Treatment with CBD

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CBD for the treatment of cocaine use disorder

A recently published systematic review evaluated the current evidence on the potential of CBD for the treatment of cocaine use disorder. We explore their key findings and conclusions below.

Cocaine use

In 2019, the World Drug Report estimated that there are approximately 18 million cocaine users around the world (aged 15 to 64). Users usually take the drug in powdered form or as “crack cocaine”, a mixture of powdered cocaine and baking soda, which after boiling, hardens and users smoke or inhale it during heating. In this form, the drug is highly concentrated and more addictive.

There is reasonable evidence that cannabinoids such as cannabidiol can have a beneficial use for treating cocaine dependence. The mechanism of action is predominantly through CBD’s general anxiety-reducing, antipsychotic, anticonvulsant properties, and effects on sleep disorders. However, CBD may also have very specific actions on reward effects, consumption, behavioral responses, neuronal proliferation, and hepatic (liver) protection.

How do we treat cocaine dependence with CBD?

There is no definitive “best-practice” recommended to treat cocaine dependence. While doctors have tested several medications, none have been consistent in their effectiveness. Cannabis/marijuana may be a “harm-reduction” approach to reducing cocaine consumption, with the aim of exchanging a more dangerous ”heavy” drug for a “lighter” less-damaging one. CBD has also a potential as a therapeutic agent in reducing crack cocaine dependence.

In reviewing the use of CBD for cocaine dependence, the authors looked at six key areas;

  • Self-administration,
  • Brain stimulation reward,
  • Conditioned place preference,
  • Neuronal proliferation,
  • Anxiety,
  • Hepatic protection, anticonvulsant effect and locomotor sensitization response.
Watch this 2:31 minute video by the American Addiction Centers: “Signs of Cocaine Use”

CBD and cocaine self-administration

Cocaine self-administration research looks at whether taking cannabidiol reduces the desire to take cocaine. In experiments with rats that received different doses of injected CBD, researchers saw no reduction in cocaine seeking behavior. However, other applications of CBD have had success. Transdermal application using gel did reduce context-induced and stress-induced drug seeking, and this behavior continued for 48 days afterward.

Similar results transpired where CBD administered 30 mins before the test reduced the self-administration of low doses of cocaine, but not of higher doses. Although by no means clear-cut, the tests do show some potential for CBD for reducing the urge to take the drug.

In real-world, observational research from Jamaica and Canada, crack cocaine users used cannabis (though not CBD specifically) as a “cheap and effective” method to reduce their cocaine use.

Brain-stimulation reward

“Brain stimulation reward” (also known as “intracranial self-stimulation”) is a procedure where animals receive pleasant electrical stimulation to their brain in response to an action (for example, pressing a lever to give themselves stimulation). The stimulation mimics the activation of brain structures that respond to the effects of euphoric drugs. 

Cocaine, given on its own, increases brain stimulation reward. However, the addition of high doses of CBD reduced the cocaine-influenced brain stimulation reward. It is thus likely that CBD reduces the motivational triggers for continued cocaine use.

Cocaine conditioned place preference

In “condition place preference” tests, cocaine administration occurs along with a location or context (similar to Pavlov’s experiments with dogs). The time that a test animal spends in that location can indicate how much the animal likes the stimulus. Similarly, this test can measure whether the animal remembers and returns to the stimulus location after a period of abstinence. Studies show that giving CBD or THC to animals with a location paired with cocaine causes them to have a lower preference for the “cocaine location” than animals that did not receive the CBD/THC over the following two weeks.

In humans, drug-related memories and environmental triggers play a significant role in the maintenance of drug-dependence. As such, behavioral routines often need to be broken to break an addiction. CBD thus acts to impair the strengthening of these triggers in cocaine use, reducing cravings, and the risk of relapse.

Neuronal proliferation

Taking any particular drugs produces neuroadaptations in the brain, as it adapts and compensates for the presence of the drug in order to continue to function properly. The process ultimately leads to tolerance and dependence on the drug.

CBD appears to reduce a number of neuroadaptive effects that cocaine causes. However, researchers’ findings are complex and contradictory. CBD appears to disrupt the brain’s dopaminergic reward mechanisms by interfering with the release and build-up of dopamine. However, some studies suggest that its neuroadaptive actions primarily works via non-dopaminergic mechanisms, such as interfering with enzyme transportation and receptor activity.

In addition, CBD encourages a reduction in cocaine-seeking behavior by increasing the levels of neurogenesis (the growth of new neurons) in the hippocampus. However, the reasons for this remain unclear. Experts suggest that neurogenesis is linked to improvements in “new memory acquisition and consolidation”, which may aid in replacing old and unhelpful drug-associated memories that can trigger a relapse.

CBD and cocaine related anxiety

A 2018 study showed that giving CBD to rats addicted to cocaine generally reduced their anxiety, compared to those not receiving CBD. CBD’s anxiolytic (anxiety-reducing) properties are already well-established for non-drug users and can contribute to the psychological challenges faced in drug withdrawal and maintenance.

Hepatic protection, anticonvulsant effect, and locomotor sensitization response

Cocaine use causes serious liver problems for addicts due to its hepatotoxic nature. The enzyme CYP450 is a protein enzyme that breaks down and clears many products from the liver. Its function is to break down cocaine to norcocaine, which is highly toxic to the liver.

CBD can reduce these effects by inhibiting CYP450 and preventing norcocaine production. In addition, CBD also significantly reduces liver inflammation and, in-turn, the subsequent seizures that are the result of the damage to liver cells from cocaine use.

Lastly, researchers examined CBD‘s effect on the common trademark hyperactive movements “locomotor activity” apparent in cocaine users. Interestingly, studies on this issue have raised contradictory findings. One study provided a pre-treatment of CBD before giving cocaine and found that at higher CBD doses, cocaine levels increased in the brain and blood, increasing locomotor activity. 

In comparison, two further studies found no effect of CBD. Nevertheless, the consensus remains that CBD does boost cocaine levels (presumably, partly because CYP450 does not break it down in the liver). However, CBD’s generally positive effects already described above generally counter the overall expected negative effects of this.

Conclusion

The controlled administration of CBD clearly does have a positive impact on the self-administration of cocaine and the quantity of drug taken. It lessens the perception of rewards that cocaine provides. 

Therefore, CBD can be a significant adjunct to countering the negative effects of cocaine withdrawal through its anxiolytic, antipsychotic and anticonvulsant properties and improvement of sleep disorders. Given CBD’s low addictive properties and safety, it offers excellent promise for future investigation.

Reference

Rodrigues LA, Caroba MES, Taba FK, Filev R, Gallassi AD. Evaluation of the potential use of cannabidiol in the treatment of cocaine use disorder: A systematic review. Pharmacol Biochem Behav. 2020 Sep;196:172982. doi: 10.1016/j.pbb.2020.172982. Epub 2020 Jul 6. PMID: 32645315.

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