Cannabidiol (CBD) may decrease cravings and anxiety in abstinent heroin users
Hello, EENetconnect!
Usually I try not to get too excited about a single small study, but this looks pretty promising!
Background
When former drug users are exposed to reminders of drug intake (for example, pictures or videos of syringes or other drug-related paraphernalia), they often report strong cravings and anxiety, and show physiological changes such as increased heart rate. This can happen long after withdrawal has stopped – meaning even after successful detox, exposure to drug reminders can trigger cravings that could lead to relapse. Currently, there are drugs to help opioid users go through withdrawal, but we don’t have drug treatments available to specifically target cravings triggered by cues in our environment.
CBD: Effects on Craving and Anxiety
Experiments in animals have shown that cannabidiol (CBD), a non-psychoactive ingredient in the cannabis sativa plant, can reduce drug-seeking behaviour that is triggered by environmental cues formerly associated with drug intake (reviewed in Hurd et al., 2019). Recently, a research group from Mount Sinai Hospital (New York, NY) has given CBD to human participants who used to use heroin to see if it would help ease cravings. After exposure to videos of heroin-related imagery (syringes, bags of powder, etc.) participants who had only received a placebo reported strong craving, anxiety, and showed increased heart rate and levels of a stress hormone called cortisol. Participants who had received 400 or 800 mg of CBD, however, reported much less craving and anxiety, and did not show changes in heart rate or cortisol levels. Taken together, this suggests that CBD may help ease craving and anxiety in former heroin users that are exposed to drug reminders.
While more work needs to be done to show if this effect is reliable and practical in the real world (i.e., would work in normal situations and not just in the lab), it could represent a new treatment approach to heroin addiction and possibly others.
Click here to read more about this study from CTV News, or click here for a link to the original study.
This encouraging research and I'm curious to see how it will play out.
Though without psychotherapeutic support, it seems like individuals could become psychologically dependent on CBD (ex: "I can't stop taking CBD, or else I'll go back to craving heroine"). I could see the $7.2 billion Canadian cannabis industry seeing this as a sustainable revenue stream.
Perhaps. In the study they repeated the drug-cue task several times and saw a sustained effect of the CBD, even though on the last test session it had been a couple days since their last dose. It's possible it was a carry-over effect (still some drug left in the system). Otherwise, it looks like a few exposures might be enough (in which case sustained dosing wouldn't be necessary).
Participants in this study had take home questionnaires about cravings and the scores on these didn't actually differ between those that had CBD and those that had placebo. This would suggest that CBD didn't have an anti-craving effect per se, but instead specifically modulated the response to environmental cues. This is still an important step forward but these sort of cue-triggered cravings could be different in nature than other types of craving, such as those that come on during stress. So even if this turns out to be a reliable, useful effect, it wouldn't be a magic bullet. Instead of replacing psychotherapeutic interventions, it would likely just be a complementary piece, as is often the case.
First, its an extremely short period of time. Second the tools used leave a bit of unintentional bias into the room. Really too early to say much except lets see what further research shows.