Full length articleAcute and long-term cannabis use among stimulant users: Results from CTN-0037 Stimulant Reduction Intervention using Dosed Exercise (STRIDE) Randomized Control Trial
Introduction
Population-based data estimates that 22 million people are current cannabis users and 4.2 million (20%) meet criteria for cannabis use disorder in the United States (Substance Abuse and Mental Health Services Administration, 2015). These estimates are extraordinarily higher than other substances, such as non-prescription use of pain relievers (4.3 million), stimulants (1.6 million), and cocaine (1.5 million), combined (Substance Abuse and Mental Health Services Administration, 2015). Furthermore, cannabis is reported to be simultaneously used with other illicit drugs, such as stimulants (Olthuis et al., 2013; Sanchez et al., 2015). Stimulants, such as cocaine, methamphetamine, and amphetamines, are often used along with other substances, such as cannabis in treatment seeking and community-based samples (Brecht et al., 2008). For example, a multistate study (Booth et al., 2006) found significantly greater use of cannabis among methamphetamine and cocaine users.
Despite its common use and increasing prevalence of abuse and dependence (Substance Abuse and Mental Health Services Administration, 2016, 2017), there are limited approved medical treatments to reduce cannabis use. Treatment thus far has relied on generic substance use reduction behavioral approaches (Budney et al., 2007; Buchowski et al., 2011). Exercise is an example of a potential behavioral approach to reduce cannabis use. Despite study limitations, exercise has been documented to have the potential to assist with tobacco smoking cessation (Marcus et al., 2005; Ussher et al., 2008); however, there are limited studies that explore the impact on cannabis use. A pilot study found that aerobic exercise training reduced cannabis craving and use in cannabis-dependent adults (Buchowski et al., 2011). However, the pilot study measured cannabis via self-report and the sample size was small.
Exercise as an approach to reduce cannabis use has the potential to provide physical and mental health benefits. A review of the literature (Brellenthin and Koltyn, 2016) found no randomized control trials that have examined the potential impact of exercise as a treatment option to reduce cannabis use; however, authors identified exercise as a promising treatment option due to its low cost, accessibility, and lack of negative stigma (Brellenthin and Koltyn, 2016). Exercise, even in short bouts, has been shown to improve sleep and mental health (Catalan-Matamoros et al., 2016; Meyer et al., 2016; Kelley and Kelley, 2017). Cannabis users reported using the substance to improve these outcomes; therefore, providing exercise as a treatment option may reduce cannabis use due to its positive impact on the aforementioned poor health outcomes (Brellenthin and Koltyn, 2016). A pilot study conducted on 12 non-treatment seeking adults with cannabis use disorder found aerobic exercise training reduced cannabis craving and use (Buchowski et al., 2011); however, there were limitations to the study. Cannabis use was measured via self-report with no objective measure confirmation. Furthermore, the pilot study’s aerobic exercise training program included 10-sessions over the course of two weeks, with a follow-up period of an additional two weeks. The short, two-week follow-up period of the pilot study resulted in the inability to assess the long-term impact (beyond two weeks) of the aerobic exercise training program on cannabis use reduction.
Despite the positive outcomes of exercise training, there is a lack of randomized trials testing such relationships. The objective of the current study was to examine the impact of a vigorous intensity high dose exercise intervention (DEI) on cannabis use compared to a health education intervention (HEI) among stimulant users. It was hypothesized that stimulant users randomized to DEI would have significantly lower cannabis use than HEI.
Section snippets
Study overview
The current study is a secondary analysis of cannabis outcomes from the Stimulant Reduction Intervention using Dosed Exercise (STRIDE), National Institute of Drug Abuse Clinical Trials Network Protocol Number 0037. The aim of the parent study (Trivedi et al., 2011, 2017), the STRIDE clinical trial, was to examine the efficacy of an aerobic exercise intervention in reducing stimulant use. Reduction in cannabis use was not the primary outcome of interest in the parent study. Details regarding the
Results
Demographic and baseline clinical characteristics are presented in Table 1. Forty-three percent (43.4%) reported cannabis use in the 30-days prior to residential treatment admission and 32% had Cannabis Dependence Diagnosis. During the Acute phase, 23.4% reported cannabis use. Of the 226 participants who did not test positive or report cannabis use at baseline, 33 initiated use during the Acute phase. Of the 271 participants who provided data for analysis in the Follow-up phase, 118 (43.5%)
Discussion
The current study sought to examine the impact of vigorous intensity high dose exercise intervention (DEI) on cannabis use among stimulant users compared to a health education intervention (HEI). It was hypothesized that cannabis use would be lower among those randomized to the DEI group compared to the HEI group. Results suggest that there were no significant short-term differences in cannabis use between the two groups. However, there were long-term differences between participants in the DEI
Conclusion
In conclusion, among cannabis users who adhered to the exercise intervention, vigorous intensity high dose exercise was found to have an impact on reducing cannabis use during the Follow-up phase of this randomized trial of stimulant users. Results suggest that there were no significant short-term differences in the reduction of cannabis use between the DEI and HEI groups. Further studies on the impact of exercise on cannabis use among non-stimulant users are needed to assess whether exercise
Contributors
Drs. Greer and Trivedi designed the study and wrote the protocol. Dr. Carmody led the statistical analyses. Drs. Vidot and Rethorst drafted the manuscript. Drs. Stoutenberg and Walker assisted with data interpretation and manuscript review. All authors contributed to and have approved the final manuscript.
Role of source funding
This work was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number U10 DA020024 and UG1 DA020024 (PI: Trivedi). Additional grant support provided by NIMHK01 MH097847 (PI: Rethorst).
Conflicts of interest
Dr. Carmody received an honorarium from the University of Texas San Antonio. Dr. Greer has received research funding from NARSAD and has received honoraria and consulting fees from H. Lundbeck A/S and Takeda Pharmaceuticals International, Inc. Dr. Trivedi has received funding support from the Agency for Healthcare Research and Quality (AHRQ), Cyberonics Inc., National Alliance for Research in Schizophrenia and Depression, National Institute of Mental Health (NIMH), National Institute on Drug
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