Oral CBD promising for treatment of heroin use disorder

Référence

Hurd YL, Spriggs S, Alishayev J, et al. Cannabidiol for the reduction of cue-induced craving and anxiety in drug-abstinent individuals with heroin use disorder: A double-blind randomized placebo-controlled trial. Am J Psychiatry 2019;176(11):911-922.

Sommaire

This was a short and small randomized placebo-controlled trial of CBD for the treatment of symptoms of craving and anxiety among abstinent patients with heroin use disorder. Participants were recruited by advertising in such venues as newspapers, halfway houses, and college campuses, as well as from addiction treatment sites. The 42 enrolled patients (aged 21 to 65 years; 83% men) had a diagnosis confirmed by DSM-IV criteria and were otherwise relatively healthy. Patients were excluded if they tested positive for any psychoactive drug other than nicotine, met the criteria for any other DSM-IV Axis I diagnosis within the previous 3 months, were using opioid-agonist maintenance therapy, had hypersensitivity to cannabinoids, or showed signs of acute heroin withdrawal. Patients were randomly assigned to receive CBD 400 mg, CBD 800 mg, or placebo once daily for 3 days. The investigators screened the patients prior to each assessment for drug and alcohol intoxication, and administered the Heroin Craving Questionnaire and a visual analog scale for anxiety. After each daily dose of the study drug, the patients were exposed to a drug cue consisting of a 3-minute video showing intravenous or intranasal drug use, depending on the patient's reported preferred route. Immediately after the video they were exposed to heroin-related paraphernalia for 2 minutes. Patients' responses were evaluated via a visual analog scale for craving (VAS-C), the Positive and Negative Affect Schedule, vital signs, and salivary cortisol. Several tests of cognition were used to assess potential CBD effects on cognition, both acutely and 7 days after the final day of study drug administration. Both doses of CBD significantly reduced craving. Cue-induced anxiety, vital signs, and cortisol levels showed similar patterns. At 7 days after the final administration of CBD or placebo, patients in the 800-mg CBD group maintained a significantly decreased reduction in mean VAS-C score vs placebo, while those who received 400-mg dosing did not. There were some other minor differences in outcomes based on CBD dose. CBD did not reduce overall cravings at home based on the Heroin Craving Questionnaire, just cue-based cravings. There were no differences from baseline in cognitive performance in any of the groups at any assessment. There were no serious adverse events reported during the study.