Cannabinoids in treatment of addiction: an overview

There is news in research on pharmaceutical-grade cannabinoids in potential therapy for substance abuse. Given that they appear to act on the body’s endocannabinoid system, that complex regulatory part of our central and peripheral nervous systems, this news should come as no surprise. 

In general, abused drugs promote short- and long-term adaptations in endocannabinoid-regulation, where they hijack neural functions related to the pursuit of rewards. Compounds within marijuana have preferential access to the cannabinoid receptor system, and therefore should form the basis of treatments for drug addiction across a very wide range of dependencies. And evidence does now suggest that, as expected, plant-derived and manufactured cannabinoids can be of use against addiction to nicotine, alcohol, opioids, cocaine, and methamphetamines. The mechanisms for this are complex, and are still being explored. Some of them involve one or both of the known cannabinoid neural receptor sites, others have to do with downstream regulation of enzymes, and some are epigenetic, relating to gene expression.

Here are the specifics. 

Cannabidiol (CBD) reduces cigarette consumption in tobacco smokers, it is known. Strangely, experimental drugs that block cannabinoid receptor site 1 (CB1) seem to as well. These particular drugs cause too many side effects to be useful, but they are pointing the way to more promising anti-smoking synthetics.

Activity at CB1 also contributes to the motivational and reinforcing properties in alcohol abuse. Alcohol and cannabinoid agonists (that is, receptor stimulants) together bring about undesirable side effects, and exposure to the synthetic agonist, WIN 55,212-2 actually causes relapse into alcohol use in rats. CB1 antagonists, however, lead to a very significant reduction in alcohol consumption. And CBD has prevented the development of high impulsivity in rats with alcohol dependence history. 

Cannabinoids and opioids interact at the receptor level, too. (The body has an endogenous opioid system as well – think endorphins and ‘runners’ high’.) It is known that illicit use of cannabis is common among opiate-dependent individuals, has the potential to confound treatment, and drops significantly following dose stabilization. Thus it is reasonable expect to find interventions in opiate dependence that target the interactions between our endogenous cannabinoid and opioid systems – the two systems do communicate.Most medications currently target just the opioid system. But CBD is a promising alternative, because it does seem to attenuate thereward-facilitating effect of morphine (through mechanisms that are now well understood), and it does so safely and palatably in trials thus far. Synthetically blocking CB1 also modifies morphine sensitivity in laboratory animals, and so does inhibiting particular downstream catabolic enzymes within the endocannabinoid system. Much is to come in treating opioid dependence with cannabinoids.

The endocannabinoid system is implicated in the neurobiology of cocaine addiction too. The CB1 and CB2 receptors are both involved, though in different ways. Distinct potential therapeutic benefits will probably come specifically from CBD. It has been observed that these preparations could be offered to community treatment centers very inexpensively, in a variety of low-risk formulations, ideal for marginalized users of cocaine and cocaine derivatives.

Finally, methamphetamine conditioning is also mediated by the endocannabinoid system.CB1-blocking has a clear effect against drug-seeking and also relapse. More and more is known about the reasons for this.

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The foregoing is a report on trends and developments in the cannabinoid industry. No product described herein is intended to diagnose, treat, cure or prevent any disease or syndrome.