Systematic analysis of changes in cannabis use among participants in control conditions of randomised controlled trials

• Systematic searches identified 8 trials reporting days of cannabis use per month in delayed or information-only controls
• Sample-weighted mean days of use fell from 24.5 per month at Baseline to 19.9 at 2-4 months
• A meta-analysis showed an average reduction of 0.442 SD.
• While there was substantial continued use, this reduction sets a challenging benchmark for treatments.

IntroductionCannabis remains the most used illegal substance across the globe, and negative outcomes and disorders are common. A spotlight therefore falls on reductions in cannabis use in people with cannabis use disorder. Current estimates of unassisted cessation or reduction in cannabis use rely on community surveys, and few studies focus on individuals with disorder. A key interest of services and researchers is to estimate effect size of reductions in consumption among treatment seekers who do not obtain treatment. Effects within waiting list or information-only control conditions of randomised controlled trials offer an opportunity to study this question.MethodThis paper examines the extent of reductions in days of cannabis use in the control groups of randomised controlled trials on treatment of cannabis use disorders. A systematic literature search was performed to identify trials that reported days of cannabis use in the previous 30 (or equivalent).ResultsSince all but one of the eight identified studies had delayed treatment controls, results could only be summarised across 2–4 months. Average weighted days of use in the previous 30 days fell from 24.5 to 19.9, and a meta-analysis using a random effects model showed an average reduction of 0.442 SD. However, every study had at least one significant methodological issue.ConclusionsWhile further high-quality data is needed to confirm the observed effects, these results provide a baseline from which researchers and practitioners can estimate the extent of change required to detect effects of cannabis treatments in services or treatment trials.