In a recent Ted Talk (2020), Yasmin Hurd, PhD, made a compelling call for federal funding to research the efficacy of CBD in treating opioid addiction. Opioid addiction is sandbagging the United States economy by $200 billion a year in lost productivity, tax-funded incarceration, healthcare and addiction treatment costs. The failing war on drugs is costing taxpayers $51 billion annually. More Americans have died by drug overdose in the last 20 years than all the combat related deaths of Americans in all of its wars combined.
How we got here is a scenario of negligent overprescribing of prescription opioids. According to the CDC, In 2012, over 255 million opioid prescriptions were written. In a couple of years, it would be apparent that the war on drugs—which has cost $1 trillion since its aggressive inception in 1971—has been lost, subverted by pharmaceutical marketing, financial incentivizing and hoodwinked physicians. According to the Center for American Progress, Between 2014 and 2016, opioid overdose deaths increased by approximately 48 percent nationwide. As can be seen on the Leafly map below, the most overprescribed regions are the deep south and the midwest.
The problem with opioids is that addiction is threefold: physical, psychological and environmental. Opiate withdrawal feels like a nasty bout of influenza. Dopamine receptors are shot from a constant barrage of opiates, therefore, the only way to get that dopamine flood and feel good is to use. And places or even things can trigger a craving, regardless of how much time an opiate addict has gone without using.
For fifty years, the only treatments for opiate addiction have been methadone and buprenorphine; both carry their own risk of dependency as opioid replacements, and they are not accessible to everyone. Only one-third of opioid addicted patients receive a form of this treatment, according to the National Institute on Drug Abuse.
A team of Hurd, neuroscientists, researchers and clinicians published the results of their study: “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” in The American Journal of Psychiatry in 2019.
“Patients were given either 400mg of CBD, 800mg of CBD or matching placebo,” the article reads. After administration, patients were shown images of drugs and drug paraphernalia, then sampled for salivary cortisol levels, heart rate, and also asked for a verbal report of cravings. Patients who were given the placebo exhibited the largest change from baseline, a manifestation of the strongest craving and associated anxiety (n=3). The 400mg CBD group exhibited a heroin cue change from baseline as n~1, a 200% decrease from the placebo group. The most effective dose in treating opiate cue responses was 800mg, with n~0.5.
800mg of CBD may seem like an expensive dose; however, but when one considers the cost of a heroin addiction, or the even more expensive opiate pill addiction, CBD treatment is a fraction of the cost. The high cost of CBD will go down with the right regulation and continued development of the industry.
Furthermore in the research, the 7-day-post administration results were promising, as displayed in the chart below. As CBD has a half-life of 18-32 hours, patients were examined in another session with the same protocol. Notice that the neutral cue induced a positive change for craving from baseline in placebo patients, as it did not in the preliminary session.
With CBD now easily accessible, it seems like everyone is asking their doctor or their hemp dispensary if CBD can help with their ailments, much to the chagrin of the FDA. The FDA released a press statement on April 23, 2020, in which it publicly warned two companies against making claims that CBD can treat opioid addiction. “There are many unanswered questions about the science, safety, effectiveness and quality of approved products containing CBD…Consumers may also put off getting important medical care, such as proper diagnosis, treatment and supportive care due to unsubstantiated claims associated with CBD products.”
“We are developing a medicine,” Hurd said to CNN in an interview after the study was published. “We are not developing recreational cannabis.”
Dr. Julie Holland, a New York psychiatrist called the findings of Hurd and her team “[A]n extremely important paper…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.”
That may be partially true Dr. Holland: many people started out with opiates prescribed because of an injury, surgery or other medical necessity, and many others took opiates specifically to get high. At the bottom line, it does not matter how someone ends up in the throes of addiction, what matters is that perhaps there may be a natural, effective and safe treatment for them.