Deep Transcranial Magnetic Stimulation for Cannabis Use Disorder

(TRANS-CANN Trial)

Overseen By Dante Duarte, MD, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: St. Joseph's Healthcare Hamilton

Must not be taking: Bupropion, Benzodiazepines

Disqualifiers: Schizophrenia, Bipolar, PTSD, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 18

Duration: 4-6 weeks

10 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new treatment called deep repetitive transcranial magnetic stimulation (dTMS) to help people reduce or quit cannabis use. The researchers aim to determine if dTMS can effectively assist frequent cannabis users seeking treatment. Participants will receive dTMS sessions alongside standard care to assess its impact on reducing cannabis use. Ideal candidates have a moderate or higher cannabis use disorder and are ready to make changes. As an unphased trial, this study offers participants the chance to contribute to groundbreaking research that could lead to new treatment options for cannabis use disorder.

Will I have to stop taking my current medications?

The trial does not specify if you must stop all current medications, but it does mention that certain medications, like high doses of bupropion or benzodiazepines, are not allowed due to safety concerns. It's best to discuss your specific medications with the trial team.

What prior data suggests that deep repetitive transcranial magnetic stimulation is safe for treating cannabis use disorder?

Earlier studies have found that repetitive transcranial magnetic stimulation (rTMS) is safe for people with cannabis use disorder (CUD). Participants handled the treatment well, and no major safety problems emerged. Some research suggests that rTMS might help reduce cannabis use. Although more research is needed to confirm these results, current findings offer promise for those considering this treatment option. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Unlike the standard treatments for Cannabis Use Disorder, which typically include behavioral therapies like motivational interviewing and contingency management, deep transcranial magnetic stimulation (dTMS) offers a unique, non-invasive approach. dTMS works by using magnetic fields to stimulate specific areas of the brain, potentially altering neural pathways associated with addiction. Researchers are excited about this treatment because it targets the brain's reward system directly, which could lead to more effective outcomes and reduce cravings in a way that standard therapies might not. Plus, its non-invasive nature means it could be a safer option with fewer side effects compared to pharmacological treatments.

What evidence suggests that deep repetitive transcranial magnetic stimulation is effective for cannabis use disorder?

Research has shown that deep repetitive transcranial magnetic stimulation (dTMS) might help reduce cannabis use in individuals with cannabis use disorder (CUD). Studies have found that dTMS is safe and may decrease cannabis consumption frequency. In a small study, targeting specific brain areas with this treatment reduced participants' cravings and cannabis use. These findings suggest that dTMS could be a valuable tool for those struggling with CUD, but further research is needed to confirm its effectiveness. ^{1 3 6 7 8}

Are You a Good Fit for This Trial?

This trial is for adults aged 25-65 with moderate to severe Cannabis Use Disorder (CUD), who use cannabis daily, mostly by smoking dried flower. Participants must want to change their habits, have a stable place to live and reliable transportation. They should also have certain levels of THC in their urine.

Inclusion Criteria

4 or more days of cannabis use per week

I am ready and willing to start treatment.

Stable domicile and reliable transportation, and willingness to attend in-person visits at SJHH Hamilton.

Exclusion Criteria

Active suicidality (past 3 months) or history of severe suicidality (i.e., requiring hospitalization)

Any other mental health condition deemed incompatible by the team

I am not on high doses of certain medications like bupropion or benzodiazepines.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive 18 H4 dTMS sessions over 4-6 weeks as an adjunct to evidence-based standard care for CUD

4-6 weeks

18 sessions

Follow-up

Participants are monitored for safety and effectiveness after treatment, including cannabis use frequency and cravings

4 weeks

Follow-up

Participants are monitored for long-term effects, including cannabis use frequency and cravings

1 month

What Are the Treatments Tested in This Trial?

Interventions

• Deep Repetitive Transcranial Magnetic Stimulation

Trial Overview The study tests deep repetitive transcranial magnetic stimulation (dTMS) using an H4 coil on the brain's lateral prefrontal cortex and insula as a potential treatment for CUD. It's an early-phase trial meant to set up for a larger future study where treatments are compared without participants knowing which one they're getting.

How Is the Trial Designed?

Group I: H4 dTMS Experimental Treatment 1 Intervention

The participants will receive 18 H4 dTMS sessions over 4-6 weeks as an adjunct to evidence-based standard care for CUD (i.e., motivational interviewing and contingency management).

Who Is Running the Clinical Trial?

St. Joseph's Healthcare Hamilton

Lead Sponsor

Trials

203

Recruited

26,900+

Published Research Related to This Trial

Repetitive transcranial magnetic stimulation (rTMS) applied to the dorsolateral prefrontal cortex is safe and feasible for individuals with cannabis use disorder (CUD), based on a study involving 72 participants.

While there were no significant differences in craving reduction, those receiving active rTMS reported fewer days of cannabis use in the final two weeks of follow-up, suggesting potential therapeutic benefits that warrant further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A preliminary randomized controlled trial of repetitive transcranial magnetic stimulation applied to the left dorsolateral prefrontal cortex in treatment seeking participants with cannabis use disorder. Sahlem, GL., Kim, B., Baker, NL., et al.[2023]

The rise in cannabis use and cannabis use disorder (CUD) due to increased legalization highlights the urgent need for effective treatments, as current options have limited success and high relapse rates.

Repetitive transcranial magnetic stimulation (rTMS) shows promise as a non-invasive treatment for substance use disorders, including CUD, and has received FDA clearance for smoking cessation, indicating its potential for broader applications in addiction therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Repetitive transcranial magnetic stimulation as a potential treatment approach for cannabis use disorder. Kearney-Ramos, T., Haney, M.[2022]

In a preliminary study involving 24 outpatients with schizophrenia and cannabis use disorder, high-frequency repetitive transcranial magnetic stimulation (rTMS) applied to the dorsolateral prefrontal cortex was found to be safe and well-tolerated, with a high retention rate of about 90%.

The active rTMS group showed a trend towards reduced cannabis use and craving, along with significant improvements in psychiatric symptoms and attention, suggesting that rTMS may be an effective treatment option for cannabis use disorder in patients with schizophrenia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Investigating repetitive transcranial magnetic stimulation on cannabis use and cognition in people with schizophrenia. Bidzinski, KK., Lowe, DJE., Sanches, M., et al.[2022]

Repetitive transcranial magnetic stimulation (rTMS) applied to the dorsolateral prefrontal cortex is safe and feasible for individuals with cannabis use disorder (CUD), based on a study involving 72 participants.

While there were no significant differences in craving reduction, those receiving active rTMS reported fewer days of cannabis use in the final two weeks of follow-up, suggesting potential therapeutic benefits that warrant further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Preliminary Investigation Of Repetitive Transcranial Magnetic Stimulation Applied To The Left Dorsolateral Prefrontal Cortex In Treatment Seeking Participants With Cannabis Use Disorder. Sahlem, GL., Kim, B., Baker, NL., et al.[2023]

The ongoing study combines THC administration with TMS to investigate how stimulating the left dorsolateral prefrontal cortex (DLPFC) affects cognitive outcomes in individuals with problematic cannabis use, aiming to clarify the relationship between brain function and addiction-related behaviors.

This research seeks to enhance our understanding of how acute neuromodulation via TMS can influence the subjective and performance-related effects of THC, potentially revealing new insights into the neural mechanisms underlying substance use disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Combining noninvasive brain stimulation with behavioral pharmacology methods to study mechanisms of substance use disorder. Wesley, MJ., Lile, JA.[2023]

Repetitive transcranial magnetic stimulation (rTMS) can be safely and feasibly administered to individuals with cannabis use disorder (CUD), with 89% of participants completing the study without adverse effects.

However, a single session of rTMS did not significantly reduce cue-elicited craving for cannabis, suggesting that while the treatment is tolerable, it may not be effective for craving reduction in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Repetitive transcranial magnetic stimulation (rTMS) administration to heavy cannabis users. Sahlem, GL., Baker, NL., George, MS., et al.[2023]

In a study involving participants with schizophrenia, high-frequency rTMS applied to the dorsolateral prefrontal cortex over 4 weeks showed that better baseline cognitive performance in sustained attention and complex planning was linked to greater reductions in cannabis use among those receiving active treatment.

While rTMS improved cognitive functions like complex planning and sustained attention, the changes in these cognitive abilities did not mediate the reduction in cannabis use, suggesting that rTMS may directly influence cannabis use independently of cognitive improvements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neurocognitive moderation of repetitive transcranial magnetic stimulation (rTMS) effects on cannabis use in schizophrenia: a preliminary analysis. Johnstone, S., Lowe, DJE., Kozak-Bidzinski, K., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10370231/

A Preliminary Investigation Of Repetitive Transcranial ... Conclusions: This trial suggests rTMS is safe and feasible in individuals with CUD and may have a therapeutic effect on frequency of cannabis ...

2. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0376871623012735

A preliminary randomized controlled trial of repetitive ... This trial suggests rTMS is safe and feasible in individuals with CUD and may have a therapeutic effect on frequency of cannabis use.

3. nature.com nature.com/articles/s41537-022-00210-6

Investigating repetitive transcranial magnetic stimulation on ... A case series (N = 3) suggested that rTMS directed to bilateral DLPFC for 20 sessions may reduced cannabis use and craving, with a large effect ...

4. cdn.clinicaltrials.gov cdn.clinicaltrials.gov/large-docs/12/NCT05720312/Prot_SAP_000.pdf

A Preliminary Investigation of Two Repetitive Transcranial ... Behavioral treatments for CUD have yielded moderate treatment effects but are not. 100% effective4, and despite some promising medications in ...

5. mdpi.com mdpi.com/2076-3425/14/4/356

Neuromodulation for Cannabis Use: A Scoping Review Findings from TMS studies suggest that cannabis users exhibit altered cortical inhibition, with decreased short interval intracortical ...

6. medrxiv.org medrxiv.org/content/10.1101/2025.10.02.25337151v1.full-text

Repetitive Transcranial Magnetic Stimulation in Substance Use ... Summary of TMS protocol parameters and reported safety outcomes in studies on substance use disorders. This table presents key intervention characteristics ...

7. psychiatryonline.org psychiatryonline.org/doi/10.1176/appi.ajp.20240403

Assessment and Management of Concurrent Substance ... Limited data are available to inform clinicians on how to manage concurrent substance use in the context of repetitive transcranial magnetic ...

8. clinicaltrials.gov clinicaltrials.gov/study/NCT05292547

Study Details | NCT05292547 | Repetitive Transcranial ... This study is to explore if repetitive transcrinal magnetic stimulation (rTMS) with different stimulation schedules will be equally effective in reducing ...