no approved agents and modest efficacy demonstrated to date. Novel compounds targeting endocannabinoid tone and motivational circuits show promise, but significant research is still needed. Future progress depends on better integration with behavioral care, trial stratification by clinical phenotype, and increased investment in translational research to move beyond withdrawal symptom management toward sustained recovery.

大麻使用障碍（Cannabis use disorder, CUD）是日益严峻的全球公共卫生问题，尽管其患病率持续上升、合法化浪潮不断推进，当前可用的药物治疗手段却极为有限。本综述系统梳理了大麻使用障碍的药物治疗研究全貌，涵盖老药新用制剂与新兴在研化合物两类。本文总结了近年系统综述与荟萃分析的核心研究结果，并重点关注其作用机制与临床相关性。本次讨论的药物包括加巴喷丁、N-乙酰半胱氨酸、合成大麻素、脂肪酸酰胺水解酶（fatty acid amide hydrolase, FAAH）抑制剂、食欲素受体拮抗剂及致幻剂。本综述采用叙述性研究方法，检索范围为2000年至2025年PubMed、Google Scholar及临床试验注册数据库的针对性文献，重点纳入与大麻使用障碍药物治疗相关的人体研究、随机对照试验及荟萃分析。当前大麻使用障碍的药物治疗仍处于起步阶段，尚未有获批上市的治疗药物，且现有疗法的疗效较为有限。针对内源性大麻素系统张力与动机环路的新型化合物展现出潜在应用价值，但仍需开展大量深入研究。未来的研究进展有赖于与行为干预的深度整合、基于临床表型的试验分层设计，以及对转化研究的投入提升，从而实现从单纯的戒断症状管理到促进持续康复的治疗目标。