Treating Opioid Addiction with CBD? TBD...

Could cannabis come to the rescue in the midst of an “opioid epidemic”?

Whether in medical or recreational contexts, questions are repeatedly raised about the addictiveness of cannabis. But studies over the last few years suggest that cannabis could actually assist in the fight against addiction – to opioids.

Prescriptions for opioids in the US are estimated at over 200 million a year, with pain management a major driver. Methadone, buprenorphine and naltrexone have all been shown to be effective for acute severe pain – but the evidence that such pharmaceuticals are effective in treating chronic pain is far less compelling (1). However, according to a recent paper in Neuron journal, the cost of developing new drugs provides a disincentive to develop new therapeutics, leading to what the authors refer to as “widespread retreat of the pharmaceutical sector” (1). Could cannabidiol (CBD) fill the void?

Research over the past few years supports the use of cannabis – specifically CBD – for treatment of addiction (2). Unlike Δ⁹-tetrahydrocannabinol (THC), CBD is non-rewarding, and modulates feelings of anxiety – a key feature of addiction (3). Combined with the fact that no severe side effects have been reported and its low lethality (3), some argue that this makes it a natural replacement for current pharmaceutically and legislatively approved medications. So why – as opioid addiction hits an all-time high – is this area of research being neglected?

In a paper published in Trends in Neurosciences earlier this year (3), neuroscientist Yasmin Hurd – whose own research indicates that CBD reduces heroin cravings and restores neurobiological damage – blames the reluctance to acknowledge CBD’s effectiveness on the scientific community’s exclusion from policymaking discourse. “Legalization has outpaced the science... This is one of the first times in US history that the question of whether a plant (or any drug) is an effective medicine has been decided at the ballot box.”

Hurd calls for a structure to “fast track” clinical CBD – and, importantly, to make trials looking at this particular cannabinoid a priority. “As the legal landscape for medical marijuana unfolds,” she says in the paper, “it is important to distinguish it from ‘medical CBD’ and other specific cannabinoids, that can more appropriately be used to maximize the medicinal potential of the marijuana plant.”

The situation certainly involves a complex interplay between neuroscience, pharma and the cannabis industry, but one thing is clear – both the barriers to scientific research and the opioid addiction epidemic need to be simultaneously addressed. And, Hurd suggests, until the scientific and medical communities are permitted to take a more leading role, safe and efficacious therapies will remain out of reach.

References

  1. P Skolnick, ND Volkow, “Re-energizing the development of pain therapeutics in light of the opioid epidemic”, Neuron, 92, 294-297 (2016).
  2. YL Hurd et al., “Early phase in the development of cannabidiol as a treatment for addiction: opioid relapse takes initial center stage”, Neurotherapeutics, 12, 807-815 (2015).
  3. YL Hurd, “Cannabidiol: Swinging the marijuana pendulum from ‘weed’ to medication to treat the opioid epidemic”, Trends Neurosci, [Epub ahead of print] (2017).