A Preliminary Investigation of Pre-Frontal Repetitive Transcranial Magnetic Stimulation (rTMS) for the Treatment of Cannabis Use Disorder

The overarching goal of this proposal is to investigate if a course of excitatory DLPFC rTMS
results in reduced cannabis cue-induced craving in treatment seeking individuals with CUD
(Aim1). Additionally, the investigators seek to explore the mechanistic underpinnings of any
observed effect, by collecting functional magnetic resonance imaging data during cannabis
cue-administration before and after the treatment course (Aim 2). These aims will be
addressed through a seven week, double-blind, randomized, sham-controlled study in which 72
treatment seeking cannabis use disordered participants (36/group) will be given 20 sessions
of either Active or Sham excitatory rTMS applied to the DLPFC. TMS will be delivered in an
accelerated fashion over two weeks (2 sessions each day, five days each week). TMS will be
applied in conjunction with a validated two-session Motivational Enhancement Therapy (MET)
behavioral intervention.

Inclusion Criteria:

1. Participants must be able to provide informed consent and function at an intellectual
level sufficient to allow accurate completion of all assessment instruments.

2. Participants must be between the ages of 18 and 60.

3. Participants must meet DSM-5 criteria for at least moderate Cannabis Use Disorder,
with use of at least 20 out of the last 28 days.

4. Participants must express a desire to quit cannabis.

5. Participants must have a Positive UDS for cannabis during their enrollment visit
(confirming they are regular users).

Exclusion Criteria:

1. Participants must not be pregnant or breastfeeding.

2. Participants must not test positive for any substance other than cannabis on UDS
during their enrollment visit.

3. Participants must not meet moderate or severe use disorder of any other substance with
the exception of Nicotine Use Disorder.

4. Participants must not be on any medications that have central nervous system effects.

5. Participants must not have a history of/or current psychotic disorder or bipolar
disorder.

6. Participants must not have any other Axis I condition requiring current treatment and
must have a HRSD24 ≤10 indicating no clinically relevant depressive symptoms.

7. Participants must not have a history of Dementia or other cognitive impairment.

8. Participants must not have active suicidal ideation, or a suicide attempt within the
past 90 days.

9. Participants must not have any contraindications to receiving rTMS (e.g. metal
implanted above the head, history of seizure, any known brain lesion).

10. Participants must not have any unstable general medical conditions.