A new study has shown that cannabidiol or CBD, found in cannabis, could help people with opioid use disorder or addiction. CBD can help reduce the symptoms of craving among addicts when on withdrawal from the opioid and also reduce the accompanying anxiety and restlessness write the authors of the study.
The study titled, “Cannabidiol for the Reduction of Cue-Induced Craving and Anxiety in Drug-Abstinent Individuals With Heroin Use Disorder: A Double-Blind Randomized Placebo-Controlled Trial,” was published this week in the American Journal of Psychiatry.
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Cannabis contains cannabidiol or CBD and Tetra hydrocannabinol or THC. The high caused by cannabis is due to the THC. CBD – a phytocannabinoid, has been shown to be beneficial in several neurological and psychiatric disorders including seizures or epilepsy, dementia, anxiety disorders etc. CBD has also been studied as an alternative to opioid pain relievers among persons liable to become dependent on opioids. This team of researchers had earlier studied the effects of cannabinoid on successfully and safely reducing opioid dependence in animals previous to their trial on humans.
For this study, the team recruited 42 males and females who were suffering from opioid use disorder or opioid addiction specifically with heroin. These individuals were presently not using the drugs. The group was divided into two units. One of the groups was given pills containing CBD (available as experimental epilepsy pill Epidiolex) in two doses – 400 and 800 mg per pill. The other group was given similar looking inert pills called placebo. After the dosing the participants were all given three minute videos to watch over one week. These contained two types of images – neutral ones such as those of nature and drug related ones including syringes, needles, bags of powder looking like heroin etc. The drug related videos were shown to record craving and anxiety among the participants.
The participants of the test group were administered CBD pills once daily for three days and then shown the videos. Immediately after viewing the videos the anxiety and craving levels were recorded. Three time points for the effects were taken –
- One immediately after the CBD dose a video was shown and effects recorded. This was done at 1, 2 and 24 hours after dosing.
- 3 consecutive days after the last CBD dose, a video was shown and effects were recorded
- A week after the last three day dosing of CBD, a video was shown and effects were recorded.
Results revealed that at all three time points, CBD showed less craving and anxiety compared to placebo groups. Other measures of anxiety among the participants such as rise in heart rate, levels of stress hormone cortisol in the saliva are also indicators of craving and anxiety. These were lower among those on CBD compared to those on placebo pills, write the researchers.
The authors as well as other experts believe that the study has greater implications. At present there are drugs to prevent relapses in opioid addictions such as methadone and buprenorphine. These drugs are not always available at all centres, say the experts. In addition, both of these agents are opioids themselves. According to the National Institute on Drug Abuse only around one third of the opioid addicts receive one of these medications. CBD is a non-opioid alternative that could help prevent opioid addiction relapses. Epidiolex, as used in this study, has already received the United States Food and Drugs Administration (FDA) nod and thus could be prescribed for this reason as well, say the experts in the field. This study is a small one and only an initial trial though. Large clinical trials with longer term use of CBD would be needed to prove the efficacy of CBD in treatment of addiction.
Authors concluded, “CBD’s potential to reduce cue-induced craving and anxiety provides a strong basis for further investigation of this phytocannabinoid as a treatment option for opioid use disorder.”
Lead author Yasmin Hurd, a professor of Neuroscience, Psychiatry, and Pharmacology and Systems Therapeutics at the Icahn School of Medicine at Mount Sinai, in a statement said, “The intense craving is what drives the drug use... If we can have the medications that can dampen that [craving], that can greatly reduce the chance of relapse and overdose risk.”
“A successful non-opioid medication would add significantly to the existing addiction medication toolbox to help reduce the growing death toll, enormous health care costs, and treatment limitations imposed by stringent government regulations amid this persistent opioid epidemic,” Hurd added. With use of the pills there may be mild side effects such as a mild diarrhea, tiredness and headache she said.
Hurd concluded in statement, “We’re too slow to address addiction in our society. When the flu comes up and the measles comes up, we have so many people trying to help. But we don’t have the same kind of urgency with addiction. A successful nonopioid medication would add significantly to the existing addiction medication toolbox to help reduce the growing death toll and enormous health care costs.” “It's not addictive. No one is diverting it. It doesn't get you high, but it can reduce craving and anxiety,” and finally, “this can really help save lives,” she said.
Since 2000 there have been 400,000 deaths in the US due to opioid-related causes. Hurd said, “So many people are dying, and there is a need for developing medications.”
Expert speak
An independent expert Ziva Cooper, the research director of the Cannabis Research Initiative at the University of California, Los Angeles said in her statement, “The study definitely demonstrates that cannabidiol can have a significant effect on certain aspects of opioid use disorder. And what’s really important is that this is a replication of earlier work, on a much smaller group, done by the researchers.”
Dr. Julie Holland, a psychiatrist in New York and former assistant professor of psychiatry at the New York University School of Medicine, an expert in the field spoke about this study saying, “This is an extremely significant paper. We need to utilize every possible treatment in helping people with chronic pain to find other ways to manage their symptoms and in people with opiate addiction to find relief.” She added, “CBD not only manages the anxiety and cue/craving cycle, it also diminishes the original pain and inflammation that leads to opiate use in the first place.”
Dr. Danesh Alam, medical director of behavioral health at Northwestern Medicine Central DuPage Hospital, not involved in the study, in a statement said, “We’re in the middle of a huge movement in CBD research, but the Mount Sinai study is not the first. We’ve seen results like this from studies done in the heroin population in 2015-16. There are many chemicals found in marijuana including CBD that need to be studied further, but the restrictions on marijuana research have set us back.” Alam added, “Heroin addiction is challenging to study because we can't bring in 100 recovering patients to our clinics, so we often have to look at the disease's symptoms which occur in three phases: the intoxication phase, the dependence phase, and the relapse phase. CBD may have a role in helping in all three, but we don't know for sure. We have so much to learn about its role in anxiety and addiction in general.”
Ian Hamilton of the Department of Health Sciences at the University of York, also not involved in this study said that this study showed, “promising results that suggest there is potential for CBD in the treatment of people who have been dependent on opiates.” He added, “Administering CBD appears to reduce craving when measured against a placebo. This is important, as craving is a significant threat to recovery and can trigger a relapse into using opiates.” He added, “The greatest effect seems to have been when CBD was first given in the laboratory setting. Unfortunately, the effect is less significant when the person is in their own home. This suggests environment is a critical factor which will require further investigation and development if CBD is to be used to help people in the real world rather than in a research setting.”
Chandni Hindocha, a University College London research fellow at Britain’s National Institute for Health Research Biomedical Research Centers is part of another team that is working on cannabinoids and its effects on drug addiction. Hindocha said in a statement, “This study is incredibly important, as it shows us that there are drugs available to treat the opioid crisis.” She also said that women suffered more from craving than men adding, “women need more support giving up than men.” She added about this study, “It would be great to see if there was a correlation between the amount of CBD in the blood with the reduction in craving and anxiety, or with the more biological measures, such as the reduction in the stress hormone cortisol.” “It is unlikely that CBD alone will be enough to stop people using heroin, but alongside other treatments, it will certainly be useful,” Hindocha concluded.