Cbd oil for opioid withdrawal
The widespread use of heroin and prescription opioids in the United States during the past decade has resulted in an unprecedented epidemic of opioid addiction, and few treatments for heroin use disorders are currently available. In this study, authors conducted a clinical trial to test whether cannabidiol (CBD), a non-intoxicating cannabinoid that is found in the cannabis plant, could reduce drug craving and anxiety in recently-abstinent individuals with heroin use disorder. The study found that, compared to those who received a placebo, individuals who received a dose of CBD medication showed a reduction in craving for heroin as well as reduced anxiety, which lasted for about a week after taking the CBD medication.
WHAT PROBLEM DOES THIS STUDY ADDRESS?
In the past decade, there has been an unprecedented spike in opioid use disorde r , which has led to more than 300,000 opioid-related deaths in the United States . O pioid use disorder medications such as methadone and buprenorphine (often prescribed in a formulation with naloxone , known by the brand name S uboxone ) help reduce opioid use and reduce risk for opioid-involved overdoses . In some areas, however, t hese medications are often underutilized and therefore can be difficult to access, creating a treatment gap in which those who need medications face barriers to actually receiving them. Further, 20-40% of opioid use disorder patients do not want to take agonist treatments .
One of the hypothesized factors contributing to these barriers is that methadone and Suboxone can be misused or diverted because they can produce euphoria . Consequently, discovering effective alternative medications that can also treat opioid use disorder that circumvent concerns about their psychoactive properties could help more of those affected . To address this problem , the authors investigated whether the cannabinoid , CBD , which is thought to be safe and non-addictive, could be useful in the treatment of opioid use disorder .
HOW WAS THIS STUDY CONDUCTED?
This was a randomized clinical trial with 42 participants who received one of two different CBD medication doses or a placebo once daily for 3 days and were then exposed to drug-related or neutral cues to see whether CBD could reduc e opioid cravings and anxiety – factors strongly associated with relapse to opioid use .
Participants were recruited through advertisements. Most participants indicated preference for intranasal heroin use, most reported currently using more than 10 bags of heroin (one bag = 1 g) daily, and on average, participants had been using heroin for over 10 years. The majority of participants (64.3%) had been abstinent from heroin use for less than 1 month.
The study medication used in this study, EPIDIOLEX, is a n FDA-approved medication that is dispensed through a pharmacy (not to be confused with “medical marijuana , ” which is comprised of a wide variety of non- federally- regulated cannabis projects ) . EPIDIOLEX is a plant-derived CBD liquid formation. P articipants were randomly assigned to receive 400 mg of CBD, 800 mg of CBD, or a placebo medication. CBD or placebo was administered once daily for 3 days . In addition to measuring the effect of the medication on opioid craving, anxiety, the authors also collected measures of positive and negative emotions, vital signs (skin temperature, blood pressure, heart rate, respiratory rate), and salivary cortisol levels , which measure stress response.
At three time points – immediately after the CBD or placebo administration ; 24 hours after the CBD or placebo administration ; and 7 days after the third and final CBD or placebo administration – p articipants were exposed to drug – related and neutral cues . The 3-minute neutral cue condition consisted of a video showing relaxing scenarios, such as scenes in nature. The drug cue condition was a 3-minute video that showed intravenous or intranasal drug use, depending on the participant’s reported preferred route of drug use . Immediately after the presentation of the videos , participants were also exposed to neutral objects or to heroin – related paraphernalia (e.g., syringe, rubber tie, and packets of powder resembling heroin) for 2 minutes. Authors examined whether patients who received CBD, compared to those who received placebo, showed differences in opioid craving, anxiety, positive and negative emotions, or vital signs , after being exposed to the drug or neutral cues.
WHAT DID THIS STUDY FIND?
I ndividuals receiving the non-psychoactive cannabinoid CBD medication reported less craving after being exposed to drug cues compared with i ndividuals receiving placebo . This effect lasted at least a week after the CBD or placebo administration, when i ndividuals receiving the high-dose of CBD (but not the low-dose) still reported less craving compared with those receiving placebo . In addition, CBD reduced measures of stress response after the drug cue – such as heart rate and salivary cortisol increases . I ndividuals receiving CBD reported less anxiety after being exposed to drug cues compared with i ndividuals receiving placebo (though t here w ere no significant difference s in anxiety between participants receiving the low-dose vs . the high-dose of CBD ) . There was no effect of CBD on positive affect or on any cognitive measures.
Figure 1. Figure 2. Figure 3.
WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?
In light of the opioid epidemic, it is important to identify as many strategies as possible to curb opioid addiction. In the past few years, scientists have asked whether or not cannabis use can help individuals recover from opioid use disorder or may serve as a less-risky pain management approach to pharmaceutical opioids . Individuals also report using cannabinoids in an effort to cut back or quit other substances , but currently, data do not support this indication. Some studies have shown no benefit; in fact, studies have shown that cannabis use is related to greater odds of both new-onset opioid use and opioid use disorder 3 years later . The small, experimental study here shows a potential benefit of CBD in reduc ing cue-induced craving and anxiety in heroin-abstinent individuals . This suggest s a potential role for CBD in relapse prevention of heroin use disorder . T his study takes a more rigorous approach that can serve as a model for future studies of cannabinoids and their potential role in OUD treatment and recovery.
- The sample size in this study was very small and , although results are promising, the findings need replication in larger samples. The small sample also did not allow for exploration of sex/gender effects, which could be important given that women typically have higher craving and anxiety than men.
- The study medication used in this study, EPIDIOLEX, is a n FDA-approved medication that you can only get from a pharmacy. Though EPIDIOLEX is derived from cannabis, it is NOT medical marijuana . This medication does not contain THC, which is the compound in the cannabis plant that causes the ‘high’ and euphoria. It is therefore important for patients to realize that although benefits of CBD were found, this study does NOT support the use of “medical marijuana” for opioid use disorder.
- This study only examined opioid craving for 7 days. It is still unknown if CBD would reduce opioid craving past the 7-day window examined in this study o r whether use of CBD actually translates into less use of actual opioids.
- Patients in this study had to be abstinent from opioids, and not taking any agonist therapie s. Therefore, the population in this study r epresent s individuals who are doing well and may respond will to lots of different interventions . However, this population may not be representative of opioid use disorder patients more generally.
- For individuals and families seeking recovery: This study showed that compared to placebo the non-psychoactive cannabinoid , CBD , was associated with substantially de creased cue-induced craving and anxiety for those with heroin use disorder . Many individuals with opioid use disorders are seeking alternative treatments to curb cravings and reduce anxiety, and many are reluctant to try agonist treatments such as methadone or suboxone . While more research is needed to flesh out whether CBD increase s the likelihood of long-term abstinence, this study suggests individuals may benefit from EPIDIOLEX, the FDA-approved CBD medication , but more larger studies are needed to confirm this . It is important to note, however, that individuals are using cannabis in its unregulated forms, and legislatures are passing med ical cannabis laws that identify opioid use disorder as one of the conditions for which cannabis is indicated without evidence to support this indication . Consequently, individuals seeking to use cannabis , in general, for opioid addiction should proceed cautiously .
- Fortreatment professionals and treatment systems: This study showed that compared to placebo, CBD was associated with substantially de creased cue-induced craving and anxiety for those with heroin use disorder . A recent survey found that a considerable percentage (30%) of individuals receiving agonist treatment were worried about encountering negative attitudes related to being prescribed agonists, and only 33% reported their provider discussed this with them prior to attending a meeting . If CBD does pan out as a potential treatment of heroin use disorder, this could appeal to many p atient s, and could be a good complement to recovery support services. It is important for treatment professionals to be aware that the unregulated forms of cannabis, e.g. , those that can be purchased at medical marijuana dispensaries, are still unproven treatments, and may in fact produce more harm than good.
- For scientists: This study showed that compared to placebo, CBD was associated with substantially de creased cue-induced craving and anxiety for those with heroin use disorder . More w ork is needed that more precisely measures whether CBD increases the likelihood of long-term abstinence , as well as for whom, and under what conditions , this medication work best. Greater knowledge in this regard could inform the nature of medication development more broadly . By pursuing investigation into other alternative treatments for opioid use disorder, scientists may be able to help reduce stigma and improve outcomes for patients with OUD .
- For policy makers: This study showed that compared to placebo CBD was associated with substantially de creased cue-induced craving and anxiety for those with heroin use disorder . While more research is needed, CBD may be an alternative to other medications for opioid use disorder, which are limited and not well-accessible to racial/ethnic minorities and those without financial means . Policy makers, however, should be aware that this study does not provide evidence that unregulated forms of cannabis, especially those containing THC, help with OUD. F unding research studies that examine pure forms of CBD, and other alternative treatments for opioid use disorder , could help improve outcomes and reduce the public health burden of the current epidemic of opioid addiction .
Hurd, Y. L., Spriggs, S., Alishayev , J., Winkel, G., Gurgov , K., Kudrich , C., . . . Salsitz , E. (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 Psy chiatry, ( ePub ahead of print). doi : 10.1176/appi.ajp.2019.18101191
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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