Using Cannabis to help treat Opioid addiction.

An excerpt from my book Fifteen Years an Addict, where I discuss everything I used in my search to overcome opioid addiction. Purchase your own copy on Amazon. Soon to be available as an audiobook!

One of these was cannabis:

Cannabis- THC, CBD, CBG (THC has a low potential for misuse)

• What it is

Cannabis is a plant genus that includes species like Cannabis sativa and Cannabis indica that have been used recreationally, medicinally, and for industrial purposes for thousands of years. Best known for its psychoactive properties, cannabis also contains a plethora of compounds that are now being acknowledged for their effects on the body. Although still federally illegal, since the 90s, many states and cities have begun to enact laws allowing for the growth, sale, and use of cannabis for medical and recreational purposes. 

Cannabis is a rich source of bioactive compounds, including numerous alkaloids and terpenoids that all blend and lend themselves to the overall effect of cannabis. Of these alkaloids, there are three that have been most extensively studied and are responsible for many if not all of the positive benefits: cannabinoids, tetrahydrocannabinol (THC), cannabidiol (CBD), and cannabigerol (CBG), which hold the key to its medicinal effects. These compounds, each with its own unique properties and therapeutic actions, work together to enhance the plant's overall healing potential. While each has its own effects, they all play an essential role in the plant's medicinal value.

• The science

THC

While not definitive, the 2022 systematic review published in Drug and Alcohol Dependence titled "Alleviation of Opioid Withdrawal by Cannabis and Delta-9-Tetrahydrocannabinol: A Systematic Review" examines the potential of cannabis and its primary psychoactive compound, delta-9-tetrahydrocannabinol (THC), in managing opioid withdrawal symptoms. 

The authors meticulously analyzed both observational and experimental human studies to assess whether cannabis or THC could alleviate symptoms associated with opioid withdrawal. Their review found that some studies suggest that THC can help reduce withdrawal symptoms, such as anxiety, pain, and insomnia. However, the evidence is mixed, with other studies indicating limited or no significant effects on the participants.

While there is some evidence supporting the use of cannabis or THC in mitigating opioid withdrawal symptoms, the current body of research is insufficient to draw any definitive conclusions. The researchers go on to state that variability in study designs, participant populations, and cannabis formulations contributes to the inconsistency in findings, obscuring the potential of THC. In hopes of helping those dealing with opioid addiction, there is a pressing need for more rigorous, controlled studies to better understand the potential therapeutic role of cannabis and THC in opioid withdrawal management. (12)

CBD

In 2022, the Journal of Cannabis and Cannabinoid Research published an article titled "Adjunctive Management of Opioid Withdrawal with the Nonopioid Medication Cannabidiol," where researchers explored the role of cannabidiol (CBD) as a supportive treatment to help patients better manage opioid withdrawal syndrome. 

Opioid withdrawal presents a long, uphill battle. Not only do patients suffer through acute withdrawal, which can include a range of symptoms, such as anxiety, pain, insomnia, and gastrointestinal distress, but there are also protracted withdrawal symptoms that can persist for months after the cessation of opioids. Unfortunately, when insufficiently managed, opioid withdrawal often leads to devastating results, including treatment failure, relapse, and overdose.

Due to the lethal nature of opioids and the current epidemic, there is a critical need for cost-effective, nonopioid medications with minimal side effects to help in the medical management of opioid withdrawal syndrome. Enter CBD.

In this meta-review, the authors analyzed 41 clinical studies examining CBD's effects on opioid withdrawal. The researchers' findings suggest that CBD possesses multiple therapeutic properties relevant to withdrawal management, including anxiolytic, antidepressant, anti-inflammatory, antiemetic, and analgesic effects. These effects are believed to be mediated through the endocannabinoid system, a complex network of receptors and neurotransmitters involved in various physiological processes. Most notably, CBD has been shown to reduce cue-induced cravings for opioids, which is a significant factor that can help prevent relapse.

The authors conclude that CBD, as a non-intoxicating component of cannabis, holds promise as an adjunctive therapy for managing opioid withdrawal symptoms. Its multifaceted benefits and minimal side effect profile make it a compelling candidate for further research, and doctors should consider potential integration into treatment protocols for opioid use disorder. Best of all, CBD has been shown in several clinical trials to be well-tolerated with no significant adverse effects, even when co-administered with a potent opioid agonist. (13)

CBG

The 2024 study, "Single and Combined Effects of Cannabigerol (CBG) and Cannabidiol (CBD) in Mouse Models of Oxaliplatin-Associated Mechanical Sensitivity, Opioid Antinociception, and Naloxone-Precipitated Opioid Withdrawal", published in Biomedicines, investigates the effects of CBG on mechanical sensitivity and naloxone-precipitated morphine withdrawal. 

The study shows CBG's potential to reverse mechanical sensitivity. When administered to mice treated with oxaliplatin, a cancer medication that induces mechanical hypersensitivity, CBG reversed this hypersensitivity under specific dosing conditions. The study also revealed that when combined with CBD, the effects of CBG were either sub-additive or synergistic, depending on the dosing regimen. 

These results not only suggest the therapeutic potential of CBG in alleviating mechanical sensitivity associated with neuropathic pain but also open up new possibilities for its application in pain management. Alongside its use to improve pain management, CBG was shown to have traits that make it especially useful in those withdrawing from opioids.

To test this, the mice were put through Naloxone-Precipitated morphine withdrawal to simulate withdrawal. In mice chronically treated with morphine, acute administration of CBG significantly reduced naloxone-precipitated jumping behavior, a standard measure of opioid withdrawal severity in mice. However, even more striking was the result that the synergistic effect of CBG combined with CBD resulted in better attenuation of withdrawal symptoms.

This suggests that these cannabinoids may interact to enhance their therapeutic effects in opioid withdrawal management, a potential area for further research and development. 

This study adds to the ever-growing body of evidence proving the therapeutic effects of CBG in reversing mechanical sensitivity and attenuating opioid withdrawal symptoms. Despite all the benefits, the complexity of cannabinoid-opioid interactions needs to be further researched to understand the mechanisms underlying these effects.

All in all, the interactions between CBG and CBD, as well as their combined effects with opioids, present a promising yet challenging area for exploration in the fields of pain management and the treatment of opioid use disorder. (14)

Whole Plant

The 2019 study titled "The Impact of Naturalistic Cannabis Use on Self-Reported Opioid Withdrawal Symptoms", published in The American Journal of Drug and Alcohol Abuse, explores how individuals using cannabis in real-world settings perceive its effects on opioid withdrawal. Researchers surveyed 200 people with a history of chronic opioid use, finding that 62.5% (125 participants) reported using cannabis to help manage withdrawal symptoms. 

Interestingly, most of the participants indicated that cannabis helped alleviate multiple symptoms such as anxiety, tremors, and trouble sleeping. However, it was intriguing to note that a small subset (6%, or 12 individuals) reported that cannabis worsened specific symptoms associated with opioid withdrawal, including yawning, teary eyes, and a runny nose. 

The study concludes that while cannabis may offer relief for some opioid withdrawal symptoms, particularly those related to anxiety, sleep, and pain, its effects are not universal and could even be detrimental in certain patients and populations. These findings underscore the urgent need for further research to better determine how and for whom cannabis may be a valuable tool in opioid withdrawal management. (15)

Whole plant

In 2018, the authors of the study "Emerging Evidence for Cannabis' Role in Opioid Use Disorder", Beth Wiese and Adrianne R. Wilson-Poe, examined existing research to assess how cannabis might alleviate opioid withdrawal symptoms, reduce relapse rates, and serve as an alternative analgesic to opioids. The goal of their study is to explore the potential of cannabis as a complementary therapy in managing opioid use disorder (OUD).

The review acknowledges that in many places, Cannabis is not seen as an appropriate treatment, and that the current treatment plans primarily revolve around using FDA-approved therapies like methadone and buprenorphine.  While these treatments are available, they are not universally effective and can be difficult to access due to legal and logistical barriers. However, the authors strongly advocate for the potential of cannabis as a complementary therapy, given its relatively favorable safety profile, in managing opioid use disorder (OUD). 

The authors discuss the mechanistic interactions between cannabis and opioids, suggesting that cannabis can help modulate opioid receptor activity and influence the endocannabinoid system, which plays an important role in pain regulation and addiction pathways.

The article also considers the use of cannabis during acute opioid withdrawal, noting that some evidence indicates it may alleviate symptoms such as anxiety, insomnia, and pain. Additionally, the authors explore the concept of cannabis as a harm reduction tool, potentially decreasing the likelihood of relapse by providing an alternative means of managing cravings and withdrawal symptoms.

It is clear that cannabis can have a positive effect on OUD treatment and should receive more attention with comprehensive, in-depth studies to fully understand cannabis's potential role in mitigating the opioid crisis. (16)

• My Experience

Cannabis has been both a source of relief and a challenge. It can indeed alleviate anxiety, pain, and aid in sleep, but it also has its drawbacks. While not everyone's experience will mirror mine, I've observed a significant dip in motivation if I let it take over. However, during the acute withdrawal period, the situation was different, and motivation be damned. Cannabis was a comforting companion, helping to ease the discomfort and distress. 

As I embarked on the journey to reclaim my life and overcame the worst of the acute withdrawal, I found that my relationship with cannabis was not as beneficial as I had hoped. It became a hindrance, leading me to abstain from THC for a few years. In turn, I explored distillates and products containing only CBD and CBG, allowing me to enjoy the benefits without compromising my productivity and motivation.

My relationship to cannabis continues to evolve, and in recent years, I have gradually increased my use of THC and cannabis as a whole while trying to gain weight for an upcoming procedure to hopefully fix back issues that have been plaguing me for years. Cannabis can be helpful for many, but because of differing biochemistry and the alkaloid and terpenoid content in each strain, extract, or product, their effects can range from mild to debilitating. Each person's endocannabinoid system works differently, so no two people will get the exact same effect. 

While I can't wholeheartedly recommend THC to everyone, I do believe that CBD and CBG are worth exploring, even if you don't have a substance use disorder. They can help alleviate anxiety, reduce cravings, and improve sleep, all with minimal side effects. However, it's crucial to approach cannabis use with caution, as it can lead to a new, albeit safer, form of dependency.

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