A Secondary Analysis Suggests That Repetitive Transcranial Magnetic Stimulation Applied to the Left Dorsolateral Prefrontal Cortex Reduces Cue-Induced-Craving in Treatment Seeking Participants with Cannabis Use Disorder.

Background: Studies across multiple addictions have suggested that repetitive transcranial magnetic stimulation (rTMS) applied to the left dorsolateral prefrontal cortex (L-DLPFC) reduces cue-induced-craving (CIC), however there are no studies in treatment seeking participants with cannabis use disorder (CUD). In this secondary analysis of a previously completed trial, we explore whether a multi-session course of rTMS reduces CIC in CUD.

Methods: Seventy-one participants with ≥moderate CUD (age=30.2±9.9;37.5% female) were randomized to twenty sessions of active or sham rTMS applied to the left DLPFC (20-sessions, Beam-F3; 10Hz) in a two-site, double-blind, sham-controlled, phase-2 trial where they also received motivational enhancement therapy. Participants rated their craving for cannabis via the short-form of the marijuana craving questionnaire (MCQ-SF) before and after a neutral and cannabis-cue presentation. Participants underwent assessment before (immediate-pre), after (immediate-post), and two-, and four- weeks following the course of rTMS.

Results: The MCQ-SF scores increased following the presentation of cannabis cues relative to neutral cues at the immediate-pre timepoint in both treatment groups (<0.0001). Following study treatment, the percent increase in MCQ-SF following cues diverged between the active and sham groups with significantly reduced CIC in the active group at the two-week post time-point (5.8±7.1% sham group, 0.91±4.1% active group; =0.02). Between-group effect sizes (Cohen's d) were 0.24, 0.89, and 0.67 at the immediate-post, 2-week, and 4-week follow-up periods respectively.

Conclusions: L-DLPFC applied rTMS may reduce CIC in treatment seeking participants with CUD.