A new study out Tuesday is the latest to suggest that cannabis—or at least a key ingredient of it—might help people struggling with addiction. It found that people with opioid use disorder experienced less symptoms of craving when given cannabidiol, or CBD, over a placebo. CBD also helped them calm down and reduced their anxiety.
CBD is the part of cannabis that won’t make you feel high (that’s THC). It’s already used to treat certain kinds of seizures, as a prescription drug approved just last year called Epidiolex. But there are plenty of other advertised health benefits, such as stress relief or preventing dementia, that have helped sprout a cottage industry around CBD.
A lot of these products and claims are unlikely to be much more than overhyped bunk. But there’s been some evidence showing CBD might help with the opioid crisis. Some people are regularly using cannabis as a partial substitute for prescription opioid painkillers to manage their pain—a use that researchers are also starting to study in the lab. And research elsewhere, including by the current study’s authors, has shown that CBD can dampen the effects of withdrawal and craving in opioid-dependent animals that are taken off the drug.
The gold standard for testing whether something is really doing what it’s claimed to be doing is a double-blinded, randomized and placebo-controlled clinical trial, though. So that’s what the authors behind this study, published in the American Journal of Psychiatry, attempted to do.
For their trial, they recruited 42 men and women who had been living with opioid use disorder, specifically heroin, but were currently not using the drug. Half were randomly given pills containing CBD (actually just Epidiolex), in two dosages, while the rest took a placebo. Then, over the course of a week, the volunteers had to watch three-minute long videos either containing nothing but neutral images, like nature sounds, or videos featuring drug paraphernalia like syringes or bags of powder meant to look like heroin. The second set of videos, it was thought, would make the volunteers crave the drug and/or anxious.
The test subjects were given CBD for three days, and they were tested for post-video craving and anxiety symptoms immediately after they took a pill, a day after a CBD session, and a week after the last session. Across these scenarios, the researchers found, people on CBD reported less craving and anxiety on average than the placebo group, while objective measurements like heart rate and cortisol levels in saliva (often used to indicate acute stress) were also lower.
“The study definitely demonstrates that cannabidiol can have a significant effect on certain aspects of opioid use disorder,” Ziva Cooper, the research director of the Cannabis Research Initiative at the University of California, Los Angeles and who is unaffiliated with this study, told Gizmodo over the phone. “And what’s really important is that this is a replication of earlier work, on a much smaller group, done by the researchers.”
The study’s implications are definitely big. There are several medications already used to manage opioid use disorder and prevent relapses, particularly methadone and buprenorphine, but not everyone can easily access these drugs, nor do many rehab centers even offer them as a treatment. That’s partly thanks to a stigma surrounding these two drugs, which are both opioids. This stigma is unfounded, though, because neither should cause an unhealthy dependence if used properly under medical supervision, and people on these drugs still experience overall less relapses or fatal opioid overdoses than those who try to quit opioids cold turkey.
But non-opioid options like CBD could only make it easier for people to get the treatment they need. And though cannabis and CBD remain in a legally murky place, the fact that Epidiolex was successfully used in this study is important too, since that could mean doctors can someday prescribe it without much hassle since the drug is already FDA-approved.
The authors do caution that their trial was still an “exploratory” study, so there’s more research that has to be done before we can be sure of CBD’s potential as an addiction treatment.
One major limitation, for example, is the study’s week-long length. Medication is only one part of the typical treatment for those recovering from opioid use disorder, in conjunction with behavioral counseling. But while some people may only need medication for a short while to manage their craving or withdrawal symptoms, many others will need a long-term, or even life-long regimen. So any drug that’s trying to help with addiction ideally needs to work over the long haul too. CBD isn’t thought to cause any serious side-effects (and it didn’t in this study), regardless of how long it’s taken, but we don’t know anything about its sustained effectiveness.
Cooper also noted that there’s other aspects of opioid use disorder left untested by this study, such as the overall risk of relapse. And the volunteers used were people who were relatively stable, not those freshly off heroin who most need a treatment to manage their cravings. Anyone who might think of using CBD to self-medicate their opioid use disorder, Cooper added, should also remember that many consumer products simply don’t contain the large dosages of CBD that’s found in Epidiolex, nor are they tested anywhere near as much for their safety.
“I don’t think people will necessarily see the same effects from taking a smaller dosage,” Cooper said.
That said, there’s certainly good reason to be hopeful.
“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,” said 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 release from Mount Sinai.