Can CBD help people who are trying to stop using heroin?

Hurd YL, Sprigss S, Alishayev J, Winkel G, Gurgov K, Kudrich C, Oprescu AN, Salsitz E. 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. Am J Psychiatry 2019;176:9110922. (full article)

Errata (Am J Psychiatry 2020: 177(7);641) for Table S4 in data supplement, corrected online June 9, 2020.

Why was this research conducted?

The number of medications available to manage opioid addiction is limited and, for a number of reasons, underutilized. If cannabidiol (CBD) could be shown to reduce the craving and anxiety associated with opioid addiction, it could become a useful tool in promoting abstinence and preventing relapse.

What do these articles add?

A double-blind, placebo-controlled randomized clinical trial was conducted with 42 American adults (21 to 65 years of age) who had been heroin users for a mean of 13.2 (8.4) years but were currently abstinent for up to 3 months (64.3% for <1 month). The ten-day study compared self-reported cue-induced and out-of-clinic craving and anxiety, as well as secondary outcomes (positive and negative affect scores, cognitive performance, and physiological measures), in response to 3 administrations of 400 or 800 mg CBD or a placebo. Both cravings and anxiety scores were greater when participants were exposed to drug-specific rather than neutral cues and were significantly reduced by either dose of CBD but not placebo, both acutely (after the first dose) and up to a week after its third and last administration. As well, CBD reduced drug-cue-induced physiological measures of heart rate and salivary cortisol levels. No serious adverse effects, including effects on cognition, were observed.

Is there anything else I should know?

The study was relatively short-term (10 days) and had only a modest (n=42) sample population of people who had recently became opioid abstinent. Although the results from in-session assessments were encouraging, the effect of CBD on cue-induced craving was not observed when the participants completed at-home, general craving self-assessments. Longer studies are needed to assess not only the potential of CBD on relapse prevention, but the longer-term impact on cognition.