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We determined whether cannabinoid exposure confers directional efficacy across opioid, alcohol, cocaine, tobacco, and methamphetamine use disorders, distinguishing symptomatic targets from sustained therapeutic outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0924933826122366_sec2\" sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed and Embase (1975\u20132025) were searched for human studies evaluating cannabinoid exposure in relation to SUD outcomes. Two reviewers independently screened and extracted data. Risk of bias was assessed using RoB 2 for randomized controlled trials (RCTs), ROBINS-I for cohort studies, and JBI checklists for cross-sectional, case, and qualitative designs. Six prespecified endpoints (treatment retention, relapse, abstinence, craving, withdrawal severity, consumption) were mapped to each target SUD. Following Synthesis Without Meta-analysis (SWiM) guidance, structured narrative synthesis used a design-based weighting scheme (RCT 1.00 to qualitative 0.25). PROSPERO: CRD420251151193.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0924933826122366_sec3\" sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ninety-seven studies (41,954 participants) contributed 195 endpoint instances: 89 Beneficial (45.6%), 80 No Significant Effect (41.0%), 12 Mixed\/Partial (6.2%), and 14 Harmful\/Inferior (7.2%). Short-term symptom targets accounted for most Beneficial findings (76.4%). Sustained outcomes were predominantly No Significant Effect, most pronounced in opioid use disorder. Beneficial symptom findings derived overwhelmingly from weaker study designs (craving 81.5%; withdrawal severity 85.7%; consumption 80.0%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0924933826122366_sec4\" sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Cannabinoids confer short-horizon symptomatic benefits but do not demonstrate efficacy for sustained abstinence, relapse prevention, or retention, most clearly in opioid use disorder, where evidence is strongest. Findings for other disorders remain preliminary. Adequately powered adjunctive randomized trials with biochemically verified endpoints are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/j.eurpsy.2026.12236","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T11:55:27Z","timestamp":1784289327000},"source":"Crossref","is-referenced-by-count":0,"title":["Cannabinoid exposure across substance use disorders: Short-term symptom benefits without sustained therapeutic gains in a tier-weighted systematic review"],"prefix":"10.1192","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6040-2683","authenticated-orcid":false,"given":"David","family":"Zammit Dimech","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01nrxwf90","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Edinburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audrey-Ann","family":"Zammit 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