Written by Renata Filiaci, MSHW

This report will discuss how cannabis can be used to reduce the cravings for addictive substances like opioids and alcohol as well as help in recovery.

Opioids are natural or synthetic (made in laboratories to mimic the properties of natural opioids) chemicals that interact with opioid receptors on the nerve cells in the body and brain and reduce feelings of pain. They are a class of drugs that include prescription pain relievers, synthetic opioids and heroin.

Opioids produce high levels of positive reinforcement, increasing the odds that people will continue using them despite negative resulting consequences. Opioid use disorder (OUD) is a chronic lifelong disorder, with serious potential consequences including disability, relapses, and death. While opioid use disorder is similar to other substance use disorders in many respects, it has several unique features. Opioids can lead to physical dependence within a short time, as little as 4-8 weeks. Also, the magnitude of non-cancer chronic pain has led to the proliferation of opioid prescriptions and addiction which is currently a public health concern in the USA.

In 2019, an estimated 10.1 million people aged 12 or older misused opioids in the past year. Specifically, 9.7 million people misused prescription pain relievers and 745,000 people used heroin. In 2020, more than 92,00 Americans died from drug overdoses, a nearly 30% increase over 2019.

Alcohol use disorder (AUD) is a pattern of alcohol use that involves problems controlling your drinking, being preoccupied with alcohol, continuing to use alcohol even when it causes problems, having to drink more to get the same effect, or having withdrawal symptoms when you rapidly decrease or stop drinking. Alcohol use may begin in the teens, but alcohol use disorder occurs more frequently in the 20s and 30s, though it can start at any age.

Long term effects can lead to liver disease, digestive problems, heart problems, reproduction issues (decreased libido or menstruation infrequency), bone damage, neurological complications, weakened immune system, and increased risk of cancer.

Within the scope of these addiction disorders, genetic factors, family history, trauma, and environmental factors, such as ease of access, contribute to the risk of these disorders.

Can cannabis be considered a substitute medication for reducing the use of addictive substances? In a randomized, controlled, double-blind trial of 42 drug-abstinent people with a heroin-use disorder. The participants took either 400 or 800 milligrams of CBD or placebo at different intervals so that researchers could assess the immediate and longer-term effects of the compound. Those in the CBD groups exhibited reduced anxiety and craving in response to drug-related cues such as videos showing drug paraphernalia. They also had reduced levels of the stress hormone cortisol in their saliva and lower heart rates. These effects of CBD lasted a week after the last dose, when little to no CBD would be expected to remain in the body.

In another article, the authors review emerging evidence that suggests that cannabis may play a role in ameliorating the impact of opioid use disorder. The evidence summarized in this article demonstrates the potential cannabis has to ease opioid withdrawal symptoms, reduce opioid consumption, ameliorate opioid cravings, prevent opioid relapse, improve OUD treatment retention, and reduce overdose deaths. Cannabis’ greatest potential to positively impact the opioid epidemic may be due to its promising role as a first line analgesic in lieu of or in addition to opioids. Patients, healthcare providers, and regulating bodies would all greatly benefit from additional evidence that fills in massive gaps in the knowledge base about the utility of cannabis for OUD treatment: dosing, cannabinoid content and ratios, bioavailability, contraindications, misuse liability, route of administration, and many other questions remain.

In a literature review compiled by the Alcohol Research Group, studies suggest that cannabis substitution for alcohol can improve overall health, physically and emotionally. For instance, most recently, another observational record review of 92 patients who substituted cannabis for alcohol showed that 100% reported cannabis as a very effective (50%) or effective (50%) substitute for alcohol. British National Group of Consultant Psychiatrists as specialists in addiction, ranked cannabis as less harmful than both alcohol and benzodiazepines in terms of physical harm, dependence and social harm; the safety ratio for cannabis is >10 times higher that of alcohol. An exploratory study of medical cannabis users in harmful substance abuse treatment suggested that medical cannabis use does not hinder drug treatment participation or adversely affect treatment outcomes. In fact, results imply that those using medical cannabis may have had better treatment completion, employment and alcohol use outcomes compared with their non-medical cannabis using counterparts.

Narrative review of studies pertaining to the assessment of CBD efficiency on drinking reduction find that CBD reduces the overall level of alcohol drinking in animal models of AUD by reducing ethanol intake, motivation for ethanol, relapse, anxiety, and impulsivity. Moreover, CBD reduces alcohol-related steatosis and fibrosis in the liver by reducing lipid accumulation, stimulating autophagy, modulating inflammation, reducing oxidative stress, and by inducing death of activated hepatic stellate cells. Finally, CBD reduces alcohol-related brain damage, preventing neuronal loss by its antioxidant and immunomodulatory properties.

Furthermore, there is an ideology that THC is a gateway drug; this marijuana gateway hypothesis remains a consistent justification for harsh policies controlling THC dominant plants. In older studies, the formulas used, like sequencing, association, and causality or simple division, have been heavily criticized by researchers for using an illogical application of math and association to determine causality, stating that the experimental methods are in turn weak.

However, with that being said, researchers have determined that alcohol and tobacco have worse priming effects. Alcohol use precedes cannabis use and tobacco use precedes alcohol use. What is more, drinking caffeinated beverages precedes tobacco use. It can be seen that the sequencing to hard, illicit drug use potentially begins much earlier in the substance use timeline.

Other results indicate a moderate relation between early teen cannabis use and young adult abuse of other illicit substances; however, this association fades from statistical significance with adjustments for stress and life-course variables. Likewise, findings show that any causal influence of teen cannabis use on other illicit substance use is contingent upon employment status and is short-term, subsiding entirely by the age of 21. In light of these findings, we urge U.S. drug control policymakers to consider stress and life-course approaches in their pursuit of solutions to the ‘drug problem.’ On average, individuals with THC dependence meet fewer DSM dependence criteria; the withdrawal experience is not as dramatic; and the severity of the associated consequences is not as extreme unlike cocaine, heroin, and alcohol.