CBD oil may help limit cravings and anxiety in heroin users, study finds
The team of New York-based scientists suggests CBD may have a potential role in helping to break the cycle of addiction.
A sample of water-soluble full spectrum cannabidiol (CBD) oil is dropped into water inside the laboratory facility at KannaSwiss GmbH in Koelliken, Switzerland, on Oct. 19, 2017. Stefan Wermuth / Bloomberg via Getty Images file
Add the possibility of reducing cravings and anxiety in heroin addicts to the growing list of potential CBD uses.
Researchers at Mount Sinai Hospital in New York announced Tuesday that results of a small study found a promising, and unexpected, new use of CBD: a reduction of cue-induced cravings and anxiety in individuals with a history of heroin abuse, suggesting a potential role for it in helping to break heroin drug addiction.
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The results of the study are published in the American Journal of Psychiatry.
“To address the critical need for new treatment options for the millions of people and families who are being devastated by this epidemic, we initiated a study to assess the potential of a nonintoxicating cannabinoid on craving and anxiety in heroin-addicted individuals,” said lead study author Yasmin Hurd, director of the Addiction Institute at Mount Sinai in a statement.
“The specific effects of CBD on cue-induced drug craving and anxiety are particularly important in the development of addiction therapeutics because environmental cues are one of the strongest triggers for relapse and continued drug use.”
Hurd and her team at Mount Sinai previously studied the effects of CBD in animals on heroin. They found that CBD reduced the animals’ tendency to use heroin in response to a drug-associated cue, so they decided to study the drug’s effects on humans.
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The researchers looked at 42 drug-abstinent men and women — ages 21 to 65 — with heroin use disorder. Half of the group, who had recently stopped using heroin, received CBD — 400 mg or 800 mg once daily — and the other half received a placebo. Participants were then exposed to neutral and drug-related cues during the course of three sessions: immediately following administration, 24 hours after CBD or placebo administration, and seven days after the third and final daily CBD or placebo administration.
They found that those who received CBD had significantly reduced drug cravings. They also found that the participants reported less anxiety when looking at pictures of people using drugs. Moreover, CBD seemed to have a lasting effect — the drug continued to reduce cravings and anxiety for seven days, well beyond the time the drug is expected to be present in the body.
Vital signs including skin temperature, blood pressure, heart rate, respiratory rate and oxygen saturation were obtained at different times during the sessions. To the researchers’ surprise they found that CBD reduced heart rate and salivary cortisol levels, which typically increase when anxiety provoking images are shown to addicts. This objective finding further supported Hurd’s idea that CBD may be a promising tool in helping to curb opioid addiction.
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“Cravings and anxiety are very subjective effects. One of the things people can do is trick themselves. That’s why we measured their physiological responses. These drug cues increase heroin users’ heart rates and the levels of cortisol so we know it’s not subjective because with the CBD their heart rates and levels of cortisol decreased — that’s really important,” Hurd told NBC News.
Still, without more research it is impossible to prove if the findings were due to the use of CBD alone, a combination of multiple factors, or by other factors entirely.
Can CBD be used to curb the opioid epidemic?
Drug overdose deaths rose above 70,000 in 2017, a record high and an increase of almost 10 percent from the previous year, according to the Centers for Disease Control and Prevention. Young adults and teens have been hit hardest by the opioid epidemic. In fact, death rates among younger adults have risen so much that they have reduced the overall life expectancy for the U.S. population as a whole.
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.
Many experts believe that with limited non-opioid medication options, the need for new alternatives is more important than ever.
“We’re in the middle of a huge movement in CBD research, but the Mount Sinai study is not the first,” said Dr. Danesh Alam, medical director of behavioral health at Northwestern Medicine Central DuPage Hospital, who was not involved in the study. “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 notes that conducting research in the field of addiction increases the challenge of finding pharmacological solutions to addiction.
“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,” Alam said. “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.”
CBD, the component of marijuana that does not get people high, has an inhibitory effect and therefore an anti-anxiety effect, Alam added.
As the popularity of CBD grows and more research is done, its role in helping to curb addiction may become a more realistic alternative.
“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,” Hurd told NBC News.
“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.”
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Previous studies in animals suggest that it might help with anxiety, pain and inflammation. Even further, recent studies published in the Journal of the American Medical Association showed that in states where people could legally use marijuana, the number of filled opioid prescriptions dropped significantly, and there were lower rates of opioid overdose and death, compared with states without legal cannabis.
This growing body of research adds to be an increasingly popular belief in the scientific community that CBD may have broad medicinal value in the fields of pain management, addiction medicine, and neurology.
“In addition to epilepsy one thing that’s been replicated over and over is anxiety,” Hurd said. “I don’t think this is just drug-induced anxiety; I think it’s anxiety in general.”
Hurd’s team plans to conduct longer, larger trials as well as human imaging studies to see if CBD use can decrease the rate of relapse long-term.
Dr. Shamard Charles is a physician-journalist for NBC News and Today, reporting on health policy, public health initiatives, diversity in medicine, and new developments in health care research and medical treatments.
Ali Galante is a medical producer for NBC News, covering health-related topics including the opioid crisis, disease, medical treatments and scientific discoveries.
Cbd oil for drug addicts
The widespread use of heroin and prescription opioids in the United States during the past decade has resulted in an unprecedented epidemic of opioid addiction, and few treatments for heroin use disorders are currently available. In this study, authors conducted a clinical trial to test whether cannabidiol (CBD), a non-intoxicating cannabinoid that is found in the cannabis plant, could reduce drug craving and anxiety in recently-abstinent individuals with heroin use disorder. The study found that, compared to those who received a placebo, individuals who received a dose of CBD medication showed a reduction in craving for heroin as well as reduced anxiety, which lasted for about a week after taking the CBD medication.
WHAT PROBLEM DOES THIS STUDY ADDRESS?
In the past decade, there has been an unprecedented spike in opioid use disorde r , which has led to more than 300,000 opioid-related deaths in the United States . O pioid use disorder medications such as methadone and buprenorphine (often prescribed in a formulation with naloxone , known by the brand name S uboxone ) help reduce opioid use and reduce risk for opioid-involved overdoses . In some areas, however, t hese medications are often underutilized and therefore can be difficult to access, creating a treatment gap in which those who need medications face barriers to actually receiving them. Further, 20-40% of opioid use disorder patients do not want to take agonist treatments .
One of the hypothesized factors contributing to these barriers is that methadone and Suboxone can be misused or diverted because they can produce euphoria . Consequently, discovering effective alternative medications that can also treat opioid use disorder that circumvent concerns about their psychoactive properties could help more of those affected . To address this problem , the authors investigated whether the cannabinoid , CBD , which is thought to be safe and non-addictive, could be useful in the treatment of opioid use disorder .
HOW WAS THIS STUDY CONDUCTED?
This was a randomized clinical trial with 42 participants who received one of two different CBD medication doses or a placebo once daily for 3 days and were then exposed to drug-related or neutral cues to see whether CBD could reduc e opioid cravings and anxiety – factors strongly associated with relapse to opioid use .
Participants were recruited through advertisements. Most participants indicated preference for intranasal heroin use, most reported currently using more than 10 bags of heroin (one bag = 1 g) daily, and on average, participants had been using heroin for over 10 years. The majority of participants (64.3%) had been abstinent from heroin use for less than 1 month.
The study medication used in this study, EPIDIOLEX, is a n FDA-approved medication that is dispensed through a pharmacy (not to be confused with “medical marijuana , ” which is comprised of a wide variety of non- federally- regulated cannabis projects ) . EPIDIOLEX is a plant-derived CBD liquid formation. P articipants were randomly assigned to receive 400 mg of CBD, 800 mg of CBD, or a placebo medication. CBD or placebo was administered once daily for 3 days . In addition to measuring the effect of the medication on opioid craving, anxiety, the authors also collected measures of positive and negative emotions, vital signs (skin temperature, blood pressure, heart rate, respiratory rate), and salivary cortisol levels , which measure stress response.
At three time points – immediately after the CBD or placebo administration ; 24 hours after the CBD or placebo administration ; and 7 days after the third and final CBD or placebo administration – p articipants were exposed to drug – related and neutral cues . The 3-minute neutral cue condition consisted of a video showing relaxing scenarios, such as scenes in nature. The drug cue condition was a 3-minute video that showed intravenous or intranasal drug use, depending on the participant’s reported preferred route of drug use . Immediately after the presentation of the videos , participants were also exposed to neutral objects or to heroin – related paraphernalia (e.g., syringe, rubber tie, and packets of powder resembling heroin) for 2 minutes. Authors examined whether patients who received CBD, compared to those who received placebo, showed differences in opioid craving, anxiety, positive and negative emotions, or vital signs , after being exposed to the drug or neutral cues.
WHAT DID THIS STUDY FIND?
I ndividuals receiving the non-psychoactive cannabinoid CBD medication reported less craving after being exposed to drug cues compared with i ndividuals receiving placebo . This effect lasted at least a week after the CBD or placebo administration, when i ndividuals receiving the high-dose of CBD (but not the low-dose) still reported less craving compared with those receiving placebo . In addition, CBD reduced measures of stress response after the drug cue – such as heart rate and salivary cortisol increases . I ndividuals receiving CBD reported less anxiety after being exposed to drug cues compared with i ndividuals receiving placebo (though t here w ere no significant difference s in anxiety between participants receiving the low-dose vs . the high-dose of CBD ) . There was no effect of CBD on positive affect or on any cognitive measures.
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WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?
In light of the opioid epidemic, it is important to identify as many strategies as possible to curb opioid addiction. In the past few years, scientists have asked whether or not cannabis use can help individuals recover from opioid use disorder or may serve as a less-risky pain management approach to pharmaceutical opioids . Individuals also report using cannabinoids in an effort to cut back or quit other substances , but currently, data do not support this indication. Some studies have shown no benefit; in fact, studies have shown that cannabis use is related to greater odds of both new-onset opioid use and opioid use disorder 3 years later . The small, experimental study here shows a potential benefit of CBD in reduc ing cue-induced craving and anxiety in heroin-abstinent individuals . This suggest s a potential role for CBD in relapse prevention of heroin use disorder . T his study takes a more rigorous approach that can serve as a model for future studies of cannabinoids and their potential role in OUD treatment and recovery.
- The sample size in this study was very small and , although results are promising, the findings need replication in larger samples. The small sample also did not allow for exploration of sex/gender effects, which could be important given that women typically have higher craving and anxiety than men.
- The study medication used in this study, EPIDIOLEX, is a n FDA-approved medication that you can only get from a pharmacy. Though EPIDIOLEX is derived from cannabis, it is NOT medical marijuana . This medication does not contain THC, which is the compound in the cannabis plant that causes the ‘high’ and euphoria. It is therefore important for patients to realize that although benefits of CBD were found, this study does NOT support the use of “medical marijuana” for opioid use disorder.
- This study only examined opioid craving for 7 days. It is still unknown if CBD would reduce opioid craving past the 7-day window examined in this study o r whether use of CBD actually translates into less use of actual opioids.
- Patients in this study had to be abstinent from opioids, and not taking any agonist therapie s. Therefore, the population in this study r epresent s individuals who are doing well and may respond will to lots of different interventions . However, this population may not be representative of opioid use disorder patients more generally.
- For individuals and families seeking recovery: This study showed that compared to placebo the non-psychoactive cannabinoid , CBD , was associated with substantially de creased cue-induced craving and anxiety for those with heroin use disorder . Many individuals with opioid use disorders are seeking alternative treatments to curb cravings and reduce anxiety, and many are reluctant to try agonist treatments such as methadone or suboxone . While more research is needed to flesh out whether CBD increase s the likelihood of long-term abstinence, this study suggests individuals may benefit from EPIDIOLEX, the FDA-approved CBD medication , but more larger studies are needed to confirm this . It is important to note, however, that individuals are using cannabis in its unregulated forms, and legislatures are passing med ical cannabis laws that identify opioid use disorder as one of the conditions for which cannabis is indicated without evidence to support this indication . Consequently, individuals seeking to use cannabis , in general, for opioid addiction should proceed cautiously .
- Fortreatment professionals and treatment systems: This study showed that compared to placebo, CBD was associated with substantially de creased cue-induced craving and anxiety for those with heroin use disorder . A recent survey found that a considerable percentage (30%) of individuals receiving agonist treatment were worried about encountering negative attitudes related to being prescribed agonists, and only 33% reported their provider discussed this with them prior to attending a meeting . If CBD does pan out as a potential treatment of heroin use disorder, this could appeal to many p atient s, and could be a good complement to recovery support services. It is important for treatment professionals to be aware that the unregulated forms of cannabis, e.g. , those that can be purchased at medical marijuana dispensaries, are still unproven treatments, and may in fact produce more harm than good.
- For scientists: This study showed that compared to placebo, CBD was associated with substantially de creased cue-induced craving and anxiety for those with heroin use disorder . More w ork is needed that more precisely measures whether CBD increases the likelihood of long-term abstinence , as well as for whom, and under what conditions , this medication work best. Greater knowledge in this regard could inform the nature of medication development more broadly . By pursuing investigation into other alternative treatments for opioid use disorder, scientists may be able to help reduce stigma and improve outcomes for patients with OUD .
- For policy makers: This study showed that compared to placebo CBD was associated with substantially de creased cue-induced craving and anxiety for those with heroin use disorder . While more research is needed, CBD may be an alternative to other medications for opioid use disorder, which are limited and not well-accessible to racial/ethnic minorities and those without financial means . Policy makers, however, should be aware that this study does not provide evidence that unregulated forms of cannabis, especially those containing THC, help with OUD. F unding research studies that examine pure forms of CBD, and other alternative treatments for opioid use disorder , could help improve outcomes and reduce the public health burden of the current epidemic of opioid addiction .
Hurd, Y. L., Spriggs, S., Alishayev , J., Winkel, G., Gurgov , K., Kudrich , C., . . . Salsitz , E. (2019). 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 . American Journal of Psy chiatry, ( ePub ahead of print). doi : 10.1176/appi.ajp.2019.18101191