Nonopioid Alternatives for Addiction Recovery Part I: CBD May Reduce Recovery Symptoms
All right, folks. My posts thus far have been fairly light and breezy. We’ve discussed some pretty exciting topics, from the skincare and pain-relieving benefits of CBD to all the smell-good-products GV Apothecary has in stock. It’s all been very positive because, let’s face it, there are so freaking many positive aspects of CBD. This post (Parts I & II) will be exciting in a way, but I won’t be discussing a light and breezy topic. Right now, I’m here to talk about a very real and very scary public health issue: substance abuse disorders (SUDs). First thing’s first, I am not a medical professional. I am merely an academic with two advanced degrees, neither of which are in any way related to the medical or behavioral health fields. So, I’m not here to give full on medical advice, though I am guilty of self-diagnosing periodically. But I’m not going to do that with you. As an academic, my only job is to present and analyze facts in order to provide an analytical argument. My argument: opioid use needs to stop, and that includes the excessive opioid prescription rate and using opioid substitutions in addiction recovery programs. That starts with considering nonopioid alternatives as harm reduction tools to aid in addiction recovery. CBD is an excellent starting point. But first, let’s take a look at some disturbing statistics. (Don’t let that adjective scare you away. I need you first to understand the gravity of the situation at hand before getting to the more positive stuff.)
We all know someone who has struggled with addiction. Many of us even know people who are currently struggling with addiction. Unfortunately, there likely aren’t many people left in our society today who don’t know someone who has died from substance abuse. It’s a sad fact and a very real problem. Substance abuse is so widespread in today’s society: friend, family member, significant other, maybe even yourself. Addiction does not discriminate. According to the National Survey on Drug Use and Health (NSDUH), 20.3 million American adults battled SUDs in 2017—that’s a 600,000 person increase from the prior year. In 2018, an estimated 2 million Americans had an opioid specific addiction, 47,600 Americans died from opioid overdoses, and over 130 people died EVERY DAY from opioid-related drug overdoses. In 2017, only 91 Americans died each day from opioid overdoses. I was hesitant to use “only” as an adverb there, since it suggests a small number, which isn’t at all the case, and I don’t want to seem dismissive of such a critical problem. But I suppose it’s appropriate relative to the significant increase in just one year. And judging by that increase, the problem has gotten significantly worse. To put things into perspective even more, there have been more than 300,000 opioid-related deaths in the United States in the past decade (Hurd et al. 911). That’s a tough pill to swallow—pardon the unintended pun. I mean, really. What in the actual f*ck is happening in our society right now?
Anyway, I’m not here only to throw heartbreaking statistics at you. I’m here to give you some more positive information from a recent study that shows how CBD may effectively help people battle symptoms of addiction recovery. I’m going to do this, promise. But first, I want to talk to you about something else that really grinds my gears.
On top of the current opioid crisis, our nation is faced with another dire problem: our ties to Big Pharma. In regard to the issue at hand, I wholeheartedly believe that Big Pharma is partly responsible—but I’m not here to give my opinions, I’m here to give you some facts. Well, one disappointing fact is that prescription medications are used in many addiction treatment programs to “help” people battle SUDs. Like, what?! The National Institute of Drug Abuse (NIDA) uses scientific research from as far back as the 1970s to form the basis of “effective” treatment programs, and one of their key principles is administering medications. That principle doesn’t quite jive with me. Like, okay, you’re treating prescription addictions with more prescriptions? So, tell me, NIDA—how do you expect to prevent relapse if you’re providing these poor people with more prescriptions that could potentially breed another addiction? I mean, the NIDA states that the goals of addiction treatment are to stop using drugs and to stay drug free, so I must be missing something. I’m a pretty freaking intelligent person, but this doesn’t make any sense to me. Every year we see more and more scientific advancements, so why is the NIDA using research dating back to the ‘70s to develop “effective” treatment programs? Why isn’t our government focusing on current research studies, studies that show there are effective alternatives to prescription medications for treating addiction recovery symptoms? These are some very good questions, to which I have no answers. But I do have information about one of those current research studies. This is where things start to get more positive.
As I’ve mentioned in my previous posts: CBD (cannabidiol) is derived from the hemp plant. Hemp is in the cannabis plant family, but unlike marijuana, hemp is very low in THC so using hemp-derived CBD products will not produce a high. And CBD can be extracted from the hemp plant to produce a THC-free product called isolate. Great, right? All the medicinal benefits but no psychoactive effects. There are so many conversations happening right now about the benefits of CBD for potential treatment of, well, basically everything from epilepsy and anxiety to inflammation and insomnia. So, it comes as no surprise that doctors and scientists are now investigating CBD’s potential for treating addiction recovery symptoms, specifically concerning opioid addiction. In fact, the American Journal of Psychiatry published a 2019 study discussing just that, titled “Cannabidiol for the Reduction of Cue-Induced Craving and Anxiety in Drug-Abstinent Individuals With Heroin Use Disorder”. The article’s main author, Yasmin L. Hurd, Ph.D., Director of the Addiction Institute at Mt. Sinai, also published an article in 2015 on using CBD to treat addiction. So, this isn’t some rubbish scientists are just now considering. No, this science-based recommendation has been a long time coming and it could help so many people. So, what’s the article say, you ask? Well, I’ll tell you.
Hurd et al. introduce a staggering fact in the article’s objective: despite the opioid epidemic, caused by the widespread availability of heroin and prescription opioids, “limited nonopioid medication options have been developed to treat this medical and public health crisis” (emphasis added, 911). In fact, the most commonly used medications to treat opioid addiction are OTHER OPIOIDS. This is what I’m talking about, people. Again, what in the actual f*ck is happening? Methadone, a synthetic opioid, is one of the predominant medications used to treat opioid addiction. I know, it sounds insane to me, too. Methadone is synthetic. It’s fake, artificial, cooked up by chemists in a lab. CBD is a plant. It’s natural, organic, grown from the same soil from which your vegetables grow. Just saying.
Now, back to my point about methadone. This stuff is bad news. Not only for the fact that it’s an opioid being used to treat opioid addiction—insert eye roll here. But also because of its side effects. The government-run Substance Abuse and Mental Health Services Administration (SAMHSA) lists its side effects: difficulty breathing or shallow breathing; feeling lightheaded or faint; hives or a rash; swelling of the face, lips, tongue, or throat; chest pain; fast or pounding heartbeat; hallucinations or confusion”. Doesn’t that make you want to trust this medication to help your loved one overcome their addiction? Unbelievable. And the list follows this disclaimer: “Side effects should be taken seriously, as some of them may indicate an emergency.” WELL, DUH. But, thanks to leading researchers like Dr. Hurd and her colleagues, we’re well on our way to incorporating nonopioid medication options into addiction treatment programs. Now, back to the study.
A treatment gap exists for a large number of people with opioid use disorder (OUD) because of the predominant addiction treatment principle of pushing more opioids. The opioid substitutions are potentially addictive—again, duh—so many people diagnosed with OUD aren’t taking advantage of treatment programs, which “highlights the urgent need to develop novel therapeutic strategies that do not target the mu opioid receptor” (911). According to Hurd, et al., “environmental cues are one of the strongest triggers for craving, which is a core component of opioid use disorder,” creating another treatment obstacle (912). Basically, in order to avoid relapse, to be successful in overcoming addiction, people diagnosed with OUD need to figure out a way to reduce their responses to environmental triggers. Enter CBD. The researchers initially conducted an animal study—I know, poor animals, but that’s the way the cookie crumbles in the field of science—and that study suggests CBD, which does not target the mu-opioid receptor, can potentially help prevent relapse due to environmental cue responses. They also found that in animals, “the reduced heroin-seeking behavior is maintained for weeks following CBD administration” (912). That’s huge! So, to put this preclinical evidence to the test with humans, they conducted a clinical trial at Mount Sinai of 42 participants (men and women) with a history of opioid use, but none were current users. The participants completed four test sessions over a two-week period. The researchers hypothesized that “CBD would reduce cue-induced craving and anxiety in heroin-abstinent individuals with heroin use disorder and have minimal adverse effects” (912). And how right they were.
During cue sessions, researchers “assessed the effects of CBD administered at doses of 400 mg and 800 mg,” and they also used a matching placebo that “was identical in appearance, taste, and composition except for the active ingredient of pure CBD” (912, 913). The researchers used Epidiolex, the first and only FDA-approved prescription CBD medication. It’s listed on the market as treating seizures associated with Lennox-Gastaut syndrome. I'm not advocating its use, especially considering the wide availability of safe, reliable, lab-tested CBD products that can be purchased from local wellness shops, likely at a much lower cost. I’m just pointing out the fact that the government is finally starting to recognize the potential medicinal benefits of CBD. About freaking time. Anyway, cue sessions consisted of both neutral and drug-related cues. For instance, they exposed participants to neutral objects and videos of nature, as well as “heroin-related paraphernalia (e.g., syringe, rubber tie, and packets of powder resembling heroin) for 2 minutes” and a three-minute video of IV or intranasal drug use (913). Each session evaluated the effects of cue-induced cravings and anxiety at different periods of time after CBD or placebo administration. I’m trying not to sound too technical here, so hopefully you’re all still following. I want to give you all the facts as clearly and descriptively as I can. Basically, the researchers were using neutral and drug-related cues to try to measure the intensity of participants’ cravings and anxiety in order to determine whether the CBD administration was effective in reducing those cue-induced responses. Right, now let’s talk findings.
Researchers found that “Across all sessions, individuals receiving placebo reported significantly greater craving after the drug cues … compared with participants in either of the CBD groups … [and] 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” (emphasis added, 916). WOW. So, 400 mg and 800 mg doses of CBD equally and significantly reduced craving compared to the placebo group. And anxiety was also significantly decreased in the CBD groups compared to the placebo group. None of the participants in either of the CBD groups experienced elevated heart rates when exposed to the drug-related cues. The placebo group, however, did experience elevated heart rates. Which means, CBD can indeed reduce responses to environmental cues. And since reduction in craving and anxiety-related responses to environmental cues is a major factor in avoiding relapse, then CBD—a nonopioid alternative—could potentially reduce addiction recovery symptoms and increase recovery success. Exciting, right?!
Now, I’m sure many of you are likely thinking CBD was shown to reduce cravings in response to environmental cues, but what about other symptoms of recovery, like withdrawal symptoms? Well, I’d assume detox is the first step in the recovery process. I’m not an expert by any means, but I know some common withdrawal symptoms are headache, insomnia, anxiety, heart palpitations, nausea, and muscle aches. CBD has been known to help all of those things. So, who knows, maybe CBD could indeed aid in that portion of recovery, as well. Also, as the researchers noted, response to environmental cues is one of the most common reasons for relapse. I mean, I can’t even imagine how taxing it must be for people battling addiction to see something that triggers a craving. It takes a very strong-willed person to fight that cue-induced response and not to succumb to the urge. Of course, I don’t know this from experience, but I’d imagine the environmental cues trigger a sort of PTSD response. If CBD can be used in addiction recovery programs to help people fight against those urges and, in turn, help them avoid relapse, then I’d say that’s a pretty freaking HUGE deal, considering the alternatives: more opioids. CNN also published an article discussing this clinical trial, in which Dr. Julie Holland, a New York psychiatrist states, “CBD not only manages the anxiety and cue/craving cycle, it also diminishes the original pain and inflammation that leads to opiate use in the first place.” In other words, many people become addicted to opioid medication simply because they need pain/inflammation relief. And it’s widely known today that CBD reduces pain and inflammation, which can significantly improve quality of life. If more people start using CBD for relief of pain/inflammation, then maybe we can decrease the annual number of first-time opioid users and start the decline from widespread addiction. Baby steps are still steps.
Also, behavioral therapy is an essential component of addiction recovery, and opioid substitutions are typically used in combination with therapy. So, why not keep using the ever-effective behavioral therapy as the most common form of treatment and just replace the opioid medications with CBD? Who knows, exposure therapy similar to what participants experienced in this clinical trial might be an effective therapy option, as well. By the final session, “the drug cue no longer increased heart rate in any group,” including the placebo group (919). This suggests that prolonged exposure—in a safe and controlled setting—to drug-related cues even without CBD can decrease cravings and anxiety in people battling OUDs. Imagine how many people could benefit from this kind of therapy in combination with CBD administration. But I’m not a doctor, so I’ll leave that decision to the pros. Point is, opioid medication options like methadone don’t seem to be necessary. Like, at all. Especially considering “no serious adverse events were noted in association with CBD administration throughout the duration of the trial” (919).
Hurd et al. state, “the potential of CBD to reduce cue-induced craving and anxiety, along with its safe pharmacological profile, low mortality risk, and lack of hedonic properties, indicates that [CBD] holds significant promise for treating individuals with heroin use disorder” (920). Now, do me a favor and compare that analysis of CBD to the side effects of using methadone. Let me remind you: difficulty breathing or shallow breathing; feeling lightheaded or faint; hives or a rash; swelling of the face, lips, tongue, or throat; chest pain; fast or pounding heartbeat; hallucinations or confusion. The Mayo Clinic also reports the following potential methadone side effects: convulsions, fainting, nausea or vomiting, sweating, trouble sleeping, unusual bleeding or bruising, anxiety, and so many more. The Mount Sinai study showed no adverse reactions to using CBD, and CBD, in fact, has been shown to help anxiety and trouble sleeping, as well as many other ailments. So, doesn’t it just make more sense to choose CBD over methadone at this point? The final sentence in the study really says it all: “A successful nonopioid medication would add significantly to the existing addiction medication toolbox to help reduce the growing death toll, enormous health care costs, and treatment limitations imposed by stringent government regulations amid this persistent opioid epidemic” (920). And no, these researchers don’t seem to be advocating methadone and other opioid substitutions for addiction recovery. Likely that is not what they mean by the existing addiction medication toolbox. It can’t be what they mean because at the beginning of the article they call attention to the need for nonopioid treatment medications. Well, they’ve given us one option, haven’t they?
Please, do your own research before blindly accepting government recommendations for addiction recovery. The rising death toll and current state of the opioid epidemic are testament to the dangers of Big Pharma. If you want unrestricted access to the American Journal of Psychiatry article, “CBD for the Reduction of Cue-Induced Craving and Anxiety in … Heroin Use Disorder,” you can likely access it from your local public library. Schenectady County Public Library, specifically, subscribes to a health journals database: Health Reference Center Academic provided by NOVEL. All you need to do is either go to a library branch and use one of their computers, or you can even access the article from home by clicking on the above link and entering your library card barcode number. Easy-peasy! Also, a news release published by the Icahn School of Medicine at Mount Sinai—posted on both HealthDay and WebMD—sums up the findings quite nicely, if you’d prefer to read a quick recap instead of the entire research article itself.
If you have any questions on the topic of CBD, please reach out to us or stop into a GV Apothecary store. We’re here to help. Our staff are super knowledgeable, and our readers and customers are our top priority. All of our CBD products are third-party lab tested and come from some of the top hemp farms in the country. In other words, they’re safe and reliable, and they can help. That’s a fact you can trust.
Stay tuned for Nonopioid Alternatives for Addiction Recovery Part II: Kratom.