Background
Our brains are wired to seek pleasure. Things that make us feel good often trigger brain chemistry in a way that encourages us to repeat those behaviors. This is true for tasting delicious food, or using mind-altering substances. Underneath our conscious awareness, our brains are designed to repeat pleasurable behaviors.
Because of this, substance use can turn into a disorder, known as substance use disorder. This is also commonly referred to as addiction. Substance use disorders are common, affecting more than 35 million people worldwide. They are also treatable. Most treatment options for substance use involve support groups, medications, or therapy — or a combination. But more recent research is exploring the role of CBD as well. Read on to learn about the role of CBD in recovery from substance use disorder.
Substance use disorders such as drug addiction are conditions with a relapse risk increased by drug cues, vulnerability to stress, anxiety and impaired impulse control. As the number of people who suffer from drug addiction in the United States continues to rise there is an increasing need for new and effective therapeutic protocols and treatments.
Can CBD help curb Addictive Behavior?
Cannabidiol (CBD) is a constituents of cannabis and in its purest form is non-psychoactive and non-addictive making it an attractive candidate for use as therapeutic drugs. Previous research has indicated that CBD may be effective when used to reduce seizures in people with epilepsy and has both anti-inflammatory and analgesic effects. Now researchers have focused their efforts into investigating the potential of CBD to control cravings associated with substance abuse.
How could CBD help people with substance use disorders?
First, let’s define some terms. When we say “cannabis,” we are referring to the cannabis sativa plant. The word “marijuana” refers to varieties of cannabis that have mind-altering properties. The two major cannabinoids in this plant are THC (tetrahydrocannabinol) and CBD (cannabidiol). THC is the active part of the plant that creates the characteristic “high” feeling. Meanwhile, CBD doesn’t cause a high.
CBD has been shown to help with some of the symptoms of substance use disorders, such as:
· Difficulty controlling how much of a substance you use
· Social problems such as strained relationships or trouble at work
· Tolerance (needing more to get the same effect)
· Withdrawal symptoms when you stop using
Below, we will go into some of the ways that CBD can help with substance use disorder symptoms.
How Does CBD Work?
Despite extensive research in this area, the exact mechanism of CBD is not yet fully understood. CBD binds to receptors in the brain and it is thought it inhibits the Endo-Cannabinoid System (ECS) which has receptors throughout the brain and the body. The endocannabinoid system has multiple functions including the regulation of mood, appetite, memory and pain sensation. CBD binds to serotonin and adenosine receptors which influence pain perception and inflammation. Unlike, marijuana, CBD does not attach to CB1 and CB2 receptors in the brain which in simple terms means that although CBD acts like a drug it does not cause the same “high” state associated with drug use.
Craving and consumption
Cravings are strong desires to use drugs or alcohol. They can be triggered by negative emotions. When someone has a craving, it can lead to using drugs or alcohol. Some important triggers for drug cravings are chronic pain, stress, and anxiety.
CBD is widely used to reduce pain, stress, and anxiety. Because of this, experts are looking into whether they could help with cravings for other substances.
For example, many studies have shown that CBD use helps people to either reduce or stop using opioids. Most of these studies have been done in people who use opioids for pain relief. But similar effects have been found in people who inject opioids such as heroin and fentanyl.
CBD use has also been linked with decreased use of other pharmaceuticals, alcohol, and tobacco. When it comes to CBD, in a study of people who misused opioids, a single high dose of CBD prevented both drug-related anxiety and opioid cravings for a whole week. For people with cocaine use disorder, however, a similar dose of CBD was not effective.
Taking into consideration the neuropharmacological and behavioural effects of CBD and its impact on the neurocircuitry controlling addiction, the implications of CBD for the development of new treatments of drug addiction has attracted the interest in the research community investigating therapeutic solutions for drug addiction and relapse.
Pre-clinical studies investigating CBD as a treatment for cocaine self-administration in animals have been contradictory. One study in rats showed no reduction in cocaine self-administration after treatment with CBD while another in mice showed a reduction in cocaine use. Gonzales-Cuevas and colleagues investigated the potential of CBD in animal models of drug craving, impulsivity and anxiety. In the study, rats with alcohol and cocaine self-administration history received CBD for seven day at a 24 hour interval basis. The results from this study document two dimensions of the potential of CBD. First, CBD had an effect on relapse conditions such as sensitivity to drug context and stress, impaired impulse control and anxiety. This points to CBD’s potential ability to refine vulnerability states that promote relapse in rats. Second, CBD’s effects were long-lasting in the animals regardless of the short period of the treatment. This discrepancies between these animal studies, potentially due to differences in methodology emphasises the need for further investigation into this controversial area of research.
A recent study published in the American Journal of Psychiatry, led by Yasmin Hurd, further demonstrates the ability of CBD to reduce cravings in people with heroin drug addiction. The study involved 42 women and men with history of heroin abuse attempting to abstain from relapse. As part of the experiment participants were shown two types of videos: neutral videos showing nature scenes and videos showing drug-related cues aiming to trigger drug cravings. The participants were divided into three groups: people who took 400mg of CBD, people who took 800mg of CBD and a placebo group. The interventions were taken for three consecutive days. The experiment was double-blinded, meaning that neither the researchers nor the participants were aware of which conditions they were assigned to during the experiment.
Participants experienced higher cravings after seeing the heroin related videos as compared to the neutral videos as expected. However, those participants who took CBD as part of the treatment reported less drug cravings that people in the placebo group after exposure to drug-related cues. Results also demonstrate reduction in anxiety as well as reduction in heart rate and cortisol which is the “stress hormone”. The effects on the intervention were visible as soon as one hour after administration of CBD and were still visible up to one week after the intervention.
Withdrawal
If a person keeps using a substance, they can develop physical dependence for it. Then, if they take a break, they can experience a wide range of symptoms. These effects are known as withdrawal symptoms. Each substance has its own pattern of withdrawal. Some common symptoms include poor sleep, irritability, and negative mood.
For example, when people stop using opiods, withdrawal is often so unpleasant that people resume using them, even if it creates other problems in their life. Some of the most common opioid withdrawal symptoms are:
Pain and body aches
Nausea
Anxiety
Irritability
Low appetite
There is a lot of potential for CBD to treat opioid withdrawal symptoms. CBD is widely used to reduce pain, nausea, and anxiety.
Similar to opioids, nicotine withdrawal is what smokers feel when they quit using tobacco products. The withdrawal symptoms can be so unpleasant that someone will go back to smoking. A single dose of CBD has not been shown to be helpful for nicotine withdrawal. But it does reduce some of the pleasantness of cigarettes, which may help people cut back.
Can CBD act as a substitute for other substances?
Harm reduction means preventing overdose and improving health for people who use drugs. Some examples are distributing clean drug-use supplies and setting up supervised injection sites.
Another important harm reduction strategy is substituting one substance with a less dangerous one. A good example of this is buprenorphine (Suboxone). Buprenorphine is used to substitute for more dangerous opioids like heroin.
People commonly use CBD as a substitute for other, more dangerous drugs. Examples of these other drugs are cocaine, methamphetamine, and opioids — as well as alcohol. People have various reasons for turning to CBD. Compared to other substances, people tend to think that CBD is:
Safer and less addictive
Effective for mind-altering effects or symptom relief
Easier to access
More socially acceptable
Some treatment centers are even using CBD as a part of their formal treatment plan for individuals with alcohol use disorder. More research is needed to know the long-term benefits and risks of substituting alcohol with CBD. But preliminary studies suggest that:
CBD is less harmful than alcohol (it has fewer health impacts).
Consuming too much CBD is safer than overdosing on alcohol.
On a society level, the healthcare costs of CBD use are less than alcohol use.
Substitution doesn’t entirely get rid of a person’s substance use. But it is a critical tool to help avoid health complications and overdose. Substitution is also a more realistic alternative to drug abstinence — staying away from drugs completely — which doesn’t work for all people..
Interestingly, CBD might also help people stay committed to their drug treatment plan. For example, CBD might relieve some withdrawal symptoms — like anxiety — when other medications aren’t working properly.
CBD could also improve the effectiveness of treatments like naltrexone (Vivitrol), which help people recover from opioid use. But there is still a lot we don’t understand about how CBD interacts with other medications and substances. So it’s important to talk to your healthcare provider about CBD and medication interactions.
Can CBD help you taper off of other substances?
Sometimes people have a difficult time completely substituting one substance for another. In this case, CBD could still be used to reduce the doses of other substances such as:
Opioids
Benzodiazepines
Stimulants (methamphetamine and cocaine)
Alcohol
Essentially, CBD helps to reduce the doses of other substances by giving people similar benefits with fewer problems. Just like drug substitution, dose reduction happens somewhat automatically, when people view CBD as safer, easier to access, and more socially acceptable than other drugs.
Substance use has great risks like health complications, overdose, and death. These risks occur when someone takes the highest dose or amount of the substance. By reducing doses, CBD may provide some important health protections. However, more research is needed to know this for sure.
What treatments exist for substance use disorder? CBD appears to be useful for relieving some withdrawal symptoms and coping with negative feelings. To move away from harmful substance use, a person may need to use several treatment strategies at the same time. Examples of these are peer support, counseling, and mindfulness.
Substance use disorders can sometimes be hard to recognize. This is why it is important to reach out for help if you think you or someone else may have a substance use disorder.
State of Drug Addiction Treatment and Future Directions
The available medication for opioid addiction unfortunately has only temporary effectiveness because these substances have addictive properties themselves. CBD may provide a potentially alternative way of targeting drug addiction without causing further addiction.
However, there is still limited evidence to support the use of CBD to treat drug addiction. The pre-clinical trials carried out are on animals and there are few human studies. To date, no clinical trials on humans have been completed and it will also be important to evaluate the long-term effect of CBD use beyond one week of intervention.
Although a promising candidate for drug addiction treatment, at the current time further research must be carried out before CBD can be safely used to treat drug addiction.
The bottom line CBD may help people reduce or stop using other substances by offering similar benefits with fewer risks. CBD may also reduce some withdrawal symptoms, and give people a way to cope with negative emotions during recovery. CBD may play an important role in harm reduction. It can reduce one’s chances of health complications, as compared to using other substances. Also, it doesn’t carry the same risk of fatal overdose as some substances do.
References
Gonzales-Cuevas et al. (2018). Unique treatment potential of cannabidiol for the prevention of relapse to drug use: preclinical proof of principle. https://doi.org/10.1038/s41386-018-0050-8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6098033/
Hurd, Y. (2017). Cannabidiol: swinging the marijuana pendulum from ‘weed’ to medication to treat the opioid epidemic. https://www.sciencedirect.com/science/article/abs/pii/S0166223617300012
Calpe-López. C (2019) Molecules 2019, 24(14), 2583; https://doi.org/10.3390/molecules24142583
Addiction Policy Forum. (2020). DSM-5 criteria for addiction simplified.
Babalonis, S., et al. (2017). Oral cannabidiol does not produce a signal for abuse liability in frequent marijuana smokers. Drug and Alcohol Dependence.
These statements have not been evaluated and are not intended to diagnose, treat, or cure disease. Please consult with a health professional when implementing with any current medical regimen.
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