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Can cannabidiol (CBD) be used effectively to relieve the symptoms in individuals experiencing opioid withdrawal?

Opioid withdrawal and CBD is a fascinating topic.

With the alarming rate of opioid overdoses in the United States increasing over the past decade, alternatives to traditional treatment should be considered. There were almost 1,100 confirmed cases of opioid overdoses in 2014, a 65% increase from 2012.

Cannabidiol, a cannabinoid in marijuana has been shown in preclinical trials to deactivate opioid receptors. This may show promise in individuals suffering from opiate withdrawal, a condition known to cause many negative health and societal outcomes.2

Before discussing cannabidiols effect on opioid withdrawal, there must first be an explanation of what opioid withdrawal is and what effects opiates have on the body. Opioids attach to receptors in the brain, spinal cord, and gastrointestinal tract, releasing a chemical called dopamine, which is responsible for the pain relief associated with the drug.3

Because the human body does not produce dopamine in large quantities on its own, the body begins to become accustomed to having the drug if it is used for a long period of time and/or in large quantities.

In the case of an addict, the body becomes so accustomed to its presence, it becomes desensitized to the effects. The body then needs more and more of the drug to achieve the same effect which increase the chance of an overdose.4

Overdoses and pharmaceutical misuse increase 114% between 2004 and 2011.5 In 2011, more than 1.4 million emergency department visits annually were due to the abuse of pharmaceuticals.1

Currently, Methadone Maintenance Treatment (MMT) is the accepted form of inhibiting withdrawal in most opioid abusing patients. Methadone clinics distribute the Methadone in controlled doses that offsets withdrawal symptoms in the patient.6

However, Methadone itself is an opioid and there are cases of opioid abusers abusing or overdosing on Methadone. It also requires the user to go to a clinic daily, which can be difficult for lower income addicts without means of transportation. Because addicts cannot be trusted with a weekly dose of Methadone, this is the only effective means of controlling the urges of withdrawal in these individuals.

Opioid withdrawal and CBD is being studied more and more around the world.

Cannabidiol (CBD), is a cannabinoid in marijuana alongside the better-known tetrahydrocannabinoid (THC) that may show promise in opioid remediation. THC has been well documented to enhance sensitivity to other drugs, a staple of the “gateway drug” theory. However, cannabidiol acts in the opposite way.7 From clinical studies involving rats, it appears to have a very low abuse potential and to inhibit drug-seeking behavior.

In an animal study, researchers examined the effects of cannabidiol on heroin use and drug seeking behavior.8 Researchers found that CBD had a drawn out effect after as long as two weeks after administration whereas Methadone must be administered daily to stop drug seeking behavior in the patient.9

Due to this being an animal study, it has issues translating to a human context. This study gives a sustainability argument that CBD could have much lower societal costs than current MMT because of its safety and that it keeps dependent individuals from relapsing.

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Cannabidiol was also seen to inhibit the reward-facilitating effect of morphine.10 A low dose of cannabidiol did not affect brain stimulation, whereas higher doses significantly inhibited the effect of morphine.10 Although there are similarities between rat and human brain reward physiology,10 sociological effects of opioid abuse are apparent in humans and not in rats.

The study does give good promise into cannabidiols effect on decreasing addiction to opioids by lowering their overall effect on the central nervous system.

Cannabidiol has also had success with attenuating other addictive behaviors. It was found to reduce cigarette consumption in tobacco smokers that had a desire to quit.11

A study assessed the number of cigarettes smoked between a treatment group with CBD and a control group during the course of one week. Nicotine craving, anxiety, and overall mood of the individuals were assessed by surveys as well

The findings were that CBD had a direct effect on lessening the urge to smoke in these individuals as well as helping with the typical symptoms associated with ceasing cigarette use.

Figure 1: Number of cigarettes smoked in a week by treatment and control group

The results of the surveys used to assess craving and anxiety revealed that there was a positive effect over time but CBD usage had no effect between the pre and follow up nicotine craving scores.

Anxiety and mood scores also had an effect over time but were not statistically different between the treatment and the control group. Overall, if attenuation is seen in a drug like nicotine, there is a chance that it may have similar results when applied to drugs of similar addiction potential such as opioids.

The only study around opioids and CBD in the scientific literature to use humans examined the safety and pharmacokinetics (how the body metabolizes a certain drug) of cannabidiol when it was administered together with fentanyl in a population of individuals that were not opioid dependent.12 CBD did not exacerbate adverse effects associated with intravenous fentanyl use and that co-administration was well tolerated by the study participants.

The study itself had a problem of having a small sample of individuals (n=17). Due to a small sample, it is hard to delineate an association off of just 6 individuals per treatment group. Although the population was healthy and not generalizable to an opioid addicted population, the findings provides a starting point to conduct further studies using CBD as a treatment for opioid abuse since it is safe and well tolerated alongside opioids.

Although the data sources are limited at this time, there are trends in the literature suggesting that CBD could remediating withdrawal symptoms within the opioid dependent population. These studies have their limitations based on generalizability to a human population and small sample sizes. However, they display associations between CBD and addiction that are promising. There must be greater coordination at the state and federal levels so that larger long-term studies of higher reliability can be conducted and funded properly in the future.

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These new studies must consider ethical issues that may arise during the research. Such ethical issues include denying effective treatment through MMT, which may cause withdrawal, a life threatening condition if CBD was not effective. It is hoped that these findings may one day assist opioid dependent individuals on their road to recovery and better health.

Although animal studies and small clinical studies suggest a promising role for cannabidiol in the management of opioid addiction, there is not sufficient evidence to support the use of this intervention at the current time. Further studies of better quality must be conducted before any direct conclusions can be made as to the benefit of cannabidiol in relieving opiate withdrawal symptoms.

 

References

  1. Evaluation ASFPA. Opioid Abuse in the U.S. and HHS Actions to Address Opioid-Drug Related Overdoses and Deaths. In: Services HaH, ed. Washington DC 2015.
  2. Crime UNOoDa. World Drug Report. United Nations Publications. Vienna 2015.
  3. Prud'homme M, Cata R, Jutras-Aswad D. Cannabidiol as an Intervention for Addictive Behaviors: A Systematic Review of the Evidence. Subst Abuse. 2015;9:33-38.
  4. Linda R. Gowing RLA. The place of detoxification in treatment of opioid dependence. Current Opinion in Psychiatry. 2006;19:266-270.
  5. Administration SAMHSA. Highlights of the 2011 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits. Rockville, Maryland 2011.
  6. Volkow ND. America's Addiction to Opioids: Heroin and Prescription Drug Abuse. The Science of Drug Abuse & Addiction 2014.
  7. Hurd YL, Yoon M, Manini AF, et al. Early Phase in the Development of Cannabidiol as a Treatment for Addiction: Opioid Relapse Takes Initial Center Stage. Neurotherapeutics. 2015;12(4):807-815.
  8. Ren Y, Whittard J, Higuera-Matas A, Morris CV, Hurd YL. Cannabidiol, a nonpsychotropic component of cannabis, inhibits cue-induced heroin seeking and normalizes discrete mesolimbic neuronal disturbances. J Neurosci. 2009;29(47):14764-14769.
  9. Gaviria M. Chasing Heroin 2016.
  10. Katsidoni V, Anagnostou I, Panagis G. Cannabidiol inhibits the reward-facilitating effect of morphine: involvement of 5-HT1A receptors in the dorsal raphe nucleus. Addict Biol. 2013;18(2):286-296.
  11. Morgan CJ, Das RK, Joye A, Curran HV, Kamboj SK. Cannabidiol reduces cigarette consumption in tobacco smokers: preliminary findings. Addict Behav. 2013;38(9):2433-2436.
  12. Manini AF, Yiannoulos G, Bergamaschi MM, et al. Safety and pharmacokinetics of oral cannabidiol when administered concomitantly with intravenous fentanyl in humans. J Addict Med. 2015;9(3):204-210.