Ministry of Hemp

Ministry of Hemp

America's leading advocate for hemp

Author: Brittany Smith

CBD In Addiction Treatment: Can CBD Help Overcome Opiate Addiction?

Anecdotes from doctors and patients point to cannabidiol (CBD) as a potential treatment for withdrawal and craving associated with opioid addiction, also known as opioid use disorder (OUD). Although medical…

Anecdotes from doctors and patients point to cannabidiol (CBD) as a potential treatment for withdrawal and craving associated with opioid addiction, also known as opioid use disorder (OUD). Although medical advancements have made withdrawal easier, patients in recovery still have a 40-60% chance of relapsing into addiction.

Between January 2014 and January 2018, the annual number of drug overdose deaths in the United States rose 47%, with the majority caused by opioids. Successful withdrawal and relapse prevention plays a vital role in reducing the growing number of fatalities, and preliminary research supports the alleged beneficial effects of CBD.

NEUROBIOLOGY OF OPIOID USE DISORDER

Opioids are a class of drugs that include prescription medications (i.e., morphine), synthetic drugs with medicinal value (i.e., methadone), and the illegal drug heroin. Opioid molecules closely resemble naturally occurring endorphins and cause similar reactions. Endorphins and opioids bind to the same receptors in the brain and spinal cord, suppressing pain responses and enhancing mood.

Life-sustaining activities, such as eating, release endorphins into the brain, promoting a positive association and desire to repeat these activities. The brain learns to associate circumstances and environmental cues with these activities. In the case of eating, these positive associations could be a mouth-watering smell or favorite restaurant that triggers hunger.

Amid a global opiate addiction crisis, can CBD be part of the solution? Photo: White pills spill from a prescription bottle, with more bottles in the background.

Amid a global opiate addiction crisis, can CBD be part of the solution?

Opioids act on the same areas of the brain, tricking the natural reward system designed to maintain life into promoting continued drug use. By the time an addiction develops, the brain has undergone fundamental changes that cause it to function normally with opioids and abnormally without them. At this point, drug use is no longer a choice; treatment is necessary to manage and reverse these changes.

THE STAGES OF OPIOID ADDICTION TREATMENT

Treatment for opioid addiction begins with detoxification, commonly referred to as withdrawal. This part of recovering from addiction has tremendous effects on the mind and body, including but not limited to nausea, fever, muscle cramping, body aches, agitation, insomnia, anxiety, and depression.

The second stage of treatment for opioid addiction is relapse prevention. Cravings are often managed with medication, while psychotherapy can help treat any underlying issues that contribute to excessive drug use. Exposure to circumstances and environmental cues (i.e., a friend that misuses drugs) also need to be controlled or effectively managed.

ESTABLISHED METHODS OF TREATING OPIOID ADDICTION

Treatment for opioid use disorder usually consists of psychotherapy, medication, and evaluation for underlying health issues. Medical devices may also be used, such as the NSS-2 Bridge that delivers electronic signals to the brain areas responsible for addiction.

Medications are the most common form of treatment, with 80% of patients taking a pharmaceutical during withdrawal. Many of these medications, such as methadone and buprenorphine, are opiate-based and carry their own set of risks. There have been deaths involving these medications, with methadone showing potential to be six times as lethal as buprenorphine.

Other drugs commonly used included clonidine and the fledgling medication lofexidine, approved for use by the FDA in May 2018. Both lofexidine and clonidine belong to a class of drugs that includes high blood pressure and some anti-anxiety medications.

It is important to note that opiate-based treatments can be safe and effective under medical supervision. Belonging to a different class of drugs does not necessarily make clonidine or lofexidine safer.

USING CBD TO MANAGE ADDICTION WITHDRAWAL SYMPTOMS

CBD may be beneficial in influencing many of the symptoms caused by opioid withdrawal. For nausea, multiple human and animal studies have demonstrated the effectiveness of CBD, possibly due to the presence of cannabinoid receptors in the areas of the brain that induce vomiting.

Among the potential benefits of CBD for people recovering from addiction: better sleep, relief of chronic pain and muscle spasms, and reduced symptoms of anxiety. Photo: A dropper bottle of amber liquid, labeled "CBD," rests on a wooden table near some hemp leaves.

Among the potential benefits of CBD for people recovering from addiction: better sleep, relief of chronic pain and muscle spasms, and reduced symptoms of anxiety.

A pharmaceutical medication that contains a 1:1 ratio of THC and CBD, called Sativex, already exists to treat pain and muscle spasms/cramping in patients with multiple sclerosis (MS). Currently approved for use in Canada, Sativex shows potential for pain management in other patients, such as those withdrawing from opioids.

Studies have consistently found CBD has the potential to alleviate insomnia by boosting levels of tryptophan, a chemical required in the production of melatonin. For symptoms of anxiety and depression, CBD is thought to encourage the production of serotonin in a similar way to prescription SSRIs, a type of antidepressants.

USING CBD TO PREVENT RELAPSE

The endocannabinoid system is a target for treatments that prevent relapse due to its potential to control cravings. CB1 receptors may influence opioid receptors, due to their location in the brain. CB2 receptors possibly affect dopamine and may reduce its rewarding effects that encourage opioid use.

Preclinical trials in rats and mice have reinforced the theory that CBD helps to control cravings, although why it works remains a bit of a mystery. Mice and rats given CBD in conjunction with morphine showed a lower reward response, making the morphine less appealing.

A similar study of rats addicted to heroin found CBD prevented relapse. Daily doses of 5 mg/kg or 10 mg/kg kept the rats from relapsing for up to two weeks following their final dose of CBD.

A third preclinical trial shows rats addicted to cocaine and alcohol experience similar effects from CBD treatment. Another trial using rats addicted to amphetamines found evidence that supports using CBD to prevent relapse.

CBD COULD BE A BENEFICIAL ADJUNCT TREATMENT

Overall, CBD shows a strong potential as an additional treatment for opioid addiction when combined with psychotherapy and pharmaceuticals. Preclinical trials using animals consistently find CBD can be beneficial in preventing relapse, although further clinical trials in humans are needed to confirm this.

Recovery from addiction requires a multi-pronged approach, including treatment of mental health conditions that may contribute. Photo : A sad looking man in athletic gear and headphones sits on a swingset.

Recovery from addiction requires a multi-pronged approach, including treatment of mental health conditions that may contribute.

CBD may also help treat many of the withdrawal symptoms during detoxification from opioids. However, CBD alone does not replace the vital role of medically assisted treatment for addiction. Anyone suffering from OUD, or any form of substance use disorder should contact their primary care physician to establish a treatment plan.

There is no one-size-fits-all solution to ending the opioid crisis, but CBD oil products may prove to be a valuable tool. At this point in time, while millions of Americans battle addictions and tens of thousands die, anything that may help deserves further investigation.

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Using CBD For Sleep: Can CBD Help Treat Insomnia?

We wanted to take a closer look at the science behind CBD as a treatment for insomnia. Millions of Americans suffer from sleeplessness, and conventional treatments often fail or lose effectiveness.

As more people begin using CBD for sleep, we wanted to take a closer look at the science behind cannabidiol as a treatment for insomnia.

Sleep has baffled humans for millennia, and although scientists have tried to unravel its secrets, it is still a bit mysterious. For the 50-70 million Americans with insomnia, it is even more elusive. Standard treatments often lose effectiveness over time and carry risks of dangerous side effects. Finding relief can be a gruelling task.

However, research has shown that cannabidiol (CBD) may be a promising alternative or addition to conventional medications. To understand how people use CBD for better sleep, some basic knowledge of insomnia and the science of sleeping is necessary.

WHAT IS INSOMNIA?

Insomnia is by far the most common of all sleep disorders. People with insomnia struggle falling and staying asleep and suffer from poor sleep quality. As many as 20 percent of adult Americans meet the diagnostic criteria for either primary (independent of outside factors) or secondary (accompanying another illness) insomnia.

During insomnia, the brain goes into flight-or-fight mode, leaving would-be sleepers too alert to drift off. Photo: A house with its lights on at the top floor, with a night time city in the background.

During insomnia, the brain goes into flight-or-fight mode, leaving would-be sleepers too alert to drift off.

When someone with insomnia attempts to fall asleep, their brain enters a state that is known as hyperarousal. During hyperarousal, the body goes into fight or flight mode and is on guard for anything that may be a threat. This increased state of alertness makes it difficult to fall asleep, remain asleep and get restful sleep.

WHAT CAUSES INSOMNIA?

Approximately 70-90 percent of people with insomnia have a mental or physical illness that is the primary cause. Over-the-counter, prescription and illegal drugs can also cause insomnia. Occasionally, it affects people independent of any outside factors.

Physical conditions that can lead to insomnia include asthma, heart disease, chronic pain, seizures, renal dysfunction, and Alzheimer’s. Most psychiatric conditions can lead to sleep disturbances, especially depression and anxiety. Secondary insomnia often results in a vicious cycle were sleeplessness worsens the primary disease, which worsens insomnia.

HOW IS INSOMNIA TREATED?

Doctors manage insomnia using pharmacological and behavioral treatment methods. Non-medicinal treatment includes stimulus control, cognitive behavioral therapy or relaxation therapy. These include breathing techniques, progressive muscle relaxation, mindfulness, and meditation.

Benzodiazepines, non-benzodiazepine hypnotics (sedative medications used for the treatment of insomnia and during surgical procedures) and melatonin receptor agonists are standard pharmacological treatments. Over-the-counter sleeping pills and supplements, like synthetic melatonin, are another common medication taken to manage insomnia.

CONVENTIONAL TREATMENT RISKS

Hypnotic medications used to treat insomnia are known for their potential to cause grave side effects. These include addiction, severe allergic reaction, memory lapses, hallucination, suicidal thoughts or actions, and abnormal sleep behaviors like sleepwalking. They may also lose effectiveness as tolerance is built or cause complications from drug interactions when another condition requires medication.

Among patients treated with pharmaceutical and over-the-counter medications, 48 percent report being dissatisfied with the amount of time it takes to fall asleep (sleep onset latency or SOL) and wake up. A 2001 study of 30 insomnia patients found medication coupled with relaxation therapies caused SOL to plummet from 124 to 29 minutes. The participants using only pharmaceuticals did not experience a change in sleep onset latency, suggesting hypnotics alone are not always successful.

THE SCIENCE OF SLEEP

To understand how cannabidiol can boost sleep it is necessary to understand the biological process responsible for inducing sleep. In humans, circadian rhythm governs a 24-hour sleep schedule that is regulated by the hormone melatonin, a product of the pineal gland. This process begins with the retina; during the day a signal is sent from the eye through the brain, down the spinal cord and back up to the pineal gland, telling it to refrain from making melatonin.

At night, these signals do not activate, allowing the pineal gland to begin producing melatonin. The amino acid tryptophan is absorbed into the pineal gland via the bloodstream, then converted into 5-hydroxytryptophan by the enzyme tryptophan hydroxylase. It is then turned into serotonin by the enzyme aromatic amino acid decarboxylase before finally becoming melatonin.

CBD COULD INCREASE MELATONIN

Cannabidiol may help stimulate melatonin production by boosting levels of tryptophan in the bloodstream; this is accomplished by reducing tryptophan degeneration caused by mitogen, the protein that tells cells to divide. CBD improves serotonin production in the same way, as an increase in tryptophan availability aids in serotonin synthesis in the brain.

Using CBD for sleep may increase melatonin levels and help ease health conditions that cause insomnia. Photo: A dark-skinned woman sleeps on a bed with white sheets, while a light shines on a nightstand.

Using CBD for sleep may increase melatonin levels and help ease health conditions that cause insomnia.

Inflammation adversely affects tryptophan cells and CBD reduces inflammation. When tryptophan is readily available in the bloodstream, the pineal gland can produce melatonin more effectively, leading to better sleep. Small doses of CBD may also help improve daytime wakefulness, helping to reset the 24-hour sleep cycle and restore balance over the long-term.

A 2018 study tracked 409 patients with insomnia during 1059 medical marijuana administrations using an educational app. Participants reported their self-perceived insomnia symptoms before and after using cannabis. On average, users reported a 4.5-point decrease after consumption, using a 0-10 visual analog scale. Researchers found that cannabis strains with higher cannabidiol levels more effectively relieved insomnia than ones with higher tetrahydrocannabinol levels.

TREATING CONDITIONS THAT CAUSE INSOMNIA WITH CBD

Cannabidiol alleviates many of the primary conditions associated with secondary insomnia through its antioxidant, analgesic and anti-inflammatory properties. It has proven useful in mitigating symptoms of anxiety, depression, chronic pain, and autoimmune disease, among others. It also helps control the endocannabinoid system, which regulates mood, pain, appetite, cognitive function, and other biological processes.

A 2015 case study showed cannabidiol was effective in treating insomnia induced by anxiety and post-traumatic stress disorder. The subject, a 10-year-old girl, had been abused and was being prescribed pharmaceutical treatments. However, these were only partially effective over the short-term and caused extreme side effects.

Over 5 months, the girl took 25 mg CBD supplements at bedtime and 6-12 mg sublingual doses as needed during the day to control anxiety. After 5 months, the girl’s score on the Sleep Disturbance Scale for Children had decreased from 59 to 38, indicating she no longer suffered from insomnia.

USING CBD FOR SLEEP

Research haven’t determined the best dose of CBD for sleep onset latency. However, a 2014 study found a 15 mg dose of CBD increased alertness, suggesting a higher dosage would work more efficiently for treating insomnia.

A 2018 study of medical marijuana users found cannabis strains with higher cannabidiol levels more effectively relieved insomnia than ones with higher tetrahydrocannabinol levels.

Unlike traditional sleeping pills, research demonstrates cannabidiol is relatively safe. CBD does not appear to be habit forming, even in very high doses. For example, a 2018 study found that an oral dose of 750 mg of CBD did not show potential for abuse among 43 people with a history of using two or more drugs for recreational purposes (polydrug use). Hypnotic medications alprazolam and dronabinol demonstrated a risk of dependency among the same participants.

WHEN TO SEE A DOCTOR FOR INSOMNIA

It is vital for anyone experiencing distress or impairment from insomnia to seek the advice of a healthcare professional. Poor sleep quality can negatively influence productivity, mental health, and cardiac function.

While some individuals find success using medicinal marijuana to treat insomnia, research suggests tetrahydrocannabinol may impair sleep quality long-term. Cannabidiol on its own is not shown to have the same risks. However, individuals taking pharmaceutical medications should consult with a physician prior to taking CBD.

IS CBD THE SLEEP AID OF THE FUTURE?

Studies from as far back as 1972 consistently demonstrate the potential of cannabis to improve sleep. New research focused specifically on cannabidiol is exhibiting the same positive results, with little potential for adverse long-term effects. Using CBD for sleep is shaping up to be a promising alternative to some risky and inefficient hypnotic medications.

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CBD For Bipolar Disorder: Can Cannabinoids Help Treat Bipolar Affective Disorder?

4.4 percent of adults are estimated to experience bipolar affective disorder. We took a look at research suggesting CBD and other cannabinoids could help.

We wanted to take a closer look at the science behind using CBD for bipolar affective disorder.

The National Mental Health Institute estimates 4.4 percent of adults in the United States will be given a diagnosis of bipolar affective disorder (BPAD) in their lifetime. Adults with BPAD experience the highest rate of impairment among psychiatric patients; an estimated 82.9 percent suffer from severe disablement.

Bipolar affective disorder and its variants can be treatment resistant, which may explain the high rate of disability. Anecdotal evidence, supported by preliminary studies, suggest that cannabinoids have the potential to improve the symptoms of BPAD in some individuals by regulating the endocannabinoid system.

WHAT IS BIPOLAR AFFECTIVE DISORDER?

Bipolar affective disorder is a mental illness that causes significant changes in mood, motivation and energy. A process known as cycling, which involves periods of euphoria (manic episodes) followed by hopelessness (depressive episodes), is a hallmark of the illness.

A man hands holding a white paper sheet with two faced head over a crowded street background.

Some preliminary research supports the use of CBD for bipolar affective disorder treatment.

There are four variants of bipolar affective disorder: bipolar I, bipolar II, cyclothymic disorder and bipolar spectrum disorders. The severity and frequency of symptoms are used to determine which variant is diagnosed. Bipolar I is the most severe form of the disease.

SYMPTOMS OF MANIC EPISODES

Manic episodes, sometimes referred to as mania, are characterized by exaggerated self-esteem, insomnia, racing thoughts and abnormal speech, inability to focus, and impulsive behaviours. True manic episodes only affect those diagnosed with bipolar I disorder. However, patients with other variants of BPAD experience hypomania, a less severe form of mania.

Although mania is considered to be the “high” stage of BPAD, it can have disastrous consequences. Many manic episodes result in hospitalization, psychotic symptoms or grave impairment (e.g., risky behaviour leading to legal trouble). Untreated manic episodes can develop into psychosis.

SYMPTOMS OF DEPRESSIVE EPISODES

Depressive episodes mimic a severe form of depression known as major depressive disorder. Symptoms can include feelings of sadness, emptiness, hopelessness, and loss of interest in activities. Additional traits of depressive episodes are changes in sleep patterns and appetite, trouble concentrating, feelings of worthlessness or guilt, and suicidal thoughts or attempts.

This cycle of bipolar disorder is the “low” point of the disease. Like mania, depressive episodes vary in severity depending on which variant of bipolar disorder is present. Patients with Bipolar I disorder may have what are known as mixed episodes, during which they show signs of both mania and depression.

CONVENTIONAL TREATMENTS OF BIPOLAR DISORDER

Prescription drugs used in conjunction with psychotherapy can help alleviate symptoms of BPAD in most patients. However, bipolar affective disorder can be treatment-resistant, making it difficult to manage in some people. Treatment-resistant BPAD is cause for concern, as up to 50 percent of individuals diagnosed will attempt suicide at least once in their lives.

Medications prescribed for BPAD include anticonvulsants, antimanic drugs and antidepressants. Use of antidepressants alone can lead to the onset of mania or rapid cycling. Mood stabilizers or anticonvulsants are often taken to negate these possible side effects.

The only pharmaceutical shown to have a consistent, positive effect on suicide rates in bipolar patients is lithium. However, newer research has shown there may be a possibility to control BPAD through manipulating the endocannabinoid (EC) system. These are the neurotransmitters responsible for binding cannabinoid proteins to receptors.

ENDOCANNABINOID SYSTEM DYSFUNCTION AND BPAD

The endocannabinoid system, discovered in the mid-1990s, is comprised of two receptors, CB1 and CB2. Cannabinoids, a type of compound found in both the human body and cannabis plants, bind to these receptors to alter brain function. Endocannabinoids are neurotransmitters produced naturally in the body, while phytocannabinoids are found in cannabis plants.

 

An illustration of neurons firing in a human head. Post-mortem studies of human brains of people with bipolar affective disorder found some abnormalities in how they process cannabinoids.

Post-mortem studies of human brains of people with bipolar affective disorder found some abnormalities in how they process cannabinoids.

Postmortem studies have found that brains of patients diagnosed with mental illness, including BPAD variants, show abnormalities in the endocannabinoid system. A similar study, conducted using brain slices from mice, showed dysfunctional CB2 receptors inhibited the release of serotonin, suggesting a healthy EC system helps to regulate mood.

An investigation of endocannabinoid gene variants in 83 patients with major depressive disorder (MDD), 134 with BPAD, and 117 healthy control participants found two marked differences in the patients afflicted with MDD and BPAD. Specifically, the CB1 receptor (CNR1) and fatty acid amide hydrolase (FAAH) genes of the ill participants were found to be abnormal when compared to the control group.

REGULATING THE EC SYSTEM WITH PHYTOCANNABINOIDS

Because of the distribution of endocannabinoid receptors throughout the brain, many of the areas they affect overlap with regions thought to be responsible for BPAD, along with other mental illnesses. Studies have shown patients with specific abnormalities in the CNR1 gene are at a higher risk of being resistant to pharmacological treatment, leaving them more vulnerable to the effects of bipolar affective disorder.

For these patients, phytocannabinoids could provide a way to manipulate the EC system and regulate the level of chemicals traditionally targeted by pharmacological medications. As always with hemp and cannabis research, these studies are still preliminary. More research will be needed to prove whether CBD and other cannabinoids can help treat bipolar affective disorder.

Anandamide and THC

Anandamide, called the bliss molecule, is naturally produced in the body and is similar in molecular structure to THC. Both anandamide and THC bind to CB1 receptors, altering areas of the brain responsible for memory, concentration, movement, perception, and pleasure.

FAAH genes are responsible for activating anandamide; indicating people with FAAH gene mutations may not have the appropriate levels of anandamide in the brain. Supplementing brains deficient in anandamide with THC may help restore chemical balances. Theoretically, this could alleviate cycling between manic and depressive phases.

Cannabidiol (CBD)

Cannabidiol has been shown to inhibit serotonin reuptake in rats, suggesting it repairs abnormalities in CB1 receptors found to inhibit release in mice. If CBD functions the same in human brains, it could provide an alternative to conventional antidepressants, especially for individuals with treatment-resistant BPAD.

A randomized clinical trial found CBD reduces abnormal brain function in regions associated with psychosis, implying it may have therapeutic effects on symptoms associated with the manic phase of BPAD. If CBD regulates both depressive and manic symptoms, it could help treat individuals who do not react well to lithium.

Other Cannabinoids

Cannabis is a complex compound, made up of over 500 chemicals. Over 100 of these compounds are suspected to be cannabinoids. There is little information on the effects of these chemicals, apart from CBD and THC, because few studies have focused on determining what reactions they produce in the EC system.

Among cannabinoids that have already been isolated, CBG and CBCV seem to show a potential for treating mood disorders, such as depression. Further study may help isolate more of these chemicals and determine what effect they have on the EC system.

A gloved scientist with a vial of CBD and a hemp leaf. Preliminary research supports further investigation into using CBD to treat bipolar affective disorder.

Though research is just beginning, it seems likely that CBD and other cannabinoids could help people with bipolar affective disorder.

USING CBDS & OTHER CANNABINOIDS FOR BIPOLAR AFFECTIVE DISORDER

CBD rarely causes adverse reactions. Still, there are risks associated with both conventional methods of treatment and using cannabis derivatives as treatment. The most dangerous side effect of any treatment for BPAD is the potential worsening of symptoms.

Individuals experiencing symptoms of bipolar affective disorder, or previously diagnosed with any of the variants, should consult with a medical professional before starting or changing treatment. Even those who present with treatment-resistant variations of the disease can benefit from traditional methods (such as psychotherapy).

Regulating the EC system through phytocannabinoids may provide a way to alleviate symptoms in those with treatment-resistant BPAD. Further clinical trials in humans are needed to validate preliminary data, but the future of cannabinoids as a BPAD treatment looks promising.

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