Is the Role of CBD in Fighting Opioid Epidemic Considerable?

Recently, CBD products have become a recommended remedy for opioid epidemics. This article covers the mechanistic interactions between cannabis and opioids, CBD as a First Line Analgesic, current Opioid Use Disorder (OUD) therapies and their shortcomings, and cannabis as a harm reduction tool in OUD. Therefore, this article will closely focus on the role of CBD in fighting opioid epidemics.

Research on the best ways to treat opioid addiction has been ongoing for decades in North America, yet overdose fatalities are at an all-time high, and recurrence is prevalent. According to Wiese et al. (2018), many FDA-approved opioid replacement therapies and maintenance drugs are widely available to alleviate opioid withdrawal symptoms and preventing relapse.

However, these medications are neither risk-free nor effective for all patients. Traditional opiate replacement medicines like methadone and buprenorphine face legal and logistical hurdles, and the need for these services usually surpasses the supply and availability. Novel, supplementary, or auxiliary OUD treatment methods are highly needed to bridge the efficacy gap between effective OUD treatments and the extensive incidence of abuse, relapse, and overdose. We address these possible benefits in our paper.

Mechanistic Interactions between Cannabis and Opioids

According to DuPont et al. (2018), cannabis may play a role in reducing OUD's negative effects. Therefore, analgesic alternatives like cannabis may help prevent opioid usage, relieve opioid cravings, and reduce relapse.

There are several ways in which the endocannabinoid and opioidergic systems interact, ranging from receptor distribution to behavioral pharmacology cross-sensitization. Cannabinoid-1 (CB1) and mu-opioid receptors (MORs) are found in similar brain regions, including but not restricted to, the periaqueductal gray, locus coeruleus, the nucleus accumbens, the prefrontal cortex, the bed nucleus of stria terminalis, and the substantia nigra.

According to Scavone et al.(2013), it is obvious from the morphology that the opioid and cannabinoid systems interact in reward and withdrawal because of the overlap in expression and regular colocalization of the CB1 and MOR. Addiction and tolerance may be alleviated by CB1 receptors, according to several studies. While it seems that the endogenous cannabinoids do not influence somatic withdrawal symptoms such as escape leaps, diarrhea, losing weight, and paw tremors, the effects of exogenous CB1 agonists on such symptoms are rather contradictory.

As opioid withdrawal is alleviated by blocking CB1 receptors inside the CeA or BNST, endogenous cannabinoid tone inside the amygdala is also engaged in the emotional component. Since the kappa opioid receptor system (KOR) contributes significantly to dysphoria and adverse effects, it may play a role in cannabis' influence on affective opioid withdrawal. More research into how the CB1 receptor affects opioid rewards and withdrawal is needed in light of these contradictory findings. 

CBD as a First Line Analgesic

According to Sideris et al. (2018), pain relief is the main goal of both prescribed painkillers and marijuana. Chronic pain is listed as a qualifying diagnosis by nearly 90% of individuals in state-level medicinal cannabis registries. Research suggests that cannabis compounds such as CBD is an effective treatment option for people with chronic pain. People already using opioids for chronic pain report a 40–60% reduction in their use when provided access to CBD, and they say they prefer cannabis over opioids. Some patients even claimed an increase in their cognitive ability, which is counterintuitive given that opioids have worsened cognitive function.

Medical marijuana users in states possessing medical marijuana legislation, employ a variety of products and delivery methods, but cannabis has consistently reduced the number of opioids required for pain management. Comparable to opioid analgesics, cannabis antinociception has similar processes. Activation of GABA production in the descending pain route is only one example of an antinociceptive mechanism shared by the CB1 and MOR, which are both G-protein-coupled receptors. If cannabis is accurately proven to be an effective treatment for acute, non-severe pain, opioid prescriptions will be drastically reduced, reducing the danger of opioid dosage escalation and physical dependency for patients.

Due to the significant knowledge gap in the medical literature and the possible clinical effects of this treatment, further research into cannabis' ability to relieve acute pain is required.

Current Opioid Use Disorder Therapies and Their Shortcomings.

Prevention of relapse, which is highly prevalent during severe withdrawal (detoxification) and prolonged recovery after physical side effects have faded, is the most obvious difficulty in treating opioid use disorder (OUD). 63–66 treatments focusing on abstinence are especially unsuccessful, with a recurrence rate of 85 percent within a year after starting treatment.

Furthermore, in-patient residential treatment facilities do not improve abstinence-based therapy since recurrence rates are as high as 80% when evaluated two years following treatment commencement. There are presently just four FDA-approved drugs for the management of OUD, which are more effective at preventing relapse than abstinence, and have been around since the 1960s. It's fairly uncommon to use off-label prescription drugs like antiemetics to treat withdrawal symptoms during severe detoxification rather than to avoid recurrence. Therefore, experts emphasize on the most extensively used OUD treatments, their flaws, and any barriers to obtaining them.

Cannabis as a Harm Reduction Tool in OUD

Opioid reward is strongly linked to the CB1 receptor in pre-clinical studies. Because of the antagonistic effects of cannabinoids on opioids, the pleasurable effects of these drugs are diminished, and drug use is prevented from returning. However, in human clinical studies, these results were not replicated. CB1 antagonism, on the other hand, may have a role in the therapy of OUD. Additional cannabis has been proven in many trials to reduce opioid intake or prevent the escalation of opioid doses. Many additional studies have shown no effect on non-medical opioid usage or even an increase when Cannabis is used.

Despite a wealth of data demonstrating cannabis' safety and tolerability, research on the drug's effectiveness in treating opioid addiction is mixed. Patients on methadone have long claimed that cannabis eases opioid withdrawal symptoms, unfamiliar pains and anxieties. However, other studies have shown that cannabis did not alleviate the symptoms of methadone withdrawal, and some researchers even reported an increase in the intensity of their symptoms.

Conclusion

Several neurotransmission systems implicated in addiction are affected by CBD, an exogenous cannabinoid. Preliminary human studies demonstrate that CBD may have a positive influence on opioid as well as psychostimulant addiction, as well as on cannabis and cigarette dependency. Many of CBD's therapeutic qualities, including its protective impact against stress vulnerability and neurotoxicity, suggest that it may be effective in treating addiction problems. There is still insufficient evidence that these qualities may enhance human therapeutic outcomes, and well-designed randomized, controlled studies are needed to test this.

References

DuPont, R. L. (2018). The opioid epidemic is a historic opportunity to improve both prevention and treatment. Brain Research Bulletin, 138, 112-114.

Scavone, J. L., Sterling, R. C., & Van Bockstaele, E. J. (2013). Cannabinoid and opioid interactions: implications for opiate dependence and withdrawal. Neuroscience, 248, 637-654.

Wiese, B., & Wilson-Poe, A. R. (2018). Emerging evidence for cannabis' role in opioid use disorder. Cannabis and cannabinoid research, 3(1), 179-189.

Sideris, A., Khan, F., Boltunova, A., Cuff, G., Gharibo, C., & Doan, L. V. (2018). New York physicians' perspectives and knowledge of the state medical marijuana program. Cannabis and cannabinoid research, 3(1), 74-84.