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CBD has an established low risk for addiction and abuse, primarily because it does not produce "rewarding" effects in the brain, nor euphoria, nor any withdrawal syndromes. So it's an excellent candidate to reduce and replace harmful addictions to substances and behaviors. CBD's low toxicity and gentle side effect profile make it a safer alternative than most of the drugs it can replace. As covered previously, CBD can reduce anxiety, which is often a driving force behind both drug abuse and relapse. Let's take a look at the evidence.
Studies on drugs that can help addiction often focus on three phases: how the treatment alters the intoxicating and rewarding effects of the addiction, how the treatment helps reduce withdrawal symptoms, and how the treatment can reduce craving and relapse.
Opioid Addiction:
In animal studies, CBD appears to have an impact on the intoxication phase of opioid addiction in animals: it's been shown to reduce the reward-facilitating effect of morphine. Regarding the withdrawal phase, CBD appears to have no or little benefits when administered alone, but may enhance THC's ability to decrease opioid withdrawal. Finally, and possibly most importantly, CBD influences the relapse phase of opioid addiction by decreasing cue-induced, drug-seeking behaviors.[1]
Human studies have established the safety of combining CBD with opioid drugs, but have primarily focused on the use of CBD to reduce opioid drug craving. A double-blind, placebo- controlled cross-over study in healthy people showed that 400mg and 800mg doses of CBD co-administered with intravenous fentanyl is well tolerated and does not increase the adverse effects of the fentanyl.[2]
A small double-blind study was conducted in opioid-dependent individuals who had been abstinent for at least 7 days. Cravings were tested by showing opioid-related and neutral video cues at 1 hour after, 24 hours after, and 7 days after administration of CBD (400mg or 800mg doses) or placebo. Remarkably, these high doses of CBD were shown to reduce cravings at all intervals, even 1 week after they were administered![3]
A recently published follow-up study in 42 drug-abstinent people with heroin use disorder were randomized to receive CBD 400mg, 800mg, or placebo daily for three days. Compared to placebo, both doses of CBD reduced cue-induced craving and anxiety both in the short-term (1-2 hours after and 24 hours after taking the CBD) and at 7 days after the final dose was administered. In the short-term, the higher dose seemed to work better, but both doses worked equally at the 7-day follow up.[4]
I want to draw attention to the fact that CBD worked so quickly and that it lasted so long. Furthermore, it's unlikely that the levels of CBD in the body 7 days later were significant, so the long-lasting effects are most likely due to changes in the brain's pathways related to addiction, craving, and anxiety.
Stimulant Addiction:
Animal studies show that, unlike opioid reward, CBD does not decrease the rewarding effects of stimulant drugs like cocaine or amphetamines.[1] One rat study showed that high-dose CBD can reduce the motivation to seek and consume methamphetamine.[5] No human studies have been published on CBD and stimulant addiction.
Tobacco Addiction:
One study looked at the impact of CBD on tobacco addiction in a randomized, double-blind, placebo-controlled study on 24 smokers who wished to stop smoking. Two groups received either a CBD inhaler (0.4mg CBD per inhalation) or a placebo inhaler. They were told to use the inhaler whenever they felt the urge to smoke, to assess daily cigarette and inhaler use, and to monitor their craving once daily for 1 week. The results showed an approximate 40% reduction in the number of cigarettes smoked in the CBD inhaler group during the week of treatment. This trend indicated a reduction in cigarette smoking 1 week after the intervention ended.[6]
Another study showed that a single 800mg dose of CBD reduced the importance and pleasantness of cigarette cues, compared with placebo, after overnight cigarette abstinence in dependent smokers. Essentially, cigarette cues become much more important, or salient, in smokers during the early stages of abstinence compared to when they are actively smoking. CBD prevented the increased interest in smoking, but the single dose of CBD did not influence tobacco craving or withdrawal.[7]
In my clinical experience, several patients have successfully used inhaled CBD to support tobacco abstinence. One interesting strategy: a patient will roll packs of cigarettes containing both tobacco and CBD-dominant cannabis flower. Over the course of a few weeks, the tobacco content decreases and the CBD flower content increases, until they are smoking only CBD flower.
Alcohol Addiction:
One randomized, double-blind, crossover study assessed the effects of CBD on acute consumption of alcohol. Researchers tested the subjective response of 10 healthy volunteers after consuming alcohol alone or in combination with CBD 200mg. The authors found that there was no difference in feeling “drunk”, “drugged”, or “bad." [8] No other human studies on alcohol addiction have been published, but several animal studies show that CBD can mitigate some of the damage that alcohol causes to the brain and liver.
Cannabis Addiction:
Human studies have evaluated the effects of CBD on all three phases of cannabis addiction. One case study on a 19-year-old who experienced severe cannabis withdrawal symptoms found that 300-600mg of CBD per day rapidly relieved the symptoms.[9] Other studies have shown that increased CBD content in cannabis can reduce the rewarding effects of THC.
[1] Reviewed in: Prud'homme, Mélissa, Romulus Cata, and Didier Jutras-Aswad. "Cannabidiol as an intervention for addictive behaviors: a systematic review of the evidence." Substance abuse: research and treatment 9 (2015): SART-S25081.
[2] Manini AF, Yiannoulos G, Bergamaschi MM, et al. Safety and pharmacokinetics of oral cannabidiol when administered concomi- tantly with intravenous fentanyl in humans. J Addict Med 2015;9: 204–210.
[3] Hurd, Yasmin L., et al. "Early phase in the development of cannabidiol as a treatment for addiction: opioid relapse takes initial center stage." Neurotherapeutics 12.4 (2015): 807-815.
[4] Hurd, Yasmin L., et al. "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(2019): appi-ajp.
[5] Hay, Gracie L., et al. "Cannabidiol treatment reduces the motivation to self-administer methamphetamine and methamphetamine-primed relapse in rats." Journal of Psychopharmacology 32.12 (2018): 1369-1378.
[6] Morgan CJ, Das RK, Joye A, Curran HV, Kamboj SK. Cannabidiol reduces cigarette consumption in tobacco smokers: preliminary findings. Addict Behav. 2013;38(9):2433–6.
[7] Hindocha, Chandni, et al. "Cannabidiol reverses attentional bias to cigarette cues in a human experimental model of tobacco withdrawal." Addiction 113.9 (2018): 1696-1705.
[8] Consroe P, Carlini EA, Zwicker AP, Lacerda LA. Interaction of cannabidiol and alcohol in humans. Psychopharmacology. 1979;66(1):45–50.
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