Cannabidiol (CBD; Epidiolex) reduced opioid cravings and anxiety among heroin users, suggesting it may have a role in curbing addiction, an exploratory trial found.
Compared with placebo, once daily CBD 400 or 800 mg diminished cue-related cravings and anxiety among people who had heroin use disorder, reported Yasmin Hurd, PhD, of the Icahn School of Medicine at Mount Sinai in New York City, and colleagues in the American Journal of Psychiatry.
Environmental cues are one of the strongest triggers for drug cravings, Hurd noted. “Cue-induced cravings trigger relapse,” she told MedPage Today. “For me, this research is extremely promising. If we can find the medication that targets that kind of system, that would be amazing.”
The study comes after years of research from Hurd’s group about the pharmacological properties of marijuana and its potential as a drug to curb opioid craving. Of the many components of marijuana, cannabidiol may hold the most promise, Hurd noted. Prior work has shown that CBD reduced animals’ tendency to use heroin in response to a drug-associated cue.
In the current study, Hurd and colleagues explored acute (1 hour, 2 hours, and 24 hours), short-term (3 consecutive days), and protracted (7 days after dosing ended) effects of CBD on drug cue-induced craving and anxiety. They studied 42 heroin-abstinent people from 2016 to 2018 who had been using heroin on average for about 13 years. Most (64%) had been abstinent from heroin for less than a month; 14% had been abstinent for 1 to 2 months, and 21% for 2 to 3 months.
The researchers randomly assigned participants to receive once-daily doses of 400 mg of oral CBD solution, 800 mg, or a placebo solution for 3 consecutive days. They exposed participants to neutral and drug-related cues in three sessions: immediately after dosing, 24 hours after dosing, and 7 days after the final dosing day. Neutral cues were a 3-minute video of relaxing scenes of nature; drug-related cues were a 3-minute video of intravenous or intranasal drug use and exposure to heroin-related paraphernalia like syringes, rubber ties, and packets of powder resembling heroin.
Craving scores significantly increased during the heroin cues and were unchanged during the neutral cues. Both 400 mg and 800 mg of CBD reduced cue-induced cravings and anxiety; these effects were most prominent 1 to 2 hours after CBD first was administered. Heroin cues also increased physiological measures of stress reactivity — heart rate, blood pressure, and cortisol levels — which CBD reduced.
Craving and anxiety still were diminished a week after the last CBD dose, mirroring preclinical findings. “This data replicates our pilot study and validates our animal models,” Hurd noted.
Hurd and colleagues will start human imaging studies soon to see how CBD affects craving and anxiety. Larger, longer clinical trials also are needed: “We’re hypothesizing that CBD will decrease relapse, but we need to see whether it does long-term,” she said.
“That’s the whole issue — decreasing relapse and decreasing overdose — that we face right now,” she continued. “It’s very difficult for people to stay off heroin. When people return from rehab and come back home, the environmental cues are very strong.”
But CBD has promise because “it’s very specific,” she noted. “It’s not rewarding; it’s not methadone or THC. CBD is actually decreasing connections to environmental cues. That’s why it is intriguing.”
The study was supported by GW Pharmaceuticals and the Icahn School of Medicine at Mount Sinai.
Hurd and co-authors disclosed no relevant relationships with industry.