CBD: The next weapon in the war against opioid addiction?
University of Florida provides funding as a founding partner of The Conversation US.
CBD, or cannabidiol, is everywhere, with word on the street saying that it can cure everything from a bad mood to cancer. However, most of these claims are not based on scientific evidence. Animal studies suggest that CBD might be beneficial for some health indications, such as pain, inflammation, arthritis and anxiety.
However, until recently, the only medical indication that CBD has been proven to treat in humans is seizures associated with pediatric epilepsy. Now, however, a recent study suggested that CBD curbed cravings in people with opioid dependence. This is one of the first double-blind controlled trials, the gold standard for drug research, to show benefit of using CBD outside epilepsy treatment. Thus, researchers can say with greater confidence that CBD may be helpful in fighting the war against opioid addiction.
While this study is very exciting, as scientists who study drugs and addiction, we want to stress that this study was very narrow and used specific, standardized amounts of CBD. Thus, the results do not suggest that buying a bottle or jar of over-the-counter CBD is going to help with opioid cravings – or any other medical conditions.
Addiction is a brain disease
In order to understand why CBD might be useful to treat opioid addiction, it is helpful to take a closer look at how addiction alters normal behavior. Addiction is broadly defined by the American Psychiatric Association as “a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence.” Addiction is classified as a disease because addiction hijacks and alters the way how the brain processes information.
People with opioid addiction issues can often be triggered by seeing drug paraphernalia, which can trigger a relapse. Oleg Mikhaylov/Shutterstock.com
Specifically, areas of the brain critical in controlling the perception of daily and pleasurable activities are susceptible to the influence of addictive drugs. Due to the rewiring of the brain under addiction, the individual often perceives the world in context to their drug of choice. The brain learns to associate drug paraphernalia or the physical location of drug partaking in the context of receiving a drug. These cues become integral reminders and reinforcers of drug use.
These events occur with most known drugs of abuse, such as cocaine, alcohol, nicotine, methamphetamines as well as opioids.
Addiction is often thought of in terms of the pursuit of the “high” associated with the use of a drug. However, most addicts continue to use, or relapse when trying to quit using their respective addictive drug. This difficulty, despite the desire and often pressure by friends, family and co-workers to quit, is often due to the negative effects of drug withdrawal.
Depending on the drug, the symptoms of drug withdrawal can vary and range from mild to severe intensity. In the case of opioid withdrawal, symptoms often include anxiety, nausea, vomiting, diarrhea, abdominal cramps and rapid heartbeat. An individual going through opioid withdrawal experiencing extreme conditions of anxiety is likely to take opioids to alleviate that anxiety. This sort of behavior can be repetitive, leading to a what is called a feed-forward loop of dependence on an abused drug.
A person is often referred to as “dependent” on a drug when the drug must be present for the individual to function normally. Importantly, anxiety and depression are correlated with opioid dependence.
For dependent individuals, ongoing use of a drug is not perceived as a conscious choice, but rather an evil necessity. Medication-assisted treatment with drugs like methadone or buprenorphine, allows for an individual to undergo recovery from an opioid use disorder. The use of medication assisted treatment significantly decreases the likelihood of an individual to relapse and fatally overdose due to withdrawal or dependence symptoms.
CBD and Epidiolex
CBD was tested in several clinical trials and was shown to work and to be safe in treating a rare form of epilepsy. A pharmaceutical grade CBD, Epidiolex, gained FDA approval in June 2018 for this specific usage.
CBD is currently only prescribed as the drug Epidiolex. That is because, up until now, CBD has only been shown to be safe and effective in the treatment of intractable pediatric epilepsy.
Importantly, CBD binds to different receptors than those that lead to opioid addiction.
CBD and opioid addiction
In experiments reported in 2009, rats were trained to press a lever to receive heroin. CBD did not decrease the amount of heroin that the rats self-administered, or the drug seeking behavior displayed by the rat while taking heroin. However, when rats were taken off heroin and given CBD, there was a decrease in drug-seeking behavior when the animals were exposed to a heroin-associated cue.
Initial studies of CBD in humans verified that CBD, when co-administered with fentanyl, is safe and well tolerated in healthy, non-opioid dependent individuals. A 2015 report of a small double-blind study conducted in opioid-dependent individuals found that a single administration of CBD, in comparison to a placebo, decreased cue-induced craving of opioids and feelings of anxiety. A double-blind, placebo-controlled study means that doctors and patients in the study do not know who is getting a real drug and who is getting a placebo. That is to guard against what is known as the placebo effect.
A double-blind placebo-controlled study published on May 21, 2019 adds to these findings by demonstrating that the Food and Drug Administration-approved Epidiolex can reduce cue-induced craving in individuals that had been former heroin users. Furthermore, in these individuals, Epidiolex reduced reports of anxiety, and blood levels of cortisol, a hormone known to increase under conditions of stress and anxiety.
Although further studies are needed, these studies strongly suggest that Epidiolex or CBD may hold promise as a critical weapon in fighting the opioid epidemic.
This could be a big deal.
A bottle of CBD oil may contain unpredictable amounts of CBD, and it also could contain THC. WIRACHAI/Shutterstock.com
Before rushing out to purchase over-the-counter CBD to treat any medical condition, there are several practical considerations that should be considered.
Only Epidiolex is FDA-approved for a medical condition – pediatric seizures. All other forms of CBD aren’t regulated. There have been numerous consumer reports that show that the actual amount of CBD in over-the-counter products is significantly less than what is reported on the label. Also, some of these over-the-counter products contain enough THC to show up on drug tests.
Although Epidiolex was found to be safe in clinical trials, it can interact with other drugs prescribed for migraines and bipolar disorder. This could mean that taking CBD with certain drugs could diminish or enhance the effects of prescriptions, leading to problems controlling particular medical conditions that were once well-managed, or increase side effects of the other medications. For this reason, it is incredibly important to talk to your doctor or pharmacist about potential drug interactions before using CBD.
Can CBD Oil Help with Opiate Withdrawal?
Opiate-related deaths are on the rise. Sadly, the U.S is in the midst of an opiate epidemic with a staggering 48,000 people dying from overdose per year (According to drugabuse.gov).
Withdrawing from opiate drugs is a mentally and physically painful process. A well-planned approach is needed to rehabilitate properly.
Having something that eases withdrawal symptoms and reduces cravings can significantly improve the chance of recovery.
CBD could be the answer.
What are Opiates & How Does Addiction Start?
Opiates are drugs that are derived from opium. Opium naturally comes from the poppy plant but there are many synthetic opioids too, such as fentanyl.
There are two terms often used interchangeably:
- Opiates are drugs directly derived from the poppy plant such as heroin and opium.
- Opioids are a synthetic form of naturally-derived drugs such as morphine and fentanyl.
Opiates and opioids come in many forms. They’re used medically for treating mild to severe pain (opioid painkillers) and recreationally for their calming and euphoric effects.
Medically, opioids in the form of codeine, morphine, and oxycontin, are used to treat a variety of conditions. Although these conditions are a legitimate reason to use the drug, patients are at risk of becoming addicted.
It’s common for addiction to start after someone has been prescribed opioid painkillers. Patients receive the drug and a specified dose from their doctor. Over time the patient can feel like the drugs are losing effectiveness due to tolerance.
As tolerance increases, people tend to consume higher doses of the drug and before they realize it, addiction sets in.
The mind-altering effects of opiates are desirable, with many users saying the first time they use heroin all their worries completely disappear. This escape from reality is what draws people in.
After the first use, some individuals will never stop chasing that feeling of calmness and euphoria. Opiates can take hold extremely quickly, with most addicts not realizing they’re dependent until it’s too late.
What is Opiate Withdrawal?
Prolonged opiate use can lead to a crippling dependency on the drug in question.
When you become dependent on an opioid, you’ll experience withdrawal as the drug is eliminated from the body.
Opioid withdrawal times can vary depending on the specific drug taken, but the symptoms are similar across the board.
For example, heroin withdrawal can start 6 to 12 hours after the last dose was taken. From here, withdrawal symptoms can last 5 to 10 days.
Withdrawal symptoms are unpleasant and can be severe. The pain from withdrawal often draws people back to their opiate of choice just to feel “normal” again. In some cases, rehab is needed so the substance is not accessible to the individual during recovery.
Symptoms of Opiate Withdrawal
- Muscle, joint, & bone pain
- Cramps & headaches
- Extreme anxiety
- Sadness & depression
- Restlessness & inability to sleep
- Hot flashes & chills
- Profuse sweating
- Tempting cravings for the drug
- Nausea, vomiting, & diarrhea
- Abdominal pain
- Flu-like symptoms (runny nose, watery eyes, sneezing)
How Does CBD Help With Opiate Withdrawal?
Studies by researchers from the John Hopkins University School of Medicine show that cannabis has the potential to improve opiate withdrawal symptoms .
The study asked 125 people that used cannabis during their withdrawal whether the cannabis helped ease or worsen their symptoms.
Out of the 125 asked, 72 percent claimed it eased their symptoms, 6.4 percent said it made their symptoms worse, and 22.4 reported mixed results.
Another study published in the American Journal of Psychiatry tested the effects of CBD on heroin addicts . The study found when cannabidiol is given to patients, their cravings for the drug decreased as well as anxiety levels.
So, what does this mean?
How can CBD help those going through opiate withdrawal?
Although there are limited studies on the topic, there’s evidence that boasts CBD’s potential as a treatment for opiate withdrawal patients.
Numerous other studies have been done on cannabidiol to uncover the cannabinoid’s medical potential. Its anti-nausea, anti-anxiety, and pain-relieving qualities to name a few could help withdrawal sufferers ease their symptoms.
Let’s take a look at some of the benefits of CBD for opiate withdrawal.
What are the Benefits of CBD for Opiate Withdrawal?
There are many benefits to using CBD and its patient reach is improving as more medical benefits of the cannabinoid are being discovered.
Some of these benefits can help people going through opiate withdrawal. CBD can help mentally, physically, and may even help people stay off the drugs for good.
1. CBD May Reduce Cravings
One of the most desirable qualities of CBD for opiate withdrawal is its apparent craving-reducing qualities. In the study mentioned in the last section, over 70 percent of withdrawal patients claimed CBD controlled their cravings for opiate drugs.
Further scientific studies are needed to find out exactly how and why CBD reduces cravings during opiate withdrawal. We can make some educated assumptions on the matter though.
Cravings during opiate withdrawal are likely alleviated because CBD helps reduce the most common side effects.
When withdrawal symptoms are reduced, it’s far easier to resist the temptation to use the drug again.
2. CBD May Alleviate Anti-Nausea
One of the main symptoms of opiate withdrawal is nausea and vomiting. Alleviating these symptoms will make the withdrawal process much easier.
A 2011 study published in the British Journal of Pharmacology found that CBD may help nausea because of its interaction with serotonin receptors . They also concluded that low doses of THC prevented vomiting and relieving nausea.
This information points toward full-spectrum CBD oils for treating nausea and vomiting. If you’re going through withdrawal and need relief from these symptoms, we suggest using THC-containing CBD oil.
3. CBD May Reduce Anxiety Levels
CBD is often used by people with stress and anxiety to relieve their symptoms. Anxiety is a common symptom of withdrawal, so using CBD may help relieve this.
Numerous studies have noted CBD’s anti-anxiety properties. A 2011 study found that CBD significantly reduced general and social anxiety levels in people with the disorder .
4. CBD Blocks Pain
CBD is excellent for pain relief. This is an extremely valuable quality for someone suffering from opiate withdrawal.
One study found that CBD and other cannabinoids can effectively suppress neuropathic pain and inflammation .
The same study also concluded that users were not likely to build up a tolerance to the cannabinoid, meaning the same dose can be used over and over again without having to increase.
5. CBD May Help Prevent Relapse
One study suggests that CBD is effective in relapse prevention . The study tested CBD on rats with cocaine and alcohol addictions.
The rats that had been administered CBD during substance recovery were less impulsive when offered their “drug of choice”.
Although the human brain is much more complex than that of a rat, CBD seems to have the potential to prevent relapse after an addiction when consumed daily.
Can You Take CBD Oil While Taking Opiates?
When CBD is consumed alongside most opioids, no reported effects seem to take place. CBD does not affect the function of the opioids and the opioids do not seem to affect the function of the CBD.
However, CBD does interact with the CYP2D6 enzyme in the liver. This enzyme is in charge of metabolizing a range of drugs including codeine and tramadol.
With this in mind, taking CBD could be dangerous if you’re taking prescription opioids or illegal opiates. Without the proper metabolization of both substances, you may experience liver toxicity.
If your liver cannot properly break down the drugs you consume you risk overdose. If unmetabolized opiates are still present in the body and you continue to consume more, the substance will accumulate.
If you’ve been prescribed opioids for your condition and want to use CBD to counteract some of the side effects, it’s extremely important that you consult your doctor first.
If you’re planning on using CBD to help you beat addiction to opiates, it’s okay to start consuming CBD as soon as you stop taking the opiate.
During the withdrawal process, you should continue to take CBD and avoid mixing any other prescription or over-the-counter medication.
CBD for Opiate Withdrawal: The Pros & Cons
There are advantages and disadvantages to any treatment and CBD is no different.
CBD doesn’t work for everyone during withdrawal but it’s certainly worth a try. The pros most definitely outweigh the cons and CBD is easily accessible, less damaging to the body, and cheaper than most other withdrawal treatments.
- CBD can help reduce drug cravings
- CBD may reduce chances of relapse
- CBD alleviates nausea symptoms
- CBD reduces pain
- CBD can ameliorate anxiety symptoms
- CBD may improve sleep onset & quality
- CBD can cause drowsiness
- CBD can be expensive
- CBD may not work for everyone
Final Thoughts: Can CBD Help With Opiate Withdrawal?
Although clinical evidence is lacking, some studies suggest that CBD is an effective way to manage opiate withdrawal symptoms. The cannabinoid may even help you stay off the drugs for good.
Whether you’re taking prescribed opioid painkillers or have an addiction to illegal opiates, withdrawal is difficult and relapse is common. Having an effective plan and talking to a specialist first is an essential step in the rehabilitation process.
If you don’t have the money for professional rehab, it’s possible to get off these substances yourself. Preparation is key and finding something to ease the withdrawal is essential.
We’re not saying CBD is the miracle cure, but with a strong mind, some determination, and some effective planning it may help you recover for good.
References Used In This Article
- Bergeria, C. L., Huhn, A. S., & Dunn, K. E. (2020). The impact of naturalistic cannabis use on self-reported opioid withdrawal. Journal of substance abuse treatment, 113, 108005.
- Yasmin L. Hurd, Sharron Spriggs, Julia Alishayev, Gary Winkel, Kristina Gurgov, Chris Kudrich, Anna M. Oprescu, Edwin Salsitz. (2019). Cannabidiol for the Reduction of Cue-Induced Craving and Anxiety in Drug-Abstinent Individuals With Heroin Use Disorder: A Double-Blind Randomized Placebo-Controlled Trial. American Journal of Psychiatry, 176(11): 911–922.
- Parker, L. A., Rock, E. M., & Limebeer, C. L. (2011). Regulation of nausea and vomiting by cannabinoids. British journal of pharmacology, 163(7), 1411-1422.
- Crippa, J. A. S., Derenusson, G. N., Ferrari, T. B., Wichert-Ana, L., Duran, F. L., Martin-Santos, R., … & Hallak, J. E. C. (2011). Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report. Journal of psychopharmacology, 25(1), 121-130.
- Xiong, W., Cui, T., Cheng, K., Yang, F., Chen, S. R., Willenbring, D., … & Zhang, L. (2012). Cannabinoids suppress inflammatory and neuropathic pain by targeting α3 glycine receptors. Journal of Experimental Medicine, 209(6), 1121-1134.
- Gonzalez-Cuevas, G., Martin-Fardon, R., Kerr, T. M., Stouffer, D. G., Parsons, L. H., Hammell, D. C., … & Weiss, F. (2018). Unique treatment potential of cannabidiol for the prevention of relapse to drug use: preclinical proof of principle. Neuropsychopharmacology, 43(10), 2036-2045.
Livvy is a registered nurse (RN) and board-certified nurse midwife (CNM) in the state of New Jersey. After giving birth to her newborn daughter, Livvy stepped down from her full-time position at the Children’s Hospital of New Jersey. This gave her the opportunity to spend more time writing articles on all topics related to pregnancy and prenatal care.
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