Anecdotes from doctors and patients point to cannabidiol (CBD) as a potential treatment for withdrawal and craving associated with opioid addiction, also known as opioid use disorder (OUD). Although medical advancements have made withdrawal easier, patients in recovery still have a 40-60% chance of relapsing into addiction.
Between January 2014 and January 2018, the annual number of drug overdose deaths in the United States rose 47%, with the majority caused by opioids. Successful withdrawal and relapse prevention plays a vital role in reducing the growing number of fatalities, and preliminary research supports the alleged beneficial effects of CBD.
Opioids are a class of drugs that include prescription medications (i.e., morphine), synthetic drugs with medicinal value (i.e., methadone), and the illegal drug heroin. Opioid molecules closely resemble naturally occurring endorphins and cause similar reactions. Endorphins and opioids bind to the same receptors in the brain and spinal cord, suppressing pain responses and enhancing mood.
Life-sustaining activities, such as eating, release endorphins into the brain, promoting a positive association and desire to repeat these activities. The brain learns to associate circumstances and environmental cues with these activities. In the case of eating, these positive associations could be a mouth-watering smell or favorite restaurant that triggers hunger.
Opioids act on the same areas of the brain, tricking the natural reward system designed to maintain life into promoting continued drug use. By the time an addiction develops, the brain has undergone fundamental changes that cause it to function normally with opioids and abnormally without them. At this point, drug use is no longer a choice; treatment is necessary to manage and reverse these changes.
Treatment for opioid addiction begins with detoxification, commonly referred to as withdrawal. This part of recovering from addiction has tremendous effects on the mind and body, including but not limited to nausea, fever, muscle cramping, body aches, agitation, insomnia, anxiety, and depression.
The second stage of treatment for opioid addiction is relapse prevention. Cravings are often managed with medication, while psychotherapy can help treat any underlying issues that contribute to excessive drug use. Exposure to circumstances and environmental cues (i.e., a friend that misuses drugs) also need to be controlled or effectively managed.
Treatment for opioid use disorder usually consists of psychotherapy, medication, and evaluation for underlying health issues. Medical devices may also be used, such as the NSS-2 Bridge that delivers electronic signals to the brain areas responsible for addiction.
Medications are the most common form of treatment, with 80% of patients taking a pharmaceutical during withdrawal. Many of these medications, such as methadone and buprenorphine, are opiate-based and carry their own set of risks. There have been deaths involving these medications, with methadone showing potential to be six times as lethal as buprenorphine.
Other drugs commonly used included clonidine and the fledgling medication lofexidine, approved for use by the FDA in May 2018. Both lofexidine and clonidine belong to a class of drugs that includes high blood pressure and some anti-anxiety medications.
It is important to note that opiate-based treatments can be safe and effective under medical supervision. Belonging to a different class of drugs does not necessarily make clonidine or lofexidine safer.
CBD may be beneficial in influencing many of the symptoms caused by opioid withdrawal. For nausea, multiple human and animal studies have demonstrated the effectiveness of CBD, possibly due to the presence of cannabinoid receptors in the areas of the brain that induce vomiting.
A pharmaceutical medication that contains a 1:1 ratio of THC and CBD, called Sativex, already exists to treat pain and muscle spasms/cramping in patients with multiple sclerosis (MS). Currently approved for use in Canada, Sativex shows potential for pain management in other patients, such as those withdrawing from opioids.
Studies have consistently found CBD has the potential to alleviate insomnia by boosting levels of tryptophan, a chemical required in the production of melatonin. For symptoms of anxiety and depression, CBD is thought to encourage the production of serotonin in a similar way to prescription SSRIs, a type of antidepressants.
The endocannabinoid system is a target for treatments that prevent relapse due to its potential to control cravings. CB1 receptors may influence opioid receptors, due to their location in the brain. CB2 receptors possibly affect dopamine and may reduce its rewarding effects that encourage opioid use.
Preclinical trials in rats and mice have reinforced the theory that CBD helps to control cravings, although why it works remains a bit of a mystery. Mice and rats given CBD in conjunction with morphine showed a lower reward response, making the morphine less appealing.
A similar study of rats addicted to heroin found CBD prevented relapse. Daily doses of 5 mg/kg or 10 mg/kg kept the rats from relapsing for up to two weeks following their final dose of CBD.
A third preclinical trial shows rats addicted to cocaine and alcohol experience similar effects from CBD treatment. Another trial using rats addicted to amphetamines found evidence that supports using CBD to prevent relapse.
Overall, CBD shows a strong potential as an additional treatment for opioid addiction when combined with psychotherapy and pharmaceuticals. Preclinical trials using animals consistently find CBD can be beneficial in preventing relapse, although further clinical trials in humans are needed to confirm this.
CBD may also help treat many of the withdrawal symptoms during detoxification from opioids. However, CBD alone does not replace the vital role of medically assisted treatment for addiction. Anyone suffering from OUD, or any form of substance use disorder should contact their primary care physician to establish a treatment plan.
There is no one-size-fits-all solution to ending the opioid crisis, but CBD may prove to be a valuable tool. At this point in time, while millions of Americans battle addictions and tens of thousands die, anything that may help deserves further investigation.
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