CBD Offers 'Significant Promise' for Heroin Addiction

Megan Brooks

May 21, 2019

An oral cannabidiol (CBD) solution reduces craving and anxiety in individuals with a history of heroin abuse, with effects lasting a week after last administration, and may be a non-opioid option to help break the cycle of continued addiction, researchers say.

CBD holds "significant promise" for treating individuals with heroin use disorder, lead investigator Yasmin Hurd, PhD, of the Department of Psychiatry and Neuroscience at the Icahn School of Medicine at Mount Sinai in New York City, told Medscape Medical News

"The specific effects of CBD on cue-induced drug craving and anxiety are particularly important in the development of addiction therapeutics because environmental cues are one of the strongest triggers for relapse and continued drug use," said Hurd, who is also director of the Addiction Institute at Mount Sinai.

The study was published online today in the American Journal of Psychiatry.

Long-Lasting Effect

In preclinical work in animals with a history of heroin self-administration, Hurd and her team at Mount Sinai found that CBD reduced the animals' tendency to use heroin in response to a drug-associated cue.

The current double-blind, randomized, placebo-controlled trial included 42 adults with heroin use disorder. About two thirds (64%) had been abstinent from heroin for less than 1 month, 14% for 1 to 2 months and 21% for 2 to 3 months. Most participants also had a history of abusing alcohol and cannabis and tobacco use.

Participants were randomly allocated to 400 or 800 mg of an oral CBD solution (Epidiolex, GW Pharmaceuticals) or a matching placebo given once daily for 3 consecutive days. They were then exposed to neutral and heroin-related cues over three sessions: immediately after administration, 24 hours after CBD or placebo administration, and 7 days after the third and final daily CBD or placebo administration.

Consistent with the literature and expectation, scores for craving on the visual analog scale for craving (VAS-C) and anxiety on the VAS anxiety (VAS-A) scale were increased with exposure to images of heroin paraphernalia but remained largely unchanged when exposed to neutral cues.

Across all sessions, those receiving placebo reported significantly greater craving after the drug cues (mean difference score 0.93) compared with those receiving 400 mg and 800 mg CBD (mean difference score 0.44 and 0.23, respectively).

There was no significant difference in craving scores between the groups of participants administered the two CBD doses, indicating that both doses equally reduced craving.

In contrast to placebo, CBD significantly reduced craving and anxiety triggered by seeing pictures of heroin paraphernalia not only right after administration, but also a week after the final CBD dose.

This supports a recent animal study demonstrating prolonged effects of CBD on drug (alcohol and cocaine) seeking and anxiety-like behaviors 5 months after its short-term administration. 

"This protracted property of CBD would have significant clinical implications, especially for patient populations in which daily medication adherence may be challenging," the authors write.

CBD also reduced the heroin cue-induced physiologic measures of stress reactivity such as increased heart rate and salivary cortisol levels. CBD administration at the doses tested had no significant effects on cognition, and was associated with only mild adverse events. There were no serious adverse events, consistent with previous reports.

Hurd said her team is working on additional studies to "understand the mechanism of CBD's effects on the brain and will do neuroimaging studies to see what are the neural circuits that CBD is working on to decrease craving and anxiety. It will also be important to figure out the right dosing and dosing regimen."

More Evidence Needed

Commenting on the findings for Medscape Medical News, Jonathan Avery, MD, director of addiction psychiatry at NewYork-Presbyterian Hospital and Weill Cornell Medicine in New York City, said, "CBD products are everywhere and being touted for everything, and so we need good clinical evidence on how to use it and at what dose, etc. This article helps add to a small group of literature that can help guide us going forward."

Support for the study was provided by GW Pharmaceuticals and by funding from the Icahn School of Medicine at Mount Sinai. The authors and Avery have disclosed no relevant financial relationships.

Am J Psych. Published online May 21, 2019. Abstract

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