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.
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.
A bottle of CBD oil may contain unpredictable amounts of CBD, and it also could contain THC. WIRACHAI/Shutterstock.com
CBD and opioid addiction
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.
University of Florida provides funding as a founding partner of The Conversation US.
This could be a big deal.
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.
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The US Agriculture Improvement Act of 2018 means that hemp (cannabis containing a low level of THC) is no longer classified, so if you’re studying hemp-derived CBD, you no longer need a licence. That has made a huge difference. The US National Institutes of Health has put out a request for grant applications on cannabinoid-related science. Now everybody is writing a CBD paper! But there’s a considerable shortage of medicinal-quality hemp-derived CBD. And CBD derived from cannabis is still a schedule 1 drug.
We showed that CBD could decrease cravings prompted in heroin users when showing them videos of drug paraphernalia (Y. L. Hurd et al. Neurotherapeutics 12, 807–815; 2015). One week after their last dose of CBD, their cravings were still reduced, as was any prompt-induced anxiety. CBD has a protracted effect.
What are the challenges in CBD research?
Addiction is such a tough disorder. It’s not about morals. I don’t understand why we’re so nonchalant about the fact that in the past decade, almost half a million people in the United States have died from opioid drug overdoses. I think that if we can better understand addiction, we will be able to develop non-addictive treatments. When we have those medications, the stigma will be decreased. People will realize that someone can function normally. You won’t even know that they had a substance-use disorder.
Nature 573, S7 (2019)
In our rat model, we observed that CBD reverses some of the glutamate-related changes that heroin induces in the brain (J. Ren et al. J. Neurosci. 29, 14764–14769; 2009). So, we will study the neurotransmitter glutamate directly in the brain using neuroimaging in people with opioid-use disorder. We’ll complement that with studies in animals to get a handle on how CBD is working. Now that we have replicated the effects of CBD on drug craving and anxiety in pilot human studies, I want to see whether it works in the real world. We are seeking funding for a large study of CBD treatment in hundreds of people with heroin-use disorder, including those being treated with the heroin substitute methadone. Methadone doesn’t completely block cravings — it’s about harm reduction. Although methadone is an opioid, it is more manageable than heroin. We will be able to see, in a large population of people who are also on methadone, whether CBD can help to reduce the amount of opioids that they consume.