The well-documented opioid crisis in the United States is spurring research into alternative therapies to combat addiction to synthetic opioids (e.g. fentanyl), prescription pain killers (e.g. oxycodone), psychostimulant drugs (e.g. cocaine), and other addictive drugs such as tobacco and alcohol. While existing pharmaceutical drugs are effective in treating addiction, cannabidiol (CBD), the natural, non-psychoactive extract from the cannabis plant, is receiving considerable attention for its therapeutic potential.
Drug addiction rates and addiction-related deaths have increased considerably since the mid 90s, and millions of Americans are currently struggling to overcome a substance abuse disorder. Statistics include:
Until as recently as May 2018, opioids were the only FDA-approved therapy for severe, chronic pain. Even as 30 states and the District of Columba have legalized medical marijuana, THC and cannabidiol are still restricted as a Schedule 1 substance, making CBD less accessible for addiction research than oxycodone, cocaine, and ketamine.
Both CBD and opioids interact with receptors in the brain that relate to pain, behavior, and addiction. Opioids interact with neurotransmitters to block pain and elevate endorphins and dopamine, creating an artificial high that can only be recreated through opioid consumption. CBD also interacts with the brain’s neurotransmitters and pain receptors, though its exact pharmacology is still under clinical study.
However, one of the most promising aspects of CBD in addiction treatment is its analgesic and anxiolytic properties, meaning its ability to reduce pain, anxiety, and other symptoms associated with drug addiction. According to research published in Substance Abuse, CBD is “thought to modulate various neuronal circuits involved in drug addiction,” meaning CBD can temper the brain’s response to addiction triggers such as stress, pain, and anxiety without creating the artificial high associated with opioids. CBD’s analgesic properties act “synergistically” with opioids and “act as opioid sparing agents,” which can mitigate pain and pain symptoms while allowing for lower opioid doses.
Despite the legal hurdles surrounding CBD and the evolving field of medical study, a growing body of clinical research is reporting the therapeutic properties of CBD and its potential as an intervention for addictive disorders. While the consensus is far from conclusive, the prospects for treating addiction with CBD look increasingly promising.
CBD addiction research typically classifies addictive behaviors into three distinct phases, and the effects of CBD treatments are studied at each stage. These include:
Researchers at the University of Montreal published a meta-analysis of 14 addiction studies that examined the effects of CBD on different addictive behaviors in animals and humans. Researchers found that CBD reduced the positive “rewarding effects” during the intoxication phase of opioid addiction in animals.
Research published in the journal Substance Abuse reported inconclusive findings on CBD’s effects during the withdrawal phase, with CBD inhibiting some withdrawal symptoms in mice, but results varied based on “co-administration of other cannabinoids such as THC.”
Other studies report more conclusive findings. In a case report published in the Journal of Clinical Pharmacy and Therapeutics researchers found that ten consecutive days of CBD treatment for cannabis withdrawal resulted in “the absence of significant withdrawal, anxiety and dissociative symptoms during the treatment.” Additional research focusing on CBD treatments for opioid addiction and withdrawal found a “harmonious and even supportive use of cannabinoids in conjunction with opioids.”
CBD is proving to be particularly effective during the relapse phase. A study out of the University of Montreal found that CBD decreased “cue-induced, drug-seeking behaviors,” during the relapse phase, concluding that CBD was effective in treating opioid relapse in that isolated study.
Another preclinical study reported in Science Daily found that CBD effectively reduced relapse provoked by anxiety, stress, and drug cues in drug-induced rats. Rats that had been treated with CBD showed reduced anxiety and improved impulsivity, and these relapse-prevention behaviors persisted five months later. The authors found strong evidence supporting the “potential of CBD in relapse prevention along two dimensions: beneficial actions across several vulnerability states and long-lasting effects with only brief treatment.”
Although there are over one thousand CBD products on the market, there is only one pure CBD medicinal treatment available in the United States.
As the regulatory framework slowly catches up with medical and biomedical discovery, consumers might soon have access to new CBD medicinal products to combat addiction. Seventeen states currently have laws relating to the legal possession of CBD, including laws that allow universities and other research institutions to conduct clinical trials using CBD with low levels of THC.
Biotech companies in the US are also beginning to genetically engineer cannabinoids that could be more pure and more affordable than the traditional process of extracting CBD from the cannabis plant.
Tangential CBD research is also underway to treat epilepsy, schizophrenia, and other health disorders. Currently, a drug called Sativex is available in several countries and contains an equal amount of THC and CBD. Epidiolex, which is used to treat a rare form of epilepsy, was the first plant-derived CBD drug approved by the FDA. And Arvisol, an oral tablet containing pure CBD that is used to treat schizophrenia and epilepsy, is available abroad and is in the early research phase in the United States.
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