Cannabis and opioids addiction

Cannabis and Opiate Addiction

Research has begun on cannabis as a treatment for addictions. The research on cannabis and opiate adiction is promising and suggests that cannabis and CBD have a positive effect on managing cravings as well as withdrawal symptoms.

What are opiates? 

Opiates are drugs with pain relieving properties that are used primarily to treat pain. Opiates can be prescribed medications like:

  • codeine
  • fentanyl
  • morphine
  • oxycodone
  • hydromorphone
  • medical heroin

Opiates can also be produced or obtained illegally. (source)

Although opiates can be effective in treating pain and is, in many cases, prescribed by a doctors individuals can easily develop a tolerance (needing an increased dose to obtain the same therapeutic effect). This tolerance can then lead to dependence and addiction. Also, if not used properly (as prescribed) opiates can lead to overdose. We have seen this with the increasing opiate crisis in North America over the last few years. 

In British Columbia, fentanyl was detected in approximately 87 per cent of illicit drug overdose deaths in 2018. Which is up from 82 per cent in 2017. And the total number of illicit drug overdose deaths with fentanyl detected was 1,310 in 2018. (source) In Canada in 2018, there was 1 death every two hours that was related to opiate use. (source)

Traditional Opiate Addiction Treatment

Two main treatment options are available for opiate addiction:

  • Medication: methadone or buprenorphine 
  • Addiction treatment counselling (e.g., withdrawal management, day treatment, mutual aid groups such as Narcotics Anonymous). (source)

Methadone is one of the most common treatment methods for opiate addictions. These medications do not cause intoxication when used correctly. When they are prescribed, they can help to eliminate a person’s withdrawal symptoms. Though, like most medications there is a long list of side effects. But other than just the side effects, there are two major problems associated with these drugs.

  1. They are also addictive and
  2. They must be taken as strictly as prescribed. Not taking them as prescribed can cause an accidental overdose.

It can be a challenge for individuals to use drugs like methadone effectively because they need to be taken daily and they generally need to be taken under supervision by the Pharmacist. This means that individuals need to travel to their pharmacy every day to take their prescription. 

It is also worth noting that depending on where a person is located it can be challenging to get prescribed methadone.

Cannabis as a Treatment for Opiate Use – What the Research says

We know the research supports the use of cannabis for chronic pain. When given access to cannabis, individuals currently using opiates for chronic pain decrease their use by 40–60% and report that they prefer cannabis to opiates. (source in resources) Patients in these studies reported fewer side effects with cannabis as well as a better quality of life. 

Despite the vast array of cannabis products and administration routes used by patients, cannabis has been consistently shown to reduce the opiates dose needed to achieve desirable pain relief. (sources in resources)

Therefore cannabis has the potential to be a safer treatment method for pain than opiates but here we are discussing addictions and those who are already long term users of opiates. 

CBD Research for Addiction and Withdrawal

The research on the effects of cannabis and opiate withdrawal are pre-clinical but promising. Research suggests that CB1 receptors play a critical role in opiate reward pathways. This indicates that CBD and other cannibinoids have the potential to affect the same or similar pathways, which is likely why we are seeing pain killing effects with CBD.

CBD has shown promising effects in not only reducing the rewards associated with the use of other drugs but also in reducing cravings (source). Therefore, CBD has the potential to be effective in supporting individuals with reducing use of opiates as well as with reducing the chance of relapse. 

Initial studies of CBD in humans verified that CBD, when co-administered with fentanyl, is safe and well tolerated in healthy, non-opiate dependent individuals. This indicates that, in some cases, it is safe for individuals to simultaneously consume CBD and opiates which has the potential to affect how individuals react to relapses. Though people should always be cautious when using more than one medication as there is always a potential for unknown interactions. 

A 2015 report of a small double-blind study conducted in opioid-dependent individuals found that a single administration of CBD, in comparison to a placebo, decreased cravings as well as feelings of anxiety. 

A double-blind placebo-controlled study published on May 21, 2019 adds to these findings by demonstrating that the FDA-approved Epidiolex can reduce cravings in individuals that had been former heroin users. Furthermore, in these individuals, Epidiolex reduced reports of anxiety, and blood levels of cortisol, a hormone known to increase under conditions of stress and anxiety.

As research continues we will get a clearer picture of how CBD can be used to help manage opioid addictions, withdrawal and cravings. 

CBD for Opiate Addiction – How to Use

Since the research is still preliminary in this field those struggling with addictions should seek professional help with treatment.

High CBD strains are recommended as they can be used more regularly without causing the psychoactive high. It is likely that regular use is going to be necessary, especially for the first few weeks, or months, as the individual goes through possible withdrawal symptoms followed by their highest levels of cravings. 

Edibles may also be a good option to consider as the effects may be longer and stronger than with other consumption methods. But also edibles often have a stronger body effect, therefore are likely to have a more significant effect on symptoms such as nausea and help manage physical cravings.

For more information on the use of cannabis for addictions and the research that has led us to considering cannabis as a treatment for alcohol addictions check out our introduction article here.

For information on Cannabis and CBD for alcohol addiction check out our other article here.

Resources

Boehnke KF, Litinas E, Clauw DJ. Medical cannabis use is associated with decreased opiate medication use in a retrospective cross-sectional survey of patients with chronic pain. J Pain. 2016;17:739–744 

Kral AH, Wenger L, Novak SP, et al. Is cannabis use associated with less opioid use among people who inject drugs? Drug Alcohol Depend. 2015;153:236–241

Reiman A, Welty M, Solomon P. Cannabis as a substitute for opioid-based pain medication: patient self-report. Cannabis Cannabinoid Res. 2017;2:160–166

Stith SS, Vigil JM, Adams IM, et al. Effects of legal access to cannabis on scheduled II-V drug prescriptions. J Am Med Dir Assoc . 2018;19:59–64.e1