Cannabidiol as a Harm Reduction Strategy for People Who Use Drugs: A Rapid Review

Abstract

Objective The drug poisoning crisis throughout North America necessitates novel harm reduction approaches. Emerging evidence suggests that cannabidiol (CBD) may have some utility as a harm reduction modality for those with problematic substance use. This rapid review aimed to synthesize available evidence on CBD as a potential harm reduction tool for people who use drugs while providing clinical and research insights. Method A systematic search in EMBASE, MEDLINE, CENTRAL, and CINAHL was completed in July 2022. For inclusion, studies had to meet the following criteria: (1) drawn from an adult population of people who use drugs; (2) investigates CBD as an intervention for problematic substance use or harm reduction–related outcomes; (3) be published after the year 2000 and in English; and (4) be primary research or a review article. A narrative synthesis was used to group outcomes relevant to harm reduction and provide clinical and research insights. Results We screened 3,134 records, of which 27 studies (5 randomized trials) were included. The evidence remains limited, but available studies support the potential utility of CBD to reduce drug-induced craving and anxiety in opioid use disorder. There were low-quality studies suggesting that CBD may improve mood and general well-being of people who use drugs. Evidence suggests that CBD monotherapy may not be an adequate harm reduction strategy for problematic substance use but rather an adjunct to the standard of care. Conclusion Low-quality evidence suggests that CBD may reduce drug cravings and other addiction-related symptoms and that CBD may have utility as an adjunct harm reduction strategy for people who use drugs. However, there is a significant need for more research that accurately reflects CBD dosing and administration regimens used in a real-world context.

Oxycodone Self-Administration in Female Rats is Enhanced by Δ9-tetrahydrocannabinol, but not by Cannabidiol, in a Progressive Ratio Procedure

“…There does not appear to be any evidence whether CBD can alter the rewarding value of opioids. A recent review of studies involving human substance users found most studies are of low quality and only hinted at a general beneficial effect of CBD on opioid craving and anxiety (Lo et al, 2023), e.g., (Suzuki et al, 2022); also see (Fernandes et al, 2023; Paulus et al, 2022). The effect may be route and/or species specific since effects of CBD in rats have only variably been demonstrated with parenteral injection (Boggs et al, 2018).…”

Use and perceptions of Cannabidiol among individuals in treatment for opioid use disorder

“…These symptoms are common complaints among individuals suffering from acute or protracted opioid withdrawal, suggesting a potential therapeutic benefit of CBD [ 10 ]. Additionally, a review article on the potential of CBD as a harm reduction intervention concluded that CBD may be able to reduce drug craving and improve well-being, which could lead to better adherence and engagement in substance use treatment such as opioid agonist therapy [ 11 ]. Since CBD is widely available OTC, it is unknown whether individuals with OUD presently use CBD as a harm reduction intervention to better control their opioid use or withdrawal symptoms.…”

Stigma‐related barriers to medical cannabis as harm reduction for substance use disorder: Obstacles and opportunities for improvement

“…Several small trials in individuals with opioid use disorder showed reduced opioid craving for up to a week following a three-day treatment regimen with CBD (Hurd et al, 2015(Hurd et al, , 2019Suzuki et al, 2022). However, despite the devastating toll of overdose and other consequences of the ongoing drug poisoning epidemic, the application of medical cannabis therapies as part of a harm-reduction approach and recovery strategy has encountered significant barriers (Belle-Isle et al, 2014;Lo et al, 2023;Lucas, 2017;Mok et al, 2021Mok et al, , 2022. The present perspective piece examines obstacles that have impeded the implementation of cannabinoid therapies in the context of problematic substance use and addiction services.…”