Cannabidiol, the non-psychoactive chemical in cannabis, could help treat heroin addiction, suggests a new study.
Patients with heroin use disorder who took medical-grade cannabidiol, also known as CBD, had reduced heroin cravings and anxiety for up to a week after their last dose of CBD.
Current medications approved by the Food and Drug Administration (FDA) for opioid addiction — methadone, buprenorphine, and naltrexone — work in a similar way, by reducing cravings.
“It’s thought that craving contributes to relapse, so if there’s a way that we can reduce craving, then perhaps we can reduce relapse,” said Ziva Cooper, PhD, research director of the UCLA Cannabis Research Initiative in the Jane and Terry Semel Institute for Neuroscience and Human Behavior.
Methadone and buprenorphine are both types of opioids, which means that their prescribing is highly regulated. Naltrexone is a non-opioid, as is CBD.
CBD reduced craving and anxiety
For the new study, Hurd and her colleagues recruited 42 adults with a history of heroin use disorder. Most had gone less than one month since their last use of heroin or another opioid.
However, they showed no signs of acute heroin withdrawal when they entered the study. They were also not currently undergoing maintenance treatment with one of the three FDA-approved medications for opioid use disorder.
During the study, people had to abstain from using heroin or any other psychoactive substance other than nicotine.
Researchers assigned people to one of three groups — taking 800 milligrams of CBD, 400 milligrams of CBD, or a non-active placebo.
They took the assigned dose by mouth once daily for three consecutive days. Researchers followed them over the next two weeks.
During three sessions after their last dose, people were shown videos of relaxing scenes such as nature, as well as drug-related videos with images of intravenous drug use or drug-related paraphernalia.
At different times during the sessions, researchers measured people’s opioid craving, anxiety, and stress response, such as heart rate and cortisol levels.
Seven days after people took their last dose, those who had taken CBD had lower craving and anxiety in response to drug-related cues in the videos.
There was no significant difference in craving or anxiety between the two CBD groups.
The stress reaction of people in the CBD groups was also lower in response to the drug-related cues, compared to those who had not taken CBD.
Potential treatment, but more research needed
More than 47,000 Americans died from an opioid-related drug overdose in 2017, according to the National Institute on Drug Abuse. This includes deaths due to prescription opioids, heroin, fentanyl, and methadone.
Some research has studied the benefits of medical marijuana for reducing the use of prescription opioids by people with chronic pain.
But the new study is one of the first to look at how CBD might help with opioid use disorder.
“This is definitely a step in the right direction, with respect to future studies addressing the potential utility of cannabidiol to help as an adjunct medication for opioid use disorder,” said Cooper, who was not involved in the study.
However, she pointed out that the study was small and researchers only followed people for one week.
The CBD used in the study is also not a “run-of-the-mill” cannabidiol that you could get at a store or cannabis dispensary.
Researchers used Epidiolex, the first FDA-approved cannabis-based medication. Unlike other CBD products on the market, the exact concentration and purity of Epidiolex is known.
More research is needed to know if CBD can help people stay clean longer and whether it will work in other groups.
“The next step would be to see if cannabidiol would help reduce this craving in a group of people that are recently abstinent or are undergoing medication- assisted treatment for their opioid use disorder,” said Cooper.
Existing opioid addiction treatments work
Dr. Chinazo Cunningham, a researcher at Albert Einstein College of Medicine who studies and treats drug addiction, said the findings are “interesting” and the effect of CBD on opioid use deserves to be studied.
However, she sees CBD’s potential — if further studies confirm that it is effective — as an adjunct to existing treatments.
“If we can have other medications that adequately treat addiction, I think that’s certainly a plus,” said Cunningham, who was not involved in the new study, “but I would never think about CBD as being used instead of what we know works — which are methadone, buprenorphine, and naltrexone.”
Cunningham also pointed out that more work needs to be done to connect people with existing treatments that are known to be effective.
”Right now we have three FDA-approved medications for the treatment of opioid use disorder,” said Cunningham. “The problem is not that the medications don’t work. The problem is that people don’t access the medications.”
The bottom line
However, experts say more study is needed before this can be recommended over proven opioid-treatment options like methadone and buprenorphine. People with opioid addiction also have issues getting any treatment in the first place.
In 2012, only 28 percent of people admitted to an opioid addiction treatment program offered medication-assisted treatment, according to the National Institute on Drug Abuse.
Is CBD legal?The 2018 Farm Bill removed hemp from the legal definition of marijuana in the Controlled Substances Act. This made some hemp-derived CBD products with less than 0.3 percent THC federally legal. However, CBD products containing more than 0.3 percent THC still fall under the legal definition of marijuana, making them federally illegal but legal under some state laws. Be sure to check state laws, especially when traveling. Also, keep in mind that the FDA has not approved nonprescription CBD products, and some products may be inaccurately labeled.
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