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Han DH, Harlow AF, Bae D, Cho J, Eckel SP, McConnell R, Barrington-Trimis JL, Audrain-McGovern JE, Leventhal AM. Association between cannabis use and nicotine use persistence among adolescents. Addict Behav 2024; 158:108106. [PMID: 39032200 PMCID: PMC11365778 DOI: 10.1016/j.addbeh.2024.108106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/22/2024]
Abstract
INTRODUCTION Prospective associations of adolescent cannabis use with nicotine use persistence are not well characterized but are important for informing prevention and policy. This study examined the association of 4 types of cannabis product use with subsequent persistent nicotine product use among adolescents. METHODS We used prospective data from an adolescent cohort (14-17 years) from Southern California surveyed at baseline and at approximately 6-month follow-up (2022-2023). We incorporated three mutually non-exclusive analytic samples comprised of individuals with baseline past 6-month use of: (1) any nicotine product (N=308 [mean[SD] age = 16.3[0.6] years]), (2) e-cigarettes (n = 276), and (3) any combustible tobacco product (n = 137). Baseline past 6-month cannabis smoking, vaping, edible use, cannabidiol [CBD] or hemp product use, and any cannabis product use (yes/no) were separately modeled as predictors of past 6-month persistent use of any nicotine products, e-cigarettes, and combustible tobacco at follow-up. RESULTS Baseline use of any cannabis product was associated with increased odds of persistent use of e-cigarettes or any nicotine product (adjusted odds ratio[OR] range: 1.96-2.66). Cannabis smoking was positively associated with persistent any nicotine product use (adjusted OR=2.19, 95 % CI=1.20-4.02). Cannabis smoking, vaping, and edible use predicted persistent use of e-cigarettes (adjusted OR range: 2.22-2.79). Cannabis product use did not predict combustible tobacco use persistence. Associations of CBD/hemp product use with nicotine use persistence outcomes were all non-significant. CONCLUSIONS Adolescents who use cannabis may be at elevated risk for persistent nicotine use.
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Affiliation(s)
- Dae-Hee Han
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA, USA; Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA.
| | - Alyssa F Harlow
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA, USA; Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Dayoung Bae
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA, USA; Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Junhan Cho
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA, USA; Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Sandrah P Eckel
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Rob McConnell
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA, USA; Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Jessica L Barrington-Trimis
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA, USA; Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | | | - Adam M Leventhal
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA, USA; Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA; Department of Psychology, University of Southern California, Los Angeles, CA, USA
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Smith DM, Kaye JT, Walters KJ, Schlienz NJ, Hyland AJ, Ashare RL, Tomko RL, Dahne J, McRae-Clark AL, McClure EA. Tobacco-cannabis co-use among cancer patients and survivors: findings from 2 US cancer centers. J Natl Cancer Inst Monogr 2024; 2024:234-243. [PMID: 39108242 PMCID: PMC11303862 DOI: 10.1093/jncimonographs/lgad035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/19/2023] [Accepted: 10/03/2023] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Cannabis use is prevalent among cancer patients and survivors and may provide some therapeutic benefits for this population. However, benefits may be attenuated when cannabis is co-used with tobacco, which is associated with more severe tobacco and cannabis use and adverse outcomes in noncancer populations. We compared cannabis use, primary mode of use, and therapeutic and/or nontherapeutic use among 3 groups of patients and survivors based on cigarette smoking status. METHODS Survey data was collected from patients and survivors with cancer (n = 1732) at 2 US National Cancer Institute-designated cancer centers in states with varying cannabis regulatory policy. Prevalence of cannabis use (prior to diagnosis, after diagnosis, before treatment, after treatment), primary mode of use, and therapeutic and/or nontherapeutic use were assessed by cigarette smoking status (current, former, never) within and across centers using weighted bivariate analyses and multivariable logistic regression, controlling for demographic and clinical variables. RESULTS Current cigarette use was associated with greater rates of cannabis use prior to diagnosis, after diagnosis, during treatment, and after treatment within each center (all P < .001) and in pooled analyses across centers (all P < .001). Primary mode of use, knowledge of cannabis products, and therapeutic and/or nontherapeutic use also statistically differed by tobacco status and study site. CONCLUSIONS Results illustrate the importance of conducting assessments for both tobacco and cannabis use among cancer patients during and after cancer treatment, regardless of the cannabis regulatory environment. Given previous data indicating harms from co-use and continued tobacco use during cancer treatment, this issue introduces new priorities for cancer care delivery and research.
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Affiliation(s)
- Danielle M Smith
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jesse T Kaye
- Center for Tobacco Research and Intervention (UW-CTRI), University of Wisconsin-Madison, Madison, WI, USA
| | - Kyle J Walters
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Nicolas J Schlienz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Andrew J Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Rebecca L Ashare
- Department of Psychology, University at Buffalo, Buffalo, NY, USA
| | - Rachel L Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Aimee L McRae-Clark
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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Gournay LR, Petry J, Bilsky S, Hill MA, Feldner M, Peters E, Bonn-Miller M, Leen-Feldner E. Cannabidiol Reduces Nicotine Withdrawal Severity and State Anxiety During an Acute E-cigarette Abstinence Period: A Novel, Open-Label Study. Cannabis Cannabinoid Res 2024; 9:996-1005. [PMID: 37167367 DOI: 10.1089/can.2022.0317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Introduction: Despite efforts to curb nicotine use, 8.1 million adults in the United States use e-cigarettes. Notably, the majority of nicotine-containing e-cigarette users report wanting to quit in the near future, yet there is a dearth of research surrounding intervention efforts. Cannabidiol (CBD) has potential to facilitate e-cigarette quit attempts by decreasing withdrawal symptom intensity and anxiety during nicotine e-cigarette abstinence. Methods: This study employed an open-label, crossover design (n=20) to test the hypothesis that among daily nicotine-containing e-cigarette users, oral administration of 320 mg CBD would reduce self-reported nicotine withdrawal severity and state anxiety following a 4-h e-cigarette abstinence period compared to withdrawal and anxiety reported after abstinence in the absence of CBD. Results: After controlling for participants' positive CBD expectancies, results were consistent with hypotheses, suggesting CBD reduced both nicotine withdrawal symptom severity and state anxiety during e-cigarette abstinence. Conclusion: These preliminary findings suggest testing the impact of CBD on e-cigarette cessation attempts is warranted.
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Affiliation(s)
- L Riley Gournay
- Department of Psychological Sciences, University of Arkansas, Fayetteville, Arkansas, USA
| | - Jordan Petry
- University of Texas at Dallas, Richardson, Texas, USA
- Steven A. Cohen Military and Family Clinic, Addison, Texas, USA
| | - Sarah Bilsky
- Department of Psychology, University of Mississippi, University, Mississippi, USA
| | - Morgan A Hill
- Department of Psychological Sciences, University of Arkansas, Fayetteville, Arkansas, USA
| | | | - Erica Peters
- Canopy Growth Corporation, Smiths Falls, Ontario, Canada
| | | | - Ellen Leen-Feldner
- Department of Psychological Sciences, University of Arkansas, Fayetteville, Arkansas, USA
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Briânis RC, Moreira FA, Iglesias LP. Cannabidiol and addiction. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 177:319-333. [PMID: 39029990 DOI: 10.1016/bs.irn.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
Cannabidiol (CBD) has been investigated for several therapeutic applications, having reached the clinics for the treatment of certain types of epilepsies. This chapter reviews the potential of CBD for the treatment of substance use disorders (SUD). We will present a brief introduction on SUD and current treatments. In the second part, preclinical and clinical studies with CBD are discussed, focusing on its potential therapeutic application for SUD. Next, we will consider the potential molecular mechanism of action of CBD in SUD. Finally, we will summarize the main findings and perspectives in this field. There is a lack of studies on CBD and SUD in comparison to the extensive literature investigating the use of this phytocannabinoid for other neurological and psychiatric disorders, such as epilepsy. However, the few studies available do suggest a promising role of CBD in the pharmacotherapy of SUD, particularly related to cocaine and other psychostimulant drugs.
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Affiliation(s)
- Rayssa C Briânis
- Department of Pharmacology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Fabrício A Moreira
- Department of Pharmacology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Lia P Iglesias
- Department of Pharmacology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Gournay LR, Ferretti ML, Zvorsky I, Fernandez DA, Leen-Feldner EW. Cannabidiol (CBD) Products: Use Patterns and Perceptions Within a Sample of Anxious Users. Subst Use Misuse 2024; 59:1604-1612. [PMID: 38946130 DOI: 10.1080/10826084.2024.2369153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
INTRODUCTION Cannabidiol (CBD) shows promise for a variety of indications, including anxiety. Prior survey work indicates anxiety ranks as a top reason for which people use cannabidiol (CBD), but no work has evaluated individuals using CBD specifically for anxiety. METHOD The current study evaluated CBD product use patterns and perceptions within a sample of 81 participants (Mage = 32.63, SDage = 12.99) who reported using CBD products for anxiety-related concerns within the past 30 days. RESULTS Family and friends, followed by popular and scientific literature, were the most common sources informing participants' decision to use CBD products to target anxiety. On average, participants reported using CBD products daily for at least a year and indicated it was very effective in targeting anxiety-related symptoms. The top three ranked symptoms improved by CBD products were subjective anxiety, difficulty falling asleep, and irritability. These findings were despite the fact that the most frequent dosing levels (∼50mg) were well below those empirically observed to yield anxiolytic effects. Most participants denied side effects, adding to the literature supporting CBD products' safety and tolerability. Finally, participants were generally poorly informed about the nature of CBD products (e.g., distinction from THC), suggesting a need for consumer education. CONCLUSION Collectively, the current study extends prior survey work suggesting powerful expectancies about CBD products, particularly in terms of anxiety reduction, including among those using it to target anxiety-related symptoms. Findings also highlight the importance of addressing the gap between scientific and consumer knowledge.
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Affiliation(s)
- L Riley Gournay
- Department of Psychological Sciences, University of Arkansas, Fayetteville, AR, USA
| | - Morgan L Ferretti
- Department of Psychological Sciences, University of Arkansas, Fayetteville, AR, USA
| | - Ivori Zvorsky
- Canopy Growth Corporation, Charlotte's Web, Louisville, CO, USA
| | - Daniella A Fernandez
- Department of Psychological Sciences, University of Arkansas, Fayetteville, AR, USA
| | - Ellen W Leen-Feldner
- Department of Psychological Sciences, University of Arkansas, Fayetteville, AR, USA
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Hall D, Lawn W, Ofori S, Trinci K, Borissova A, Mokrysz C, Petrilli K, Bloomfield MAP, Wall MB, Freeman TP, Curran HV. The acute effects of cannabis, with and without cannabidiol, on attentional bias to cannabis related cues: a randomised, double-blind, placebo-controlled, cross-over study. Psychopharmacology (Berl) 2024; 241:1125-1134. [PMID: 38416223 PMCID: PMC11106134 DOI: 10.1007/s00213-024-06543-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 01/20/2024] [Indexed: 02/29/2024]
Abstract
RATIONALE Attentional bias to drug-related stimuli is hypothesised to contribute towards addiction. However, the acute effects of Δ9-tetrahydrocannabinol (THC) on attentional bias to cannabis cues, the differential response in adults and adolescents, and the moderating effect of cannabidiol (CBD) are unknown. OBJECTIVES Our study investigated (1) the acute effects of vaporised cannabis on attentional bias to cannabis-related images in adults and adolescents and (2) the moderating influences of age and CBD. METHODS We conducted a randomised, double-blind, placebo-controlled, cross-over study where three weight-adjusted vaporised cannabis preparations: 'THC' (8 mg THC for a 75-kg person), 'THC + CBD' (8 mg THC and 24 mg CBD for a 75-kg person) and PLA (matched placebo). Cannabis was administered on 3 separate days to 48 participants, who used cannabis 0.5-3 days/week: 24 adolescents (12 females, aged 16-17) and 24 adults (12 females, aged 26-29). Participants completed a visual probe task with cannabis cues. Our primary outcome was attentional bias to cannabis stimuli, measured using the differential reaction time to a cannabis vs. neutral probe, on 200-ms trials. RESULTS In contrast to hypotheses, attention was directed away from cannabis cues on placebo, and there was a main effect of the drug (F(2,92) = 3.865, p = 0.024, η2p = 0.077), indicating THC administration eliminated this bias. There was no significant impact of CBD nor an age-by-drug interaction. CONCLUSIONS Acute THC intoxication eliminated attentional bias away from cannabis cues. There was no evidence of differential response in adolescents compared to adults and no evidence that a moderate vaporised dose of CBD altered the impact of cannabis on attentional bias. TRIAL REGISTRATION This study was listed with the US National Library of Medicine and registered on ClinicalTrials.gov, URL: Do Adolescents and Adults Differ in Their Acute Response to Cannabis?-Full Text View-ClinicalTrials.gov, registration number: NCT04851392.
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Affiliation(s)
- Daniel Hall
- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology, University College London, London, UK
- Daniel Hall, Springfield University Hospital, 15 Springfield Drive, London, SW17 0YF, UK
| | - Will Lawn
- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology, University College London, London, UK
- Department of Psychology, Institute of Psychiatry Psychology and Neuroscience, King's College, London, UK
| | - Shelan Ofori
- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology, University College London, London, UK
| | - Katie Trinci
- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology, University College London, London, UK
| | - Anya Borissova
- Department of Neuroimaging, Institute of Psychiatry Psychology and Neuroscience, King's College, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, UK
| | - Claire Mokrysz
- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology, University College London, London, UK
| | - Kat Petrilli
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, London, UK
| | - Michael A P Bloomfield
- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology, University College London, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, UK
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, University College London, London, UK
| | - Matthew B Wall
- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology, University College London, London, UK
- Invicro London, Hammersmith Hospital, London, UK
| | - Tom P Freeman
- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology, University College London, London, UK
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, London, UK
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology, University College London, London, UK.
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Dammann I, Rohleder C, Leweke FM. Cannabidiol and its Potential Evidence-Based Psychiatric Benefits - A Critical Review. PHARMACOPSYCHIATRY 2024; 57:115-132. [PMID: 38267003 DOI: 10.1055/a-2228-6118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
The endocannabinoid system shows promise as a novel target for treating psychiatric conditions. Cannabidiol (CBD), a naturally occurring cannabinoid, has been investigated in several psychiatric conditions, with diverse effects and an excellent safety profile compared to standard treatments. Even though the body of evidence from randomised clinical trials is growing, it remains relatively limited in most indications. This review comprises a comprehensive literature search to identify clinical studies on the effects of CBD in psychiatric conditions. The literature search included case studies, case reports, observational studies, and RCTs published in English before July 27, 2023, excluding studies involving nabiximols or cannabis extracts containing CBD and ∆9-tetrahydrocannabinol. Completed studies were considered, and all authors independently assessed relevant publications.Of the 150 articles identified, 54 publications were included, covering the effects of CBD on healthy subjects and various psychiatric conditions, such as schizophrenia, substance use disorders (SUDs), anxiety, post-traumatic stress disorder (PTSD), and autism spectrum disorders. No clinical studies have been published for other potential indications, such as alcohol use disorder, borderline personality disorder, depression, dementia, and attention-deficit/hyperactivity disorder. This critical review highlights that CBD can potentially ameliorate certain psychiatric conditions, including schizophrenia, SUDs, and PTSD. However, more controlled studies and clinical trials, particularly investigating the mid- to long-term use of CBD, are required to conclusively establish its efficacy and safety in treating these conditions. The complex effects of CBD on neural activity patterns, likely by impacting the endocannabinoid system, warrant further research to reveal its therapeutic potential in psychiatry.
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Affiliation(s)
- Inga Dammann
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Endosane Pharmaceuticals GmbH, Berlin, Germany
| | - Cathrin Rohleder
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Endosane Pharmaceuticals GmbH, Berlin, Germany
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - F Markus Leweke
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Cheeks SN, Buzzi B, Valdez A, Mogul AS, Damaj MI, Fowler CD. Cannabidiol as a potential cessation therapeutic: Effects on intravenous nicotine self-administration and withdrawal symptoms in mice. Neuropharmacology 2024; 246:109833. [PMID: 38176534 PMCID: PMC10958588 DOI: 10.1016/j.neuropharm.2023.109833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/21/2023] [Accepted: 12/28/2023] [Indexed: 01/06/2024]
Abstract
Cigarette smoking remains a leading cause of preventable disease and death worldwide. Due to the devastating negative health effects of smoking, many users attempt to quit, but few are successful in the long-term. Thus, there is a critical need for novel therapeutic approaches. In these investigations, we sought to examine whether cannabidiol (CBD) has the potential to be repurposed as a nicotine cessation therapeutic. In the first study, male and female mice were trained to respond for intravenous nicotine infusions at either a low or moderate nicotine dose and then were pretreated with CBD prior to their drug-taking session. We found that CBD produced a significant decrease in the number of nicotine rewards earned, and this effect was evidenced across CBD doses and with both the low and moderate levels of nicotine intake. These effects on drug intake were not due to general motor-related effects, since mice self-administering food pellets did not alter their behavior with CBD administration. The potential effects of CBD in mitigating nicotine withdrawal symptoms were then investigated. We found that CBD attenuated the somatic signs of nicotine withdrawal and prevented nicotine's hyperalgesia-inducing effects. Taken together, these results demonstrate that modulation of cannabinoid signaling may be a viable therapeutic option as a smoking cessation aid.
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Affiliation(s)
- Samantha N Cheeks
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, CA, 92697, USA
| | - Belle Buzzi
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Ashley Valdez
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, CA, 92697, USA
| | - Allison S Mogul
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, CA, 92697, USA
| | - M Imad Damaj
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Christie D Fowler
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, CA, 92697, USA.
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Fehr F, Lo LA, Nelson C, Nanson K, Diehl L, Nielson K, Reddon H, Walsh Z. Stigma-related barriers to medical cannabis as harm reduction for substance use disorder: Obstacles and opportunities for improvement. Int J Ment Health Nurs 2024; 33:195-201. [PMID: 37767954 DOI: 10.1111/inm.13231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
Emerging evidence on substituting cannabis for more harmful drugs has led to cannabis becoming a novel harm-reduction strategy for combating the current drug poisoning crisis. However, the authorization of medical cannabis as part of a harm-reduction approach and recovery strategy has significant implementation barriers rooted in longstanding stigma towards cannabis. Through a multi-discipline collaboration of Canadian clinicians and academic researchers, we highlighted stigma barriers and opportunities to address these barriers to elicit improved delivery of medical cannabis as a harm-reduction therapy within existing therapeutic frameworks. Evidence from existing literature and real-world experiences converged on three key themes related to stigma barriers: (1) Lack of medical cannabis education within the healthcare community, (2) lack of consensus and coordination among harm-reduction services and (3) access to medical cannabis. We highlight potential solutions to these issues, including improved healthcare education, better coordination between care teams and suggestions for improving access. Through this discussion, we hope to contribute to reducing the stigma around using medical cannabis as a harm-reduction strategy for individuals with a substance use disorder and consider new perspectives in policy development surrounding recovery services.
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Affiliation(s)
- Florriann Fehr
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Lindsay A Lo
- Department of Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Chris Nelson
- Department of Psychology, University of British Columbia, Kelowna, British Columbia, Canada
| | - Kate Nanson
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Lauren Diehl
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Karl Nielson
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Hudson Reddon
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, Kelowna, British Columbia, Canada
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Oliver D, Englund A, Chesney E, Chester L, Wilson J, Sovi S, Wigroth S, Hodsoll J, Strang J, Murray RM, Freeman TP, Fusar‐Poli P, McGuire P. Cannabidiol does not attenuate acute delta-9-tetrahydrocannabinol-induced attentional bias in healthy volunteers: A randomised, double-blind, cross-over study. Addiction 2024; 119:322-333. [PMID: 37821096 PMCID: PMC10952555 DOI: 10.1111/add.16353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 08/30/2023] [Indexed: 10/13/2023]
Abstract
AIMS To test how attentional bias and explicit liking are influenced by delta-9-tetrahydrocannabinol (THC) and whether these effects are moderated by cannabidiol (CBD). DESIGN Double-blind, randomised, within-subjects cross-over study. SETTING NIHR Wellcome Trust Clinical Research Facility at King's College Hospital, London, United Kingdom. PARTICIPANTS/CASES Forty-six infrequent cannabis users (cannabis use <1 per week). INTERVENTION(S) Across four sessions, participants inhaled vaporised cannabis containing 10 mg of THC and either 0 mg (0:1 CBD:THC), 10 mg (1:1), 20 mg (2:1) or 30 mg (3:1) of CBD, administered in a randomised order and counter-balanced across participants (a total of 24 order groups). MEASUREMENTS Participants completed two tasks: (1) Attentional Bias (AB), comparing reaction times toward visual probes presented behind 28 target stimuli (cannabis/food) compared with probes behind corresponding non-target (neutral) stimuli. Participants responding more quickly to probes behind target than non-target stimuli would indicate greater attentional bias to cannabis/food; (2) Picture Rating (PR), where all AB stimuli were rated on a 7-point pleasantness scale, measuring explicit liking. FINDINGS During the AB task, participants were more biased toward cannabis stimuli in the 0:1 condition compared with baseline (mean difference = 12.2, 95% confidence intervals [CIs] = 1.20-23.3, d = 0.41, P = 0.03). No other significant AB or PR differences were found between cannabis and food stimuli between baseline and 0:1 condition (P > 0.05). No significant CBD effect was found on AB or PR task performance at any dose (P > 0.05). There was additionally no cumulative effect of THC exposure on AB or PR outcomes (P > 0.05). CONCLUSIONS A double-blind, randomised, cross-over study among infrequent cannabis users found that inhaled delta-9-tetrahydrocannabinol increased attentional bias toward cannabis in the absence of explicit liking, a marker of liability toward cannabis use disorder. At the concentrations normally found in legal and illegal cannabis, cannabidiol had no influence on this effect.
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Affiliation(s)
- Dominic Oliver
- Department of PsychiatryUniversity of OxfordOxfordUK
- NIHR Oxford Health Biomedical Research CentreOxfordUK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Amir Englund
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- Addictions Department, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Edward Chesney
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Lucy Chester
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- Laboratoire Didier Jutras‐AswadCentre de Recherche du Centre hospitalier de l'Université de MontréalMontréalQCCanada
| | - Jack Wilson
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building, G02The University of SydneyNSWAustralia
| | - Simina Sovi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Stina Wigroth
- Addictions Department, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - John Hodsoll
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - John Strang
- Addictions Department, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- South London and the Maudsley National Health Service Foundation TrustLondonUK
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Tom P. Freeman
- Addictions Department, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- Department of PsychologyUniversity of BathBathUK
| | - Paolo Fusar‐Poli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- South London and the Maudsley National Health Service Foundation TrustLondonUK
- Department of Brain and Behavioural SciencesUniversity of PaviaPaviaItaly
- Department of Psychiatry and PsychotherapyLudwig‐Maximilian‐University MunichMunichGermany
| | - Philip McGuire
- Department of PsychiatryUniversity of OxfordOxfordUK
- NIHR Oxford Health Biomedical Research CentreOxfordUK
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11
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Gournay LR, Ferretti ML, Bilsky S, Vance E, Nguyen AM, Mann E, Williams P, Leen-Feldner EW. The effects of cannabidiol on worry and anxiety among high trait worriers: a double-blind, randomized placebo controlled trial. Psychopharmacology (Berl) 2023; 240:2147-2161. [PMID: 37552290 DOI: 10.1007/s00213-023-06437-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Abstract
RATIONALE Evidence suggests cannabidiol (CBD) displays broad therapeutic potential in the context of anxiety; however, no study has examined the effects of CBD on worry, a defining, cognitive feature of anxiety. Additionally, no study has examined the effects of an acute, single dose of CBD compared to repeated CBD administration. OBJECTIVES Within a sample of 63 individuals with elevated trait worry, the current study aimed to assess the effects of an empirically-derived high dose of CBD (i.e., 300mg) compared to a commercially-derived dose of CBD (i.e., 50mg) versus placebo on worry severity and anxiety symptoms after an acute dose and after a 2-week administration period. RESULTS Results indicated no effect of acute CBD dosing on worry severity or anxiety symptoms. Repeated CBD administration similarly did not impact worry severity; however, 300mg of CBD reduced anxiety symptoms across the 2-week administration period compared to placebo. CONCLUSIONS Taken together, these findings suggest 300mg of oral CBD does not attenuate cognitive symptoms of anxiety (i.e., worry), following both acute and repeated administration. Some evidence for repeated administration of 300mg on physical symptoms of anxiety was obtained. Findings from the current study suggest CBD's modest anxiolytic effects may be specific to the physical aspects of anxious arousal.
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Affiliation(s)
- L Riley Gournay
- University of Arkansas, 216 Memorial Hall, Fayetteville, AR, 72701, USA.
| | - Morgan L Ferretti
- University of Arkansas, 216 Memorial Hall, Fayetteville, AR, 72701, USA
| | | | - Emily Vance
- University of Arkansas, 216 Memorial Hall, Fayetteville, AR, 72701, USA
| | - Anna Marie Nguyen
- University of Arkansas, 216 Memorial Hall, Fayetteville, AR, 72701, USA
| | - Eric Mann
- University of Arkansas, 216 Memorial Hall, Fayetteville, AR, 72701, USA
- Laureate Institute for Brain Research, Tulsa, USA
| | - Parker Williams
- University of Arkansas, 216 Memorial Hall, Fayetteville, AR, 72701, USA
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12
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Fernandes JAB, Filev R, Fidalgo TM. Cannabinoids for Substance Use Disorder Treatment: What Does the Current Evidence Say? Cannabis Cannabinoid Res 2023; 8:703-715. [PMID: 37262132 DOI: 10.1089/can.2023.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Background: The prevalence of Substance Use Disorder (SUD) is increasing along with the need to develop approaches to reduce the harm associated with substance use, including investigating alternatives such as cannabinoids, which show promising results, although the current evidence is limited. This scoping review focuses on the limitations and potentials of cannabinoid-based treatments for SUDs. Methods: We examined between-subject randomized controlled trials (RCTs) investigating the use of CBD and THC as pharmacological treatment for SUDs in adults, with the procedures attending the expectations of the Preferred Reporting Items for Scoping reviews and Meta-Analyses (PRISMA) for Scoping Reviews guidelines and assessed risk of bias using the Cochrane Risk of Bias Assessment Tool 2. Results: Ten RCTs were included, with six demonstrating low risk of bias, and positive results were found for treating Cannabis Use Disorder, while contradictory results were found for Opioid Use Disorder, and inconclusive results for treating Cocaine Use Disorder. Conclusions: CBD and THC demonstrate potential for treating some SUDs, but evidence is limited. Robust RCTs with larger samples and longer follow-up periods are necessary to assess carefully developed outcomes for different SUD patients. New cannabinoid-based medications and scientific-based policies may advance SUD treatment. A comprehensive approach to treatment and careful methodological choices may benefit patients with SUD.
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Affiliation(s)
- João Ariel Bonar Fernandes
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renato Filev
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Thiago M Fidalgo
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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13
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Luo M, Gan Q, Fu Y, Chen Z. Cue-reactivity targeted smoking cessation intervention in individuals with tobacco use disorder: a scoping review. Front Psychiatry 2023; 14:1167283. [PMID: 37743997 PMCID: PMC10512743 DOI: 10.3389/fpsyt.2023.1167283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives Cue-reactivity is a critical step leading to the emergence of addictive psychology and the triggering of addictive behaviors within the framework of addiction theory and is considered a significant risk factor for addiction-related behaviors. However, the effect of cue-reactivity targeted smoking cessation intervention and the cue-reactivity paradigms used in the randomized controlled trials varies, which introduces more heterogeneity and makes a side-by-side comparison of cessation responses difficult. Therefore, the scoping review aims to integrate existing research and identify evidence gaps. Methods We searched databases in English (PubMed and Embase) and Chinese (CNKI and Wanfang) using terms synonymous with 'cue' and 'tobacco use disorder (TUD)' to April 2023, and via hand-searching and reference screening of included studies. Studies were included if they were randomized controlled trials taking cue-reactivity as an indicator for tobacco use disorder (TUD) defined by different kinds of criteria. Results Data were extracted on each study's country, population, methods, timeframes, outcomes, cue-reactivity paradigms, and so on. Of the 2,944 literature were retrieved, 201 studies met the criteria and were selected for full-text screening. Finally, 67 pieces of literature were selected for inclusion and data extraction. The results mainly revealed that non-invasive brain stimulation and exercise therapy showed a trend of greater possibility in reducing subjective craving compared to the remaining therapies, despite variations in the number of research studies conducted in each category. And cue-reactivity paradigms vary in materials and mainly fall into two main categories: behaviorally induced craving paradigm or visually induced craving paradigm. Conclusion The current studies are still inadequate in terms of comparability due to their heterogeneity, cue-reactivity can be conducted in the future by constructing a standard library of smoking cue materials. Causal analysis is suggested in order to adequately screen for causes of addiction persistence, and further explore the specific objective cue-reactivity-related indicators of TUD.
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Affiliation(s)
- Miaoling Luo
- Medical School, Kunming University of Science and Technology, Kunming, China
- Brain Science and Visual Cognition Research Center, Medical School of Kunming University of Science and Technology, Kunming, China
| | - Quan Gan
- Medical School, Kunming University of Science and Technology, Kunming, China
- Brain Science and Visual Cognition Research Center, Medical School of Kunming University of Science and Technology, Kunming, China
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Yu Fu
- Medical School, Kunming University of Science and Technology, Kunming, China
- Brain Science and Visual Cognition Research Center, Medical School of Kunming University of Science and Technology, Kunming, China
| | - Zhuangfei Chen
- Medical School, Kunming University of Science and Technology, Kunming, China
- Brain Science and Visual Cognition Research Center, Medical School of Kunming University of Science and Technology, Kunming, China
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14
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O'Sullivan SE, Jensen SS, Nikolajsen GN, Bruun HZ, Bhuller R, Hoeng J. The therapeutic potential of purified cannabidiol. J Cannabis Res 2023; 5:21. [PMID: 37312194 DOI: 10.1186/s42238-023-00186-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/30/2023] [Indexed: 06/15/2023] Open
Abstract
The use of cannabidiol (CBD) for therapeutic purposes is receiving considerable attention, with speculation that CBD can be useful in a wide range of conditions. Only one product, a purified form of plant-derived CBD in solution (Epidiolex), is approved for the treatment of seizures in patients with Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex. Appraisal of the therapeutic evidence base for CBD is complicated by the fact that CBD products sometimes have additional phytochemicals (like tetrahydrocannabinol (THC)) present, which can make the identification of the active pharmaceutical ingredient (API) in positive studies difficult. The aim of the present review is to critically review clinical studies using purified CBD products only, in order to establish the upcoming indications for which purified CBD might be beneficial. The areas in which there is the most clinical evidence to support the use of CBD are in the treatment of anxiety (positive data in 7 uncontrolled studies and 17 randomised controlled trials (RCTs)), psychosis and schizophrenia (positive data in 1 uncontrolled study and 8 RCTs), PTSD (positive data in 2 uncontrolled studies and 4 RCTs) and substance abuse (positive data in 2 uncontrolled studies and 3 RCTs). Seven uncontrolled studies support the use of CBD to improve sleep quality, but this has only been verified in one small RCT. Limited evidence supports the use of CBD for the treatment of Parkinson's (3 positive uncontrolled studies and 2 positive RCTs), autism (3 positive RCTs), smoking cessation (2 positive RCTs), graft-versus-host disease and intestinal permeability (1 positive RCT each). Current RCT evidence does not support the use of purified oral CBD in pain (at least as an acute analgesic) or for the treatment of COVID symptoms, cancer, Huntington's or type 2 diabetes. In conclusion, published clinical evidence does support the use of purified CBD in multiple indications beyond epilepsy. However, the evidence base is limited by the number of trials only investigating the acute effects of CBD, testing CBD in healthy volunteers, or in very small patient numbers. Large confirmatory phase 3 trials are required in all indications.
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15
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Yau GTY, Tai W, Arnold JC, Chan HK, Kwok PCL. Cannabidiol for the Treatment of Brain Disorders: Therapeutic Potential and Routes of Administration. Pharm Res 2023; 40:1087-1114. [PMID: 36635488 PMCID: PMC10229467 DOI: 10.1007/s11095-023-03469-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 01/02/2023] [Indexed: 01/14/2023]
Abstract
The use of cannabidiol (CBD) for treating brain disorders has gained increasing interest. While the mechanism of action of CBD in these conditions is still under investigation, CBD has been shown to affect numerous different drug targets in the brain that are involved in brain disorders. Here we review the preclinical and clinical evidence on the potential therapeutic use of CBD in treating various brain disorders. Moreover, we also examine various drug delivery approaches that have been applied to CBD. Due to the slow absorption and low bioavailability with the current oral CBD therapy, more efficient routes of administration to bypass hepatic metabolism, particularly pulmonary delivery, should be considered. Comparison of pharmacokinetic studies of different delivery routes highlight the advantages of intranasal and inhalation drug delivery over other routes of administration (oral, injection, sublingual, buccal, and transdermal) for treating brain disorders. These two routes of delivery, being non-invasive and able to achieve fast absorption and increase bioavailability, are attracting increasing interest for CBD applications, with more research and development expected in the near future.
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Affiliation(s)
- Grace Tsz Yan Yau
- Advanced Drug Delivery Group, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Waiting Tai
- Advanced Drug Delivery Group, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Jonathon Carl Arnold
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW, 2050, Australia
- Discipline of Pharmacology, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Hak-Kim Chan
- Advanced Drug Delivery Group, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Philip Chi Lip Kwok
- Advanced Drug Delivery Group, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
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16
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Schröder B, Mühlberger A. Measuring attentional bias in smokers during and after psychosocial stress induction with a Trier Social Stress Test in virtual reality via eye tracking. Front Psychol 2023; 14:1129422. [PMID: 37063522 PMCID: PMC10103713 DOI: 10.3389/fpsyg.2023.1129422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/14/2023] [Indexed: 04/03/2023] Open
Abstract
Introduction Attentional bias (AB) is considered an important factor not only in the etiology of addiction, but also with respect to relapse. However, evidence for the predictive ability of AB for relapse is not robust. One reason for this might be fluctuations of AB due to stress. Therefore, the current study investigated whether AB was present during and after stress induction and whether AB was enhanced by stress induction. Methods A Virtual Reality (VR) adaptation of the Trier Social Stress Test (VR-TSST) was used to induce psychosocial stress in smokers (n = 34) and non-smokers (n = 37) followed by a novel free-viewing task in VR. Eye tracking data was recorded to examine gaze behavior to smoking-related and neutral stimuli presented in the VR-TSST and the free-viewing task. Results Stress ratings increased significantly from baseline to post VR-TSST in smokers and non-smokers. During the VR-TSST we observed, more frequent, longer, and earlier fixations on smoke-related compared with neutral stimuli without significant group differences. However, in the free-viewing task following the stress induction, a specific AB of smokers in terms of earlier and longer fixations on smoke stimuli was found. Conclusion Results indicate that AB is not a persistent trait in smokers, but is context dependent. It is suggested that emotional learning processes such as smoking in the context of relief after stress may contribute to changes of AB both in terms of increased initial attention and deeper stimulus processing. Additionally, the potential of the VR-TSST to induce psychosocial stress could be replicated.
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Affiliation(s)
- Benedikt Schröder
- Department for Psychology, Clinical Psychology and Psychotherapy, University of Regensburg, Regensburg, Germany
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17
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Suzuki J, Prostko S, Szpak V, Chai PR, Spagnolo PA, Tenenbaum RE, Ahmed S, Weiss RD. Impact of cannabidiol on reward- and stress-related neurocognitive processes among individuals with opioid use disorder: A pilot, double-blind, placebo-controlled, randomized cross-over trial. Front Psychiatry 2023; 14:1155984. [PMID: 37065899 PMCID: PMC10098189 DOI: 10.3389/fpsyt.2023.1155984] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/10/2023] [Indexed: 04/18/2023] Open
Abstract
Introduction Opioid use disorder (OUD) continues to be a significant public health concern. Medications for OUD (MOUD) such as buprenorphine reduce overdose mortality, but relapses occur often, leading to adverse outcomes. Preliminary data suggest that cannabidiol (CBD) may be a potential adjunctive treatment to MOUD by attenuating cue-reactivity. This pilot study sought to evaluate the impact of a single dose of CBD on reward- and stress-related neurocognitive processes implicated in relapse among those with OUD. Methods The study was a pilot, double-blind, placebo-controlled, randomized cross-over trial aimed at assessing the effects of a single dose of CBD (Epidiolex®) 600 mg or matching placebo administered to participants with OUD receiving either buprenorphine or methadone. Vital signs, mood states, pain, opioid withdrawal, cue-induced craving, attentional bias, decision-making, delayed discount, distress tolerance, and stress-reactivity were examined at each testing session on two separate testing days at least 1 week apart. Results Ten participants completed all study procedures. Receipt of CBD was associated with a significant decrease in cue-induced craving (0.2 vs. 1.3, p = 0.040), as well as reduced attentional bias toward drug-related cues as measured by the visual probe task (-80.4 vs. 100.3, p = 0.041). No differences were found among all the other outcomes examined. Discussion CBD may have promise as an adjunct to MOUD treatment by attenuating the brain response to drug-related cues, which, in turn, may reduce the risk of relapse and overdoses. Further research is warranted to evaluate the potential for CBD as an adjunctive therapy for individuals in treatment for OUD. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT04982029.
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Affiliation(s)
- Joji Suzuki
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Sara Prostko
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
| | - Veronica Szpak
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
| | - Peter R. Chai
- Harvard Medical School, Boston, MA, United States
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, United States
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States
- The Fenway Institute, Boston, MA, United States
| | - Primavera A. Spagnolo
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | | | - Saeed Ahmed
- Rutland Regional Medical Center, Rutland, VT, United States
| | - Roger D. Weiss
- Harvard Medical School, Boston, MA, United States
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA, United States
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18
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Gharbi KA, Bonomo YA, Hallinan CM. Evidence from Human Studies for Utilising Cannabinoids for the Treatment of Substance-Use Disorders: A Scoping Review with a Systematic Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4087. [PMID: 36901098 PMCID: PMC10001982 DOI: 10.3390/ijerph20054087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/02/2023] [Accepted: 02/10/2023] [Indexed: 06/08/2023]
Abstract
Substance-use disorders are pervasive, comorbid with a plethora of disease and possess limited treatment options. Medicinal cannabinoids have been proposed as a novel potential treatment based on preclinical/animal trials. The objective of this study was to examine the efficacy and safety of potential therapeutics targeting the endocannabinoid system in the treatment of substance-use disorders. We performed a scoping review using a systematic approach of systematic reviews, narrative reviews, and randomised control trials that utilised cannabinoids as treatment for substance-use disorders. For this scoping review we used the PRISMA guidelines, a framework for systematic reviews and meta-analyses, to inform our methodology. We conducted a manual search of Medline, Embase, and Scopus databases in July 2022. Of the 253 results returned by the databases, 25 studies including reviews were identified as relevant, from which 29 randomised controlled trials were derived and analysed via a primary study decomposition. This review captured a small volume of highly heterogenous primary literature investing the therapeutic effect of cannabinoids for substance-use disorders. The most promising findings appeared to be for cannabis-use disorder. Cannabidiol appeared to be the cannabinoid showing the most promise for the treatment of multiple-substance-use disorders.
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Affiliation(s)
- Kayvan Ali Gharbi
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Yvonne Ann Bonomo
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
- St Vincent’s Health—Department of Addiction Medicine, Fitzroy, VIC 3065, Australia
| | - Christine Mary Hallinan
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
- Health & Biomedical Research Information Technology Unit (HaBIC R2), Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
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Nasrin S, Coates S, Bardhi K, Watson C, Muscat JE, Lazarus P. Inhibition of Nicotine Metabolism by Cannabidiol (CBD) and 7-Hydroxycannabidiol (7-OH-CBD). Chem Res Toxicol 2023; 36:177-187. [PMID: 36626330 PMCID: PMC9945182 DOI: 10.1021/acs.chemrestox.2c00259] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Indexed: 01/11/2023]
Abstract
Cannabis-based products have experienced notable increases in co-usage alongside tobacco products. Several cannabinoids exhibit inhibition of a number of cytochrome P450 (CYP) and UDP glucuronosyltransferase (UGT) enzymes, but few studies have examined their inhibition of enzymes involved in nicotine metabolism. The goal of the present study was to examine potential drug-drug interactions occurring in the nicotine metabolism pathway perpetrated by cannabidiol (CBD) and its active metabolite, 7-hydroxy-CBD (7-OH-CBD). The inhibitory effects of CBD and 7-OH-CBD were tested in microsomes from HEK293 cells overexpressing individual metabolizing enzymes and from human liver tissue. Assays with overexpressing microsomes demonstrated that CBD and 7-OH-CBD inhibited CYP-mediated nicotine metabolism. Binding-corrected IC50,u values for CBD inhibition of nicotine metabolism to cotinine and nornicotine, and cotinine metabolism to trans-3'-hydroxycotinine (3HC), were 0.27 ± 0.060, 0.23 ± 0.14, and 0.21 ± 0.14 μM, respectively, for CYP2A6; and 0.26 ± 0.17 and 0.029 ± 0.0050 μM for cotinine and nornicotine formation, respectively, for CYP2B6. 7-OH-CBD IC50,u values were 0.45 ± 0.18, 0.16 ± 0.08, and 0.78 ± 0.23 μM for cotinine, nornicotine, and 3HC formation, respectively, for CYP2A6, and 1.2 ± 0.44 and 0.11 ± 0.030 μM for cotinine and nornicotine formation, respectively, for CYP2B6. Similar IC50,u values were observed in HLM. Inhibition (IC50,u = 0.37 ± 0.06 μM) of 3HC to 3HC-glucuronide formation by UGT1A9 was demonstrated by CBD. Significant inhibition of nicotine metabolism pathways by CBD and 7-OH-CBD suggests that cannabinoids may inhibit nicotine metabolism, potentially impacting tobacco addiction and cessation.
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Affiliation(s)
- Shamema Nasrin
- Department
of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical
Sciences, Washington State University, Spokane, Washington99223, United States
| | - Shelby Coates
- Department
of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical
Sciences, Washington State University, Spokane, Washington99223, United States
| | - Keti Bardhi
- Department
of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical
Sciences, Washington State University, Spokane, Washington99223, United States
| | - Christy Watson
- Department
of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical
Sciences, Washington State University, Spokane, Washington99223, United States
| | - Joshua E. Muscat
- Penn
State Cancer Institute, Department of Public Health Sciences, Penn State University College of Medicine, Hershey, Pennsylvania17033, United States
| | - Philip Lazarus
- Department
of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical
Sciences, Washington State University, Spokane, Washington99223, United States
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Singh C, Rao K, Yadav N, Vashist Y, Chugh P, Bansal N, Minocha N. Current Cannabidiol Safety: A Review. Curr Drug Saf 2023; 18:465-473. [PMID: 36056846 DOI: 10.2174/1574886317666220902100511] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/17/2022] [Accepted: 05/27/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Marijuana, also known as cannabis, is the second most widely used illegal psychoactive substance smoked worldwide after tobacco, mainly due to the psychoactive effects induced by D-9-tetrahydrocannabinol (9-THC). Cannabidiol (CBD) is extracted from cannabis and may be used as an anti-inflammatory agent. Some patents on cannabidiol are discussed in this review. The cannabinoid is a non-psychoactive isomer of the more infamous tetrahydrocannabinol (THC); and is available in several administration modes, most known as CBD oil. OBJECTIVES This study aims to provide an enhanced review of cannabidiol properties used in treating inflammation. This review also emphasises the current safety profile of cannabidiol. METHODS Cannabis is also called Marijuana. It is the second most commonly used illegal psychoactive substance in the universe after tobacco. D-9-tetrahydrocannabinol (9-THC) present in cannabis produces psychoactive effects. Cannabidiol (CBD) extracted from cannabis is used for antiinflammatory purposes. Cannabis smoking causes various types of cancer, such as lung, tongue, and jaw. The current review took literature from Google Scholar, PubMed, and Google Patents. Many clinical investigations are included in this review. RESULT After analysing the literature on cannabis, it has been suggested that although cannabis is banned in some countries, it may be included in the treatment and mitigation of some diseases and symptoms like pain management, epilepsy, cancer, and anxiety disorder. Mild side effects were frequently observed in cannabis medications, which included infertility in females, liver damage, etc. Conclusion: Cannabis contains chemical compounds such as the cannabinoids delta-9- tetrahydrocannabinol (THC), a psychoactive substance, and non-psychoactive cannabidiol (CBD). Cannabidiol has been confirmed as an efficient treatment of epilepsy in several clinical trials, with one pure CBD product named Epidiolex. It is also used in treating anxiety and acne, as a pain reliever, and has anti-inflammatory properties.
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Affiliation(s)
- Chander Singh
- School of Medical & Allied Sciences, K. R. Mangalam University, Sohna Road, Gurugram- 122103, Haryana, India
| | - Komal Rao
- School of Medical & Allied Sciences, K. R. Mangalam University, Sohna Road, Gurugram- 122103, Haryana, India
| | - Nikita Yadav
- School of Medical & Allied Sciences, K. R. Mangalam University, Sohna Road, Gurugram- 122103, Haryana, India
| | - Yogesh Vashist
- School of Medical & Allied Sciences, K. R. Mangalam University, Sohna Road, Gurugram- 122103, Haryana, India
| | - Palak Chugh
- School of Medical & Allied Sciences, K. R. Mangalam University, Sohna Road, Gurugram- 122103, Haryana, India
| | - Nidhi Bansal
- School of Medical & Allied Sciences, K. R. Mangalam University, Sohna Road, Gurugram- 122103, Haryana, India
| | - Neha Minocha
- School of Medical & Allied Sciences, K. R. Mangalam University, Sohna Road, Gurugram- 122103, Haryana, India
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A Systemic Review of Medical Cannabinoids Dosing in Human. Clin Ther 2022; 44:e39-e58. [DOI: 10.1016/j.clinthera.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/12/2022] [Accepted: 10/19/2022] [Indexed: 11/19/2022]
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Abstract
PURPOSE OF REVIEW There have been many debates, discussions, and published writings about the therapeutic value of cannabis plant and the hundreds of cannabinoids it contains. Many states and countries have attempted, are attempting, or have already passed bills to allow legal use of cannabinoids, especially cannabidiol (CBD), as medicines to treat a wide range of clinical conditions without having been approved by a regulatory body. Therefore, by using PubMed and Google Scholar databases, we have reviewed published papers during the past 30 years on cannabinoids as medicines and comment on whether there is sufficient clinical evidence from well-designed clinical studies and trials to support the use of CBD or any other cannabinoids as medicines. RECENT FINDINGS Current research shows that CBD and other cannabinoids currently are not ready for formal indications as medicines to treat a wide range of clinical conditions as promoted except for several exceptions including limited use of CBD for treating two rare forms of epilepsy in young children and CBD in combination with THC for treating multiple-sclerosis-associated spasticity. SUMMARY Research indicates that CBD and several other cannabinoids have potential to treat multiple clinical conditions, but more preclinical, and clinical studies and clinical trials, which follow regulatory guidelines, are needed to formally recommend CBD and other cannabinoids as medicines.
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Khalsa JH, Bunt G, Blum K, Maggirwar SB, Galanter M, Potenza MN. Review: Cannabinoids as Medicinals. CURRENT ADDICTION REPORTS 2022; 9:630-646. [PMID: 36093358 PMCID: PMC9449267 DOI: 10.1007/s40429-022-00438-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 12/04/2022]
Abstract
Purpose of review
There have been many debates, discussions, and published writings about the therapeutic value of cannabis plant and the hundreds of cannabinoids it contains. Many states and countries have attempted, are attempting, or have already passed bills to allow legal use of cannabinoids, especially cannabidiol (CBD), as medicines to treat a wide range of clinical conditions without having been approved by a regulatory body. Therefore, by using PubMed and Google Scholar databases, we have reviewed published papers during the past 30 years on cannabinoids as medicines and comment on whether there is sufficient clinical evidence from well-designed clinical studies and trials to support the use of CBD or any other cannabinoids as medicines. Recent findings Current research shows that CBD and other cannabinoids currently are not ready for formal indications as medicines to treat a wide range of clinical conditions as promoted except for several exceptions including limited use of CBD for treating two rare forms of epilepsy in young children and CBD in combination with THC for treating multiple-sclerosis-associated spasticity. Summary Research indicates that CBD and several other cannabinoids have potential to treat multiple clinical conditions, but more preclinical, and clinical studies and clinical trials, which follow regulatory guidelines, are needed to formally recommend CBD and other cannabinoids as medicines.
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Affiliation(s)
- Jag H. Khalsa
- Division of Therapeutics and Medical Consequences, Medical Consequences of Drug Abuse and Infections Branch, National Institute on Drug Abuse, NIH, Special Volunteer, 16071 Industrial Drive, Gaithersburg, MD 20877 USA
- Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University School of Medicine, Ross Hall Room 502A, 2300 I Street, Washington, NWDC 20037 USA
- Drug Addiction and Co-occurring Infections, Aldie, VA 20105-5572 USA
| | - Gregory Bunt
- Samaritan Day Top Village, NYU School of Medicine, 550 First Ave, New York, NY 10016 USA
| | - Kenneth Blum
- Center for Behavioral Health & Sports, Western University Health Sciences, Pomona, CA USA
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Division of Nutrigenomics, Precision Translational Medicine, LLC, San Antonio, TX USA
- Division of Nutrigenomics, Institute of Behavior & Neurogenetics, LLC, San Antonio, TX USA
- Department of Psychiatry, University of Vermont, Burlington, VT USA
- Department of Psychiatry, Wright University Boonshoff School of Medicine, Dayton, OH USA
| | - Sanjay B. Maggirwar
- Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University School of Medicine, Ross Hall Room 502A, 2300 I Street, Washington, NWDC 20037 USA
| | - Marc Galanter
- Department of Psychiatry, NYU School of Medicine, 550 First Avenue, Room NBV20N28, New York, NY 10016 USA
| | - Marc N. Potenza
- Departments of Psychiatry and Neuroscience and the Child Study Center, Yale School of Medicine, 1 Church Street, Rm726, New Haven, CT 06510 USA
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Paulus V, Billieux J, Benyamina A, Karila L. Cannabidiol in the context of substance use disorder treatment: A systematic review. Addict Behav 2022; 132:107360. [PMID: 35580370 DOI: 10.1016/j.addbeh.2022.107360] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/15/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Cannabidiol (CBD) is a phytocannabinoid found in the Cannabis plant. CBD has received significant medical attention in relation to its anticonvulsant, anxiolytic, and antipsychotic characteristics. An increasing number of studies focusing on the anti-addictive properties of CBD have recently been published. In this systematic review, we aim to offer a comprehensive overview of animal and human studies regarding the impact of CBD on substance use disorders (SUDs). METHODS A systematic search was performed on the PubMed database in February 2021. We included all articles assessing the effects of CBD on substance use disorders. RESULTS The current systematic review suggests that CBD might offer promising therapeutic potential for the treatment of SUD, based on available animal and human studies. Animal studies showed a positive impact of CBD in the context of alcohol, opioids, and methamphetamine use (e.g., diminishing of drug-seeking behaviors). The results for cocaine use were mixed among reviewed studies, and CBD was not found to have an effect in animal studies on cannabis use. No animal study was identified that focused on the impact of CBD on nicotine use. Human studies showed a positive impact of CBD in the context of nicotine, cannabis, and opioid use (e.g., frequency and quantity of consumption). In contrast, CBD was not found to have an effect in human studies on cocaine or alcohol use. No human study was identified that investigated the impact of CBD on methamphetamine use. CONCLUSIONS CBD might offer promising therapeutic potential for the treatment of SUD, especially for nicotine, cannabis, and opioid use disorders, based on available human studies. The available research evidence is, however, sparse and more research on humans is needed.
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Affiliation(s)
- Victoria Paulus
- Hôpital Universitaire Paul Brousse (AP-HP), UR PSYCOMADD, Université Paris-Saclay, Villejuif, France; Faculty of Medicine, AP-HP, Sorbonne Université, Paris, France
| | - Joël Billieux
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Amine Benyamina
- Hôpital Universitaire Paul Brousse (AP-HP), UR PSYCOMADD, Université Paris-Saclay, Villejuif, France
| | - Laurent Karila
- Hôpital Universitaire Paul Brousse (AP-HP), UR PSYCOMADD, Université Paris-Saclay, Villejuif, France.
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Suzuki J, Martin B, Prostko S, Chai PR, Weiss RD. Cannabidiol Effect on Cue-Induced Craving for Individuals with Opioid Use Disorder Treated with Buprenorphine: A Small Proof-of-Concept Open-Label Study. INTEGRATIVE MEDICINE REPORTS 2022; 1:157-163. [PMID: 36105269 PMCID: PMC9462449 DOI: 10.1089/imr.2022.0070] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 12/02/2022]
Abstract
Background: Opioid use disorder (OUD) remains a major public health concern. Despite the use of medications for OUD such as buprenorphine, the current gold-standard treatment, relapse in the context of increased craving remains common. Cannabidiol (CBD) has been shown to reduce cue-induced craving in individuals with OUD, but among those who were not receiving any buprenorphine treatment. This small proof-of-concept open-label study sought to evaluate the effect of CBD on cue-induced craving among individuals with OUD who were being actively treated with buprenorphine. Methods: Participants (n = 5) received CBD (Epidiolex®) 600 mg once daily for 3 consecutive days in an open-label manner. Primary outcome was cue-induced craving measured on a visual analog scale of 0 to 10, calculated as the difference in craving in response to drug-related versus neutral cues. The cue-reactivity paradigm was performed at baseline before CBD administration, and was repeated after 3 days of CBD. Secondary outcomes included scores on depression, anxiety, pain, opioid withdrawal, and side effects. Results: All participants were actively taking buprenorphine for an average of 37.8 months (range 1–120 months). Cue-induced craving was significantly lower after CBD dosing compared with baseline (0.4 vs. 3.2, paired t-test, p = 0.0046). No significant changes in scores for depression, anxiety, pain, or opioid withdrawal were noted. CBD was well tolerated, although one participant experienced moderate sedation; otherwise, no other adverse effects were reported. Conclusions: Given the high risk for bias in a small uncontrolled open label study such as this, results must be interpreted with caution. A larger adequately powered trial with a suitable control group is needed to confirm the finding that CBD may help to reduce cue-induced craving among individuals with OUD currently on buprenorphine treatment. Research should further evaluate whether adjunctive use of CBD can improve clinical outcomes for individuals with OUD maintained on buprenorphine. ClinicalTrials.gov (NCT04192370).
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Affiliation(s)
- Joji Suzuki
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Bianca Martin
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Sara Prostko
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter R. Chai
- Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- The Fenway Institute, Boston, MA, USA
| | - Roger D. Weiss
- Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
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Wall MB, Freeman TP, Hindocha C, Demetriou L, Ertl N, Freeman AM, Jones AP, Lawn W, Pope R, Mokrysz C, Solomons D, Statton B, Walker HR, Yamamori Y, Yang Z, Yim JL, Nutt DJ, Howes OD, Curran HV, Bloomfield MA. Individual and combined effects of cannabidiol and Δ 9-tetrahydrocannabinol on striato-cortical connectivity in the human brain. J Psychopharmacol 2022; 36:732-744. [PMID: 35596578 PMCID: PMC9150138 DOI: 10.1177/02698811221092506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) are the two major constituents of cannabis with contrasting mechanisms of action. THC is the major psychoactive, addiction-promoting, and psychotomimetic compound, while CBD may have opposite effects. The brain effects of these drugs alone and in combination are poorly understood. In particular, the striatum is implicated in the pathophysiology of several psychiatric disorders, but it is unclear how THC and CBD influence striato-cortical connectivity. AIMS To examine effects of THC, CBD, and THC + CBD on functional connectivity of striatal sub-divisions (associative, limbic and sensorimotor). METHOD Resting-state functional Magnetic Resonance Imaging (fMRI) was used across two within-subjects, placebo-controlled, double-blind studies, with a unified analysis approach. RESULTS Study 1 (N = 17; inhaled cannabis containing 8 mg THC, 8 mg THC + 10 mg CBD or placebo) showed strong disruptive effects of both THC and THC + CBD on connectivity in the associative and sensorimotor networks, but a specific effect of THC in the limbic striatum network which was not present in the THC + CBD condition. In Study 2 (N = 23, oral 600 mg CBD, placebo), CBD increased connectivity in the associative network, but produced only relatively minor disruptions in the limbic and sensorimotor networks. OUTCOMES THC strongly disrupts striato-cortical networks, but this effect is mitigated by co-administration of CBD in the limbic striatum network. Oral CBD administered has a more complex effect profile of relative increases and decreases in connectivity. The insula emerges as a key region affected by cannabinoid-induced changes in functional connectivity, with potential implications for understanding cannabis-related disorders, and the development of cannabinoid therapeutics.
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Affiliation(s)
- Matthew B Wall
- Invicro London, London, UK.,Clinical Psychopharmacology Unit, University College London, London, UK.,Faculty of Medicine, Imperial College London, London, UK
| | - Tom P Freeman
- Clinical Psychopharmacology Unit, University College London, London, UK.,Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Chandni Hindocha
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Lysia Demetriou
- Invicro London, London, UK.,Faculty of Medicine, Imperial College London, London, UK.,Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Natalie Ertl
- Invicro London, London, UK.,Faculty of Medicine, Imperial College London, London, UK
| | - Abigail M Freeman
- Clinical Psychopharmacology Unit, University College London, London, UK
| | | | - Will Lawn
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Rebecca Pope
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Claire Mokrysz
- Clinical Psychopharmacology Unit, University College London, London, UK
| | | | - Ben Statton
- MRC London Institute of Medical Sciences, London, UK
| | - Hannah R Walker
- Division of Psychiatry, University College London, London, UK
| | - Yumeya Yamamori
- Division of Psychiatry, University College London, London, UK
| | - Zixu Yang
- Faculty of Medicine, Imperial College London, London, UK
| | - Jocelyn Ll Yim
- Division of Psychiatry, University College London, London, UK
| | - David J Nutt
- Faculty of Medicine, Imperial College London, London, UK
| | - Oliver D Howes
- MRC London Institute of Medical Sciences, London, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, University College London, London, UK
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Cannabidiol effects on cognition in individuals with cocaine use disorder: Exploratory results from a randomized controlled trial. Pharmacol Biochem Behav 2022; 216:173376. [DOI: 10.1016/j.pbb.2022.173376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/16/2022] [Accepted: 03/25/2022] [Indexed: 11/22/2022]
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Alegre-Zurano L, Berbegal-Sáez P, Luján MÁ, Cantacorps L, Martín-Sánchez A, García-Baos A, Valverde O. Cannabidiol decreases motivation for cocaine in a behavioral economics paradigm but does not prevent incubation of craving in mice. Biomed Pharmacother 2022; 148:112708. [DOI: 10.1016/j.biopha.2022.112708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 11/26/2022] Open
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Navarrete F, Gasparyan A, Manzanares J. CBD-mediated regulation of heroin withdrawal-induced behavioural and molecular changes in mice. Addict Biol 2022; 27:e13150. [PMID: 35229949 DOI: 10.1111/adb.13150] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/12/2021] [Accepted: 01/11/2022] [Indexed: 11/25/2022]
Abstract
Cannabidiol (CBD) may represent a promising therapeutic tool for treating opioid use disorder (OUD). This study was aimed to evaluate the effects of CBD on the behavioural and gene expression alterations induced by spontaneous heroin withdrawal. Thirty hours after cessation of 8-day heroin treatment (5, 10, 20 and 40 mg·kg-1 /12 h; s.c.), spontaneous heroin withdrawal was evaluated in CD1 male mice. The effects of CBD (5, 10 and 20 mg·kg-1 ; i.p.) on withdrawal-related behaviour were evaluated by measuring anxiety-like behaviour, motor activity and somatic signs. Furthermore, gene expression changes of mu-opioid receptor (Oprm1), proopiomelanocortin (Pomc), cannabinoid CB1 (Cnr1) and CB2 (Cnr2) receptors in the nucleus accumbens (NAcc) and tyrosine hydroxylase (TH) and Pomc in the ventral tegmental area (VTA) were also evaluated by real-time PCR. Anxiety-like behaviour, motor activity and withdrawal-related somatic signs were significantly increased in heroin-treated mice compared to the control group. Interestingly, CBD treatment significantly reduced these behavioural impairments and normalized gene expression of Cnr1 and Pomc in the NAcc and TH in the VTA of mice exposed to spontaneous heroin withdrawal. Also, CBD induced an up-regulation of Cnr2, whereas it did not change the increased gene expression of Oprm1 in the NAcc of abstinent animals. The results suggest that CBD alleviates spontaneous heroin withdrawal and normalizes the associated gene expression changes. Future studies are needed to determine the relevance of CBD as a potential therapeutic tool for the treatment of heroin withdrawal.
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Affiliation(s)
- Francisco Navarrete
- Instituto de Neurociencias Universidad Miguel Hernández‐CSIC Avda. de Ramón y Cajal s/n, San Juan de Alicante Alicante Spain
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER Madrid Spain
- Departamento de Medicina Clínica Universidad Miguel Hernández, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL) Alicante España
| | - Ani Gasparyan
- Instituto de Neurociencias Universidad Miguel Hernández‐CSIC Avda. de Ramón y Cajal s/n, San Juan de Alicante Alicante Spain
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER Madrid Spain
- Departamento de Medicina Clínica Universidad Miguel Hernández, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL) Alicante España
| | - Jorge Manzanares
- Instituto de Neurociencias Universidad Miguel Hernández‐CSIC Avda. de Ramón y Cajal s/n, San Juan de Alicante Alicante Spain
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER Madrid Spain
- Departamento de Medicina Clínica Universidad Miguel Hernández, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL) Alicante España
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Kirkland AE, Fadus MC, Gruber SA, Gray KM, Wilens TE, Squeglia LM. A scoping review of the use of cannabidiol in psychiatric disorders. Psychiatry Res 2022; 308:114347. [PMID: 34952255 PMCID: PMC8799523 DOI: 10.1016/j.psychres.2021.114347] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 02/08/2023]
Abstract
Cannabidiol (CBD) has become a fast-growing avenue for research in psychiatry, and clinicians are challenged with understanding the implications of CBD for treating mental health disorders. The goal of this review is to serve as a guide for mental health professionals by providing an overview of CBD and a synthesis the current evidence within major psychiatric disorders. PubMed and PsycINFO were searched for articles containing the terms "cannabidiol" in addition to major psychiatric disorders and symptoms, yielding 2952 articles. Only randomized controlled trials or within-subject studies investigating CBD as a treatment option for psychiatric disorders (N = 16) were included in the review. Studies were reviewed for psychotic disorders (n = 6), anxiety disorders (n = 3), substance use disorders (tobacco n = 3, cannabis n = 2, opioid n = 1), and insomnia (n = 1). There were no published studies that met inclusion criteria for alcohol or stimulant use disorder, PTSD, ADHD, autism spectrum disorder, or mood disorders. Synthesis of the CBD literature indicates it is generally safe and well tolerated. The most promising preliminary findings are related to the use of CBD in psychotic symptoms and anxiety. There is currently not enough high-quality evidence to suggest the clinical use of CBD for any psychiatric disorder.
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Affiliation(s)
- Anna E Kirkland
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.
| | - Matthew C Fadus
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Staci A Gruber
- Cognitive and Clinical Neuroimaging Core, Marijuana Investigations for Neuroscientific Discovery (MIND) Program, McLean Hospital, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Timothy E Wilens
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Center for Addiction Medicine Co-Director, Massachusetts General Hospital, Boston, MA, United States
| | - Lindsay M Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
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Karimi-Haghighi S, Razavi Y, Iezzi D, Scheyer AF, Manzoni O, Haghparast A. Cannabidiol and substance use disorder: Dream or reality. Neuropharmacology 2022; 207:108948. [PMID: 35032495 PMCID: PMC9157244 DOI: 10.1016/j.neuropharm.2022.108948] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cannabidiol (CBD) is one of the major constituents of Cannabis sativa L. that lacks psychotomimetic and rewarding properties and inhibits the rewarding and reinforcing effects of addictive drugs such as cocaine, methamphetamine (METH), and morphine. Additionally, CBD's safety profile and therapeutic potential are currently evaluated in several medical conditions, including pain, depression, movement disorders, epilepsy, multiple sclerosis, Alzheimer's disease, ischemia, and substance use disorder. There is no effective treatment for substance use disorders such as addiction, and this review aims to describe preclinical and clinical investigations into the effects of CBD in various models of opioid, psychostimulant, cannabis, alcohol, and nicotine abuse. Furthermore, the possible mechanisms underlying the therapeutic potential of CBD on drug abuse disorders are reviewed. METHODS The current review considers and summarizes the preclinical and clinical investigations into CBD's effects in various models of drug abuse include opioids, psychostimulants, cannabis, alcohol, and nicotine. RESULTS Several preclinical and clinical studies have proposed that CBD may be a reliable agent to inhibit the reinforcing and rewarding impact of drugs. CONCLUSIONS While the currently available evidence converges to suggest that CBD could effectively reduce the rewarding and reinforcing effects of addictive drugs, more preclinical and clinical studies are needed before CBD can be added to the therapeutic arsenal for treating addiction.
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Affiliation(s)
- Saeideh Karimi-Haghighi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Neuroscience Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yasaman Razavi
- Neuroscience Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Daniela Iezzi
- INMED, INSERM U1249, Marseille, France; Aix-Marseille University, Marseille, France
| | - Andrew F Scheyer
- INMED, INSERM U1249, Marseille, France; Aix-Marseille University, Marseille, France
| | - Olivier Manzoni
- INMED, INSERM U1249, Marseille, France; Aix-Marseille University, Marseille, France
| | - Abbas Haghparast
- Neuroscience Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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The acute effects of cannabidiol on emotional processing and anxiety: a neurocognitive imaging study. Psychopharmacology (Berl) 2022; 239:1539-1549. [PMID: 35445839 PMCID: PMC9110481 DOI: 10.1007/s00213-022-06070-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 01/21/2022] [Indexed: 11/10/2022]
Abstract
RATIONALE There is growing interest in the therapeutic potential of cannabidiol (CBD) across a range of psychiatric disorders. CBD has been found to reduce anxiety during experimentally induced stress in anxious individuals and healthy controls. However, the mechanisms underlying the putative anxiolytic effects of CBD are unknown. OBJECTIVES We sought to investigate the behavioural and neural effects of a single dose of CBD vs. placebo on a range of emotion-related measures to test cognitive-mechanistic models of its effects on anxiety. METHODS We conducted a randomised, double-blind, placebo-controlled, crossover, acute oral challenge of 600 mg of CBD in 24 healthy participants on emotional processing, with neuroimaging (viewing emotional faces during functional magnetic resonance imaging) and cognitive (emotional appraisal) measures as well as subjective response to experimentally induced anxiety. RESULTS CBD did not produce effects on brain responses to emotional faces and cognitive measures of emotional processing, or modulate experimentally induced anxiety, relative to placebo. CONCLUSIONS Given the rising popularity of CBD for its putative medical benefits, these findings question whether further research is warranted to investigate the clinical potential of CBD for the treatment of anxiety disorders.
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Fischer B, Robinson T, Bullen C, Curran V, Jutras-Aswad D, Medina-Mora ME, Pacula RL, Rehm J, Room R, van den Brink W, Hall W. Lower-Risk Cannabis Use Guidelines (LRCUG) for reducing health harms from non-medical cannabis use: A comprehensive evidence and recommendations update. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 99:103381. [PMID: 34465496 DOI: 10.1016/j.drugpo.2021.103381] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cannabis use is common, especially among young people, and is associated with risks for various health harms. Some jurisdictions have recently moved to legalization/regulation pursuing public health goals. Evidence-based 'Lower Risk Cannabis Use Guidelines' (LRCUG) and recommendations were previously developed to reduce modifiable risk factors of cannabis-related adverse health outcomes; related evidence has evolved substantially since. We aimed to review new scientific evidence and to develop comprehensively up-to-date LRCUG, including their recommendations, on this evidence basis. METHODS Targeted searches for literature (since 2016) on main risk factors for cannabis-related adverse health outcomes modifiable by the user-individual were conducted. Topical areas were informed by previous LRCUG content and expanded upon current evidence. Searches preferentially focused on systematic reviews, supplemented by key individual studies. The review results were evidence-graded, topically organized and narratively summarized; recommendations were developed through an iterative scientific expert consensus development process. RESULTS A substantial body of modifiable risk factors for cannabis use-related health harms were identified with varying evidence quality. Twelve substantive recommendation clusters and three precautionary statements were developed. In general, current evidence suggests that individuals can substantially reduce their risk for adverse health outcomes if they delay the onset of cannabis use until after adolescence, avoid the use of high-potency (THC) cannabis products and high-frequency/-intensity of use, and refrain from smoking-routes for administration. While young people are particularly vulnerable to cannabis-related harms, other sub-groups (e.g., pregnant women, drivers, older adults, those with co-morbidities) are advised to exercise particular caution with use-related risks. Legal/regulated cannabis products should be used where possible. CONCLUSIONS Cannabis use can result in adverse health outcomes, mostly among sub-groups with higher-risk use. Reducing the risk factors identified can help to reduce health harms from use. The LRCUG offer one targeted intervention component within a comprehensive public health approach for cannabis use. They require effective audience-tailoring and dissemination, regular updating as new evidence become available, and should be evaluated for their impact.
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Affiliation(s)
- Benedikt Fischer
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada; Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Tessa Robinson
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Chris Bullen
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; National Institute for Health Innovation (NIHI), The University of Auckland, Auckland, New Zealand
| | - Valerie Curran
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada; Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Maria Elena Medina-Mora
- Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico; Department of Psychiatry and Mental Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rosalie Liccardo Pacula
- Schaeffer Center for Health Policy and Economics, Sol Price School of Public Policy, University of Southern California, Los Angeles, United States
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction & Mental Health, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia; Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Wim van den Brink
- Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Wayne Hall
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, QLD 4072, Australia; National Addiction Centre, Institute of Psychiatry, Kings College London, United Kingdom
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Saravia R, Ten-Blanco M, Pereda-Pérez I, Berrendero F. New Insights in the Involvement of the Endocannabinoid System and Natural Cannabinoids in Nicotine Dependence. Int J Mol Sci 2021; 22:13316. [PMID: 34948106 PMCID: PMC8715672 DOI: 10.3390/ijms222413316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 12/14/2022] Open
Abstract
Nicotine, the main psychoactive component in tobacco smoke, plays a major role in tobacco addiction, producing a high morbidity and mortality in the world. A great amount of research has been developed to elucidate the neural pathways and neurotransmitter systems involved in such a complex addictive behavior. The endocannabinoid system, which has been reported to participate in the addictive properties of most of the prototypical drugs of abuse, is also implicated in nicotine dependence. This review summarizes and updates the main behavioral and biochemical data involving the endocannabinoid system in the rewarding properties of nicotine as well as in nicotine withdrawal and relapse to nicotine-seeking behavior. Promising results from preclinical studies suggest that manipulation of the endocannabinoid system could be a potential therapeutic strategy for treating nicotine addiction.
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Affiliation(s)
- Rocio Saravia
- Laboratory of Neuropharmacology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra, PRBB, 08003 Barcelona, Spain;
| | - Marc Ten-Blanco
- Faculty of Experimental Sciences, Universidad Francisco de Vitoria, UFV, Pozuelo de Alarcón, 28223 Madrid, Spain; (M.T.-B.); (I.P.-P.)
| | - Inmaculada Pereda-Pérez
- Faculty of Experimental Sciences, Universidad Francisco de Vitoria, UFV, Pozuelo de Alarcón, 28223 Madrid, Spain; (M.T.-B.); (I.P.-P.)
| | - Fernando Berrendero
- Faculty of Experimental Sciences, Universidad Francisco de Vitoria, UFV, Pozuelo de Alarcón, 28223 Madrid, Spain; (M.T.-B.); (I.P.-P.)
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Cannabis/Cannabinoids for Treating COVID-19 Associated Neuropsychiatric Complications. J Neuroimmune Pharmacol 2021; 16:718-721. [PMID: 34655372 PMCID: PMC8520083 DOI: 10.1007/s11481-021-10013-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/19/2021] [Indexed: 10/31/2022]
Abstract
COVID-19 epidemic has resulted in devastating mortality and morbidity consisting of socioeconomic and health effects that have included respiratory/pulmonary, cardiovascular, mental health and neurological consequences such as anxiety, depression, and substance use. Several effective vaccines have been developed and extensive efforts are underway to develop therapeutics to treat COVID-19. Cannabis and/or its product-cannabidiol (CBD) are being advertised for the treatment of COVID-19 associated mental/neurological complications and substance use disorders. However, research reviewed shows that there is insufficient data from clinical studies to support the use of cannabis or CBD for the treatment of COVID-19 associated mental health and neurological complications. Additional basic and clinical research is suggested to develop cannabis or cannabidiol for the treatment of mental health problems associated with coronavirus infection and or substance use disorders. In the meantime, it is important that the addiction physician/psychiatrist must caution while prescribing or recommending cannabis or CBD for treating such clinical indications. Research shows that currently there is no clinical evidence to support the use of cannabis or any of its compounds including CBD for treating any of the neuropsychiatric complications of COVID-19. Thus, it is important that the addiction physicians/psychiatrists caution their patients from using cannabis or cannabis products for treating any such complications.
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Fowler C. The Use of Marijuana Derivatives in Primary Care: An Evidence-Based Approach to Cannabidiol. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mongeau‐Pérusse V, Brissette S, Bruneau J, Conrod P, Dubreucq S, Gazil G, Stip E, Jutras‐Aswad D. Cannabidiol as a treatment for craving and relapse in individuals with cocaine use disorder: a randomized placebo-controlled trial. Addiction 2021; 116:2431-2442. [PMID: 33464660 PMCID: PMC8451934 DOI: 10.1111/add.15417] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/26/2020] [Accepted: 01/06/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Cocaine use disorder (CUD) is a significant public health concern for which no efficacious pharmacological interventions are available. Cannabidiol (CBD) has attracted considerable interest as a promising treatment for addiction. This study tested CBD efficacy for reducing craving and preventing relapse in people with CUD. DESIGN Single-site double-blind randomized controlled superiority trial comparing CBD with placebo. SETTING AND PARTICIPANTS Centre Hospitalier de l'Université de Montréal, Canada. Seventy-eight adults (14 women) with moderate to severe CUD participated. INTERVENTION Participants were randomly assigned (1 : 1) by stratified blocks to daily 800 mg CBD (n = 40) or placebo (n = 38). They first underwent an inpatient detoxification phase lasting 10 days. Those who completed this phase entered a 12-week outpatient follow-up. MEASUREMENTS Primary outcomes were drug-cue-induced craving during detoxication and time-to-cocaine relapse during subsequent outpatient treatment. FINDINGS During drug-cue exposure, craving scores [mean ± standard deviation (SD)] increased from baseline by 4.69 (2.89) versus 3.21 (2.78) points, respectively, in CBD (n = 36) and placebo (n = 28) participants [confidence interval (CI) = -0.33 to 3.04; P = 0.069; Bayes factor = 0.498]. All but three participants relapsed to cocaine by week 12 with similar risk for CBD (n = 34) and placebo (n = 27) participants (hazard ratio = 1.20, CI = 0.65-2.20, P = 0.51; Bayes factor = 0.152). CBD treatment was well tolerated and associated mainly with diarrhoea. CONCLUSIONS CBD did not reduce cocaine craving or relapse among people being treated for CUD.
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Affiliation(s)
- Violaine Mongeau‐Pérusse
- Research CenterCentre Hospitalier de l'Université de Montréal (CRCHUM)MontréalQCCanada,Department of Psychiatry and Addiction, Faculty of MedicineUniversité de MontréalMontréalQCCanada
| | - Suzanne Brissette
- Research CenterCentre Hospitalier de l'Université de Montréal (CRCHUM)MontréalQCCanada,Department of Family and Emergency Medicine, Faculty of MedicineUniversité de MontréalMontréalQCCanada
| | - Julie Bruneau
- Research CenterCentre Hospitalier de l'Université de Montréal (CRCHUM)MontréalQCCanada,Department of Family and Emergency Medicine, Faculty of MedicineUniversité de MontréalMontréalQCCanada
| | - Patricia Conrod
- Department of Psychiatry and Addiction, Faculty of MedicineUniversité de MontréalMontréalQCCanada,Research CenterCentre Hospitalier Universitaire (CHU) Sainte‐JustineMontréalQCCanada
| | - Simon Dubreucq
- Research CenterCentre Hospitalier de l'Université de Montréal (CRCHUM)MontréalQCCanada,Department of Psychiatry and Addiction, Faculty of MedicineUniversité de MontréalMontréalQCCanada
| | - Guillaume Gazil
- Unité de recherche clinique appliquée (URCA)Research Center, CHU Sainte‐JustineMontrealQCCanada
| | - Emmanuel Stip
- Research CenterCentre Hospitalier de l'Université de Montréal (CRCHUM)MontréalQCCanada,Department of Psychiatry and Addiction, Faculty of MedicineUniversité de MontréalMontréalQCCanada,Department of Psychiatry and Behavioral Science, College of Medicine and Health ScienceUnited Arab Emirates UniversityAl AinAbu DhabiUnited Arab Emirates
| | - Didier Jutras‐Aswad
- Research CenterCentre Hospitalier de l'Université de Montréal (CRCHUM)MontréalQCCanada,Department of Psychiatry and Addiction, Faculty of MedicineUniversité de MontréalMontréalQCCanada,University Institute on AddictionsMontrealQCCanada
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Smith LC, Tieu L, Suhandynata RT, Boomhower B, Hoffman M, Sepulveda Y, Carrette LLG, Momper JD, Fitzgerald RL, Hanham K, Dowling J, Kallupi M, George O. Cannabidiol reduces withdrawal symptoms in nicotine-dependent rats. Psychopharmacology (Berl) 2021; 238:2201-2211. [PMID: 33909102 PMCID: PMC8295227 DOI: 10.1007/s00213-021-05845-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
RATIONALE Cannabidiol (CBD) reduces craving in animal models of alcohol and cocaine use and is known to modulate nicotinic receptor function, suggesting that it may alleviate symptoms of nicotine withdrawal. However, preclinical evaluation of its efficacy is still lacking. OBJECTIVES The goal of this study was to test the preclinical efficacy of a chronic CBD treatment in reducing nicotine dependence using measures of withdrawal symptoms including somatic signs, hyperalgesia, and weight gain during acute and protracted abstinence. METHODS Male and female Wistar rats were made dependent on nicotine using osmotic minipumps (3.15 mg/kg/day) for 2 weeks, after which minipumps were removed to induce spontaneous withdrawal. Three groups received CBD injections at doses of 7.5, 15, and 30 mg/kg/day for 2 weeks, starting 1 week into chronic nicotine infusion. The control groups included rats with nicotine minipumps that received vehicle injections of sesame oil instead of CBD; rats implanted with saline minipumps received sesame oil injections (double vehicle) or the highest dose of CBD 30 mg/kg/day. Throughout the experiment, serum was collected for determination of CBD and nicotine concentrations, mechanical sensitivity threshold and withdrawal scores were measured, and body weight was recorded. RESULTS CBD prevented rats from exhibiting somatic signs of withdrawal and hyperalgesia during acute and protracted abstinence. There was no dose-response observed for CBD, suggesting a ceiling effect at the doses used and the potential for lower effective doses of CBD. The saline minipump group did not show either somatic signs of withdrawal or hyperalgesia during acute and protracted abstinence, and the highest dose of CBD used (30 mg/kg/day) did not alter these results. CONCLUSIONS This preclinical study suggests that using CBD as a strategy to alleviate the withdrawal symptoms upon nicotine cessation may be beneficial.
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Affiliation(s)
- Lauren C Smith
- Department of Neuroscience, The Scripps Research Institute, 10550 N. Torrey Pines Rd., La Jolla, CA, 92037, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA,, 92093, USA
| | - Lani Tieu
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA,, 92093, USA
| | - Raymond T Suhandynata
- Department of Pathology, University of California, San Diego School of Medicine, San Diego, CA, 92093, USA
| | - Brent Boomhower
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA,, 92093, USA
| | - Melissa Hoffman
- Department of Pathology, University of California, San Diego School of Medicine, San Diego, CA, 92093, USA
| | - Yadira Sepulveda
- Division of Pharmaceutical Sciences, University of California, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, 92093, USA
| | - Lieselot L G Carrette
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA,, 92093, USA
| | - Jeremiah D Momper
- Division of Pharmaceutical Sciences, University of California, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, 92093, USA
| | - Robert L Fitzgerald
- Department of Pathology, University of California, San Diego School of Medicine, San Diego, CA, 92093, USA
| | - Kate Hanham
- CV Sciences, Inc., 10070 Barnes Canyon Road, San Diego, CA, 92121, USA
| | - Joseph Dowling
- CV Sciences, Inc., 10070 Barnes Canyon Road, San Diego, CA, 92121, USA
| | - Marsida Kallupi
- Department of Neuroscience, The Scripps Research Institute, 10550 N. Torrey Pines Rd., La Jolla, CA, 92037, USA.
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA,, 92093, USA.
| | - Olivier George
- Department of Neuroscience, The Scripps Research Institute, 10550 N. Torrey Pines Rd., La Jolla, CA, 92037, USA.
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA,, 92093, USA.
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Navarrete F, García-Gutiérrez MS, Gasparyan A, Austrich-Olivares A, Manzanares J. Role of Cannabidiol in the Therapeutic Intervention for Substance Use Disorders. Front Pharmacol 2021; 12:626010. [PMID: 34093179 PMCID: PMC8173061 DOI: 10.3389/fphar.2021.626010] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/04/2021] [Indexed: 01/04/2023] Open
Abstract
Drug treatments available for the management of substance use disorders (SUD) present multiple limitations in efficacy, lack of approved treatments or alarming relapse rates. These facts hamper the clinical outcome and the quality of life of the patients supporting the importance to develop new pharmacological agents. Lately, several reports suggest that cannabidiol (CBD) presents beneficial effects relevant for the management of neurological disorders such as epilepsy, multiple sclerosis, Parkinson's, or Alzheimer's diseases. Furthermore, there is a large body of evidence pointing out that CBD improves cognition, neurogenesis and presents anxiolytic, antidepressant, antipsychotic, and neuroprotective effects suggesting potential usefulness for the treatment of neuropsychiatric diseases and SUD. Here we review preclinical and clinical reports regarding the effects of CBD on the regulation of the reinforcing, motivational and withdrawal-related effects of different drugs of abuse such as alcohol, opioids (morphine, heroin), cannabinoids, nicotine, and psychostimulants (cocaine, amphetamine). Furthermore, a special section of the review is focused on the neurobiological mechanisms that might be underlying the 'anti-addictive' action of CBD through the regulation of dopaminergic, opioidergic, serotonergic, and endocannabinoid systems as well as hippocampal neurogenesis. The multimodal pharmacological profile described for CBD and the specific regulation of addictive behavior-related targets explains, at least in part, its therapeutic effects on the regulation of the reinforcing and motivational properties of different drugs of abuse. Moreover, the remarkable safety profile of CBD, its lack of reinforcing properties and the existence of approved medications containing this compound (Sativex®, Epidiolex®) increased the number of studies suggesting the potential of CBD as a therapeutic intervention for SUD. The rising number of publications with substantial results on the valuable therapeutic innovation of CBD for treating SUD, the undeniable need of new therapeutic agents to improve the clinical outcome of patients with SUD, and the upcoming clinical trials involving CBD endorse the relevance of this review.
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Affiliation(s)
- Francisco Navarrete
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain
- Red Temática de Investigación Cooperativa en Salud (RETICS), Red de Trastornos Adictivos, Instituto de Salud Carlos III, MICINN and FEDER, Madrid, Spain
| | - María Salud García-Gutiérrez
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain
- Red Temática de Investigación Cooperativa en Salud (RETICS), Red de Trastornos Adictivos, Instituto de Salud Carlos III, MICINN and FEDER, Madrid, Spain
| | - Ani Gasparyan
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain
- Red Temática de Investigación Cooperativa en Salud (RETICS), Red de Trastornos Adictivos, Instituto de Salud Carlos III, MICINN and FEDER, Madrid, Spain
| | | | - Jorge Manzanares
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain
- Red Temática de Investigación Cooperativa en Salud (RETICS), Red de Trastornos Adictivos, Instituto de Salud Carlos III, MICINN and FEDER, Madrid, Spain
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Lucas P, Walsh Z, Hendricks PS, Boyd S, Milloy MJ. Self-reported reductions in tobacco and nicotine use following medical cannabis initiation: Results from a cross-sectional survey of authorized medical cannabis patients in Canada. J Subst Abuse Treat 2021; 130:108481. [PMID: 34118713 DOI: 10.1016/j.jsat.2021.108481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/18/2021] [Accepted: 05/11/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Despite decades of campaigns aimed at reducing tobacco/nicotine (T/N) use and the development of many different T/N reduction and cessation strategies, the impacts on international public health remain significant. Some studies have found an association between medical and non-medical cannabis use and T/N use, although the evidence on whether cannabis/cannabinoids increase or decrease the odds of reducing or ceasing T/N use remain contradictory. This paper explores the self-reported use of cannabis and associated changes in T/N use among a Canadian medical cannabis patient population. METHODS This study examines the impact of medical cannabis on T/N use by comparing self-reported patterns of use before and after the initiation of medical cannabis. Participants completed an online cross-sectional survey examining demographics, patterns of medical cannabis use, and the impact of medical cannabis on the use of T/N and other substances. The survey also included novel measures examining whether patients intended to use medical cannabis to reduce T/N use or had experience with other pharmacological or psychobehavioral T/N cessation strategies. We conducted a series of descriptive analyses and univariate and multivariate logistic regressions to explore the potential association between primary variables of interest and T/N reduction and cessation. RESULTS In total, the study recruited 2102 individuals, of whom 650 were current or former T/N users. Following initiation of medical cannabis use 320 (49%) T/N users self-reported reductions in use, with 160 (24.6%) reporting no T/N use in the 30 days prior to the survey. Odds of T/N cessation were greater among those who were age 55 or older (Adjusted Odds Ratio [AOR] = 2.56, 95% Confidence Interval [CI] 1.53-4.26), or those who reported >25 T/N uses per day in the pre-period (AOR = 2.11, 95% CI 1.14-3.92). Specific intent to use medical cannabis to quit resulted in significantly greater odds of reducing T/N use (AOR = 2.79, 95% CI 1.49-5.22); however, involvement with traditional T/N cessation treatments (pharmacological or psychobehavioral) was negatively associated with T/N cessation (AOR 0.39, 95% CI 0.18-0.86). CONCLUSIONS Results from this retrospective survey of medical cannabis users suggest that initiation of medical cannabis use was associated with self-reported reductions and/or cessation of T/N use in nearly half of study participants. In light of the significant morbidity, mortality, and health care costs related to T/N dependence, future research should further evaluate the potential of cannabis-based treatments to support efforts to reduce or cease T/N use.
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Affiliation(s)
- Philippe Lucas
- Social Dimensions of Health, University of Victoria, 3800 Finnerty Rd., Victoria, BC V8P 5C2, Canada; Canadian Institute for Substance Use Research, 2300 McKenzie Ave., Victoria, BC V8N 5M8, Canada; Tilray, 1100 Maughan Rd., Nanaimo, BC V9X 1J2, Canada.
| | - Zach Walsh
- Department of Psychology, University of British Columbia, Okanagan, 3333 University Way, Kelowna, BC V1V 1V7, Canada; Centre for the Advancement of Psychological Science and Law, University of British Columbia, Okanagan, 3333 University Way, Kelowna, BC V1V 1V7, Canada.
| | - Peter S Hendricks
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, 227L Ryals Public Health Building, 1665 University Blvd., Birmingham, AL 35294, USA.
| | - Susan Boyd
- Faculty of Human and Social Development, School of Public Health and Social Policy, University of Victoria, 3800 Finnerty Rd., Victoria, BC V8P 5C2, Canada.
| | - M-J Milloy
- Faculty of Medicine, University of British Columbia, St. Paul's Hospital 806-1081, Burrard St., Vancouver, BC, Canada; British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC V6Z 2A9, Canada.
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Laksmidewi AAAP, Soejitno A. Endocannabinoid and dopaminergic system: the pas de deux underlying human motivation and behaviors. J Neural Transm (Vienna) 2021; 128:615-630. [PMID: 33712975 PMCID: PMC8105194 DOI: 10.1007/s00702-021-02326-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 03/04/2021] [Indexed: 01/11/2023]
Abstract
Endocannabinoid system (ECS) has been identified ever since cannabinoid, an active substance of Cannabis, was known to interact with endogenous cannabinoid (endocannabinoid/eCB) receptors. It later turned out that eCB was more intricate than previously thought. It has a pervasive role and exerts a multitude of cellular signaling mechanisms, regulating various physiological neurotransmission pathways in the human brain, including the dopaminergic (DA) system. eCB roles toward DA system were robust, clearly delineated, and reproducible with respect to physiological as well as pathological neurochemical and neurobehavioral manifestations of DA system, particularly those involving the nigrostriatal and mesocorticolimbic pathways. The eCB–DA system regulates the basics in the Maslow’s pyramid of hierarchy of needs required for individual survival such as food and sexual activity for reproductive purpose to those of higher needs in the pyramid, including self-actualization behaviors leading to achievement and reward (e.g., academic- and/or work-related performance and achievements). It is, thus, interesting to specifically discuss the eCB–DA system, not only on the molecular level, but also its tremendous potential to be developed as a future therapeutic strategy for various neuropsychiatric problems, including obesity, drug addiction and withdrawal, pathological hypersexuality, or low motivation behaviors.
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Affiliation(s)
- A A A Putri Laksmidewi
- Neurobehavioral and Cognitive Division, Neurology Department, Faculty of Medicine, Udayana University/Sanglah Hospital, Denpasar, Bali, Indonesia.
| | - Andreas Soejitno
- Neurobehavioral and Cognitive Division, Neurology Department, Faculty of Medicine, Udayana University/Sanglah Hospital, Denpasar, Bali, Indonesia
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Moltke J, Hindocha C. Reasons for cannabidiol use: a cross-sectional study of CBD users, focusing on self-perceived stress, anxiety, and sleep problems. J Cannabis Res 2021; 3:5. [PMID: 33602344 PMCID: PMC7893882 DOI: 10.1186/s42238-021-00061-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 02/08/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Public and medical interest in cannabidiol (CBD) has been rising, and CBD is now available from various sources. Research into the effects of low-dose CBD on outcomes like stress, anxiety, and sleep problems have been scarce, so we conducted an online survey of CBD users to better understand patterns of use, dose, and self-perceived effects of CBD. METHODS The sample consisted of 387 current or past-CBD users who answered a 20-question online survey. The survey was sent out to CBD users through email databases and social media. Participants reported basic demographics, CBD use patterns, reasons for use, and effects on anxiety, sleep, and stress. RESULTS The sample (N = 387) consisted of 61.2% females, mostly between 25 and 54 years old (72.2%) and primarily based in the UK (77.4%). The top 4 reasons for using CBD were self-perceived anxiety (42.6%), sleep problems (42.5%), stress (37%), and general health and wellbeing (37%). Fifty-four per cent reported using less than 50 mg CBD daily, and 72.6% used CBD sublingually. Adjusted logistic models show females had lower odds than males of using CBD for general health and wellbeing [OR 0.45, 95% CI 0.30-0.72] and post-workout muscle-soreness [OR 0.46, 95%CI 0.24-0.91] but had higher odds of using CBD for self-perceived anxiety [OR 1.60, 95% CI 0.02-2.49] and insomnia [OR 1.87, 95% CI 1.13-3.11]. Older individuals had lower odds of using CBD for general health and wellbeing, stress, post-workout sore muscles, anxiety, skin conditions, focusing, and sleep but had higher odds of using CBD for pain. Respondents reported that CBD use was effective for stress, sleep problems, and anxiety in those who used the drug for those conditions. CONCLUSION This survey indicated that CBD users take the drug to manage self-perceived anxiety, stress, sleep, and other symptoms, often in low doses, and these patterns vary by demographic characteristics. Further research is required to understand how low doses, representative of the general user, might impact mental health symptoms like stress, anxiety, and sleep problems.
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Affiliation(s)
- Julie Moltke
- Clinic Horsted, Chronic Pain Clinic, Farvegade 2, 1463, Copenhagen, Denmark.
| | - Chandni Hindocha
- Clinical Psychopharmacology Unit, Department of Clinical, Educational & Health Psychology, University College London, London, UK
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
- University College Hospital National Institute of Health Research (NIHR) Biomedical Research Centre, London, UK
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Anooshe M, Nouri K, Karimi-Haghighi S, Mousavi Z, Haghparast A. Cannabidiol efficiently suppressed the acquisition and expression of methamphetamine-induced conditioned place preference in the rat. Behav Brain Res 2021; 404:113158. [PMID: 33571569 DOI: 10.1016/j.bbr.2021.113158] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/26/2021] [Accepted: 01/31/2021] [Indexed: 12/14/2022]
Abstract
Methamphetamine (MET) is one of the most prevalently abused psychostimulants in the world with drastic repercussions. Several studies emphasized the inhibitory effect of Cannabidiol (CBD) on the reward properties of psychostimulants. The current investigation utilized conditioned place preference (CPP) to assay CBD's impact on MET's reward characteristic, including acquisition and expression phases of MET-induced CPP. Like our prior researches, animals received MET (1 mg/kg; sc) in a five-day schedule to induce CPP. The rats were given intracerebroventricular (ICV) microinjection of CBD (2, 10, and 50 μg/5 μL DMSO) during the 5-day conditioning phase in the CPP paradigm to highlight the CBD's impact on the development (acquisition) of MET-induced place preference. Furthermore, animals were treated with CBD (2, 10 and 50 μg/5 μL) in the lateral ventricle on the post-conditioning day to elucidate the effect of ICV injection of CBD on the expression of MET-induced CPP. It was revealed that CBD (10 and 50 μg/5 μL) microinjection profoundly inhibited both phases of MET-induced CPP without any side effect on the locomotion in animals were treated by MET injection over conditioning phase. Also, CBD's inhibitory impact was more potent in the acquisition phase than the expression phase of MET-induced CPP. Ultimately, the current research reported that CBD could be a beneficial compound to treat drug abuse however more investigations are needed.
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Affiliation(s)
- Mahsa Anooshe
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Kiana Nouri
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran
| | | | - Zahra Mousavi
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Abbas Haghparast
- Neuroscience Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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44
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Britch SC, Babalonis S, Walsh SL. Cannabidiol: pharmacology and therapeutic targets. Psychopharmacology (Berl) 2021; 238:9-28. [PMID: 33221931 PMCID: PMC7796924 DOI: 10.1007/s00213-020-05712-8] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/10/2020] [Indexed: 12/24/2022]
Abstract
RATIONALE Cannabidiol (CBD) products lacking regulatory approval are being used to self-treat a myriad of conditions and for their unsubstantiated health benefits. The scientific evidence supporting these claims largely arises not from controlled clinical trials, but from the recognition that CBD has numerous biological targets. Yet, CBD is commonly consumed and often in over-the-counter products that are unapproved and of unknown composition. Epidiolex® is the only product that has undergone rigorous pharmacokinetic assessment and testing in clinical trials; it was approved as a non-scheduled drug by the U.S. Food and Drug Administration for the treatment of intractable childhood-onset seizures. However, studies investigating CBD for other medical conditions are limited in number and often lack the scientific rigor, controls, or sample sizes required to draw clinically meaningful conclusions. Although Epidiolex® is safe for human consumption, recent changes in regulation of commercially available CBD products have resulted in limited quality control and products marketed with unknown CBD bioavailability. Even scientifically rigorous studies have used different sources of CBD and different suspension vehicles for administration, making it difficult to compare results among studies and resolve mixed outcomes. OBJECTIVES This paper reviews the molecular targets, pharmacokinetics, and safety and abuse liability of CBD; additionally, the extant evidence on its potential therapeutic effects for neurological disorders, pain, inflammation, conditions related to immune function, psychiatric disorders, and substance use are described.
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Affiliation(s)
- Stevie C Britch
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA.
- Department of Behavioral Science, University of Kentucky, Lexington, KY, 40508, USA.
| | - Shanna Babalonis
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA
- Department of Behavioral Science, University of Kentucky, Lexington, KY, 40508, USA
| | - Sharon L Walsh
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA
- Department of Behavioral Science, University of Kentucky, Lexington, KY, 40508, USA
- Department of Pharmacology, University of Kentucky, Lexington, KY, 40508, USA
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington, KY, 40508, USA
- Department of Psychiatry, University of Kentucky, Lexington, KY, 40508, USA
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Morel A, Lebard P, Dereux A, Azuar J, Questel F, Bellivier F, Marie-Claire C, Fatséas M, Vorspan F, Bloch V. Clinical Trials of Cannabidiol for Substance Use Disorders: Outcome Measures, Surrogate Endpoints, and Biomarkers. Front Psychiatry 2021; 12:565617. [PMID: 33692705 PMCID: PMC7937926 DOI: 10.3389/fpsyt.2021.565617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 01/21/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Cannabidiol (CBD) is a cannabinoid of potential interest for the treatment of substance use disorders. Our aim was to review the outcome measures, surrogate endpoints, and biomarkers in published and ongoing randomized clinical trials. Methods: We conducted a search in PubMed, Web of Science, PMC, PsycINFO, EMBASE, CENTRAL Cochrane Library, "clinicalTrials.gov," "clinicaltrialsregister.eu," and "anzctr.org.au" for published and ongoing studies. Inclusion criteria were randomized clinical trials (RCTs) examining the use of CBD alone or in association with other cannabinoids, in all substance use disorders. The included studies were analyzed in detail and their qualities assessed by a standardized tool (CONSORT 2010). A short description of excluded studies, consisting in controlled short-term or single administration in non-treatment-seeking drug users, is provided. Findings: The screening retrieved 207 published studies, including only 3 RCTs in cannabis use disorder. Furthermore, 12 excluded studies in cannabis, tobacco, and opioid use disorders are described. Interpretation: Primary outcomes were validated withdrawal symptoms scales and drug use reduction in the three RCTs. In the short-term or crossover studies, the outcome measures were visual analog scales for subjective states; self-rated scales for withdrawal, craving, anxiety, or psychotomimetic symptoms; and laboratory tasks of drug-induced craving, effort expenditure, attentional bias for substance, impulsivity, or anxiety to serve as surrogate endpoints for treatment efficacy. Of note, ongoing studies are now adding peripheral biomarkers of the endocannabinoid system status to predict treatment response. Conclusion: The outcome measures and biomarkers assessed in the ongoing CBD trials for substance use disorders are improving.
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Affiliation(s)
- Alix Morel
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Lariboisière-Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, 200 rue du Fg St Denis, Paris, France
| | - Pierre Lebard
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Lariboisière-Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, 200 rue du Fg St Denis, Paris, France
| | - Alexandra Dereux
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Lariboisière-Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, 200 rue du Fg St Denis, Paris, France.,INSERM UMRS1144, 4 avenue de l'Observatoire, Paris, France.,FHU NOR-SUD, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Julien Azuar
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Lariboisière-Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, 200 rue du Fg St Denis, Paris, France.,INSERM UMRS1144, 4 avenue de l'Observatoire, Paris, France.,FHU NOR-SUD, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Frank Questel
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Lariboisière-Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, 200 rue du Fg St Denis, Paris, France.,INSERM UMRS1144, 4 avenue de l'Observatoire, Paris, France.,FHU NOR-SUD, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Frank Bellivier
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Lariboisière-Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, 200 rue du Fg St Denis, Paris, France.,INSERM UMRS1144, 4 avenue de l'Observatoire, Paris, France.,FHU NOR-SUD, Assistance Publique - Hôpitaux de Paris, Paris, France.,UFR Médecine, Université de Paris, 3 rue Thomas Mann, Paris, France
| | - Cynthia Marie-Claire
- INSERM UMRS1144, 4 avenue de l'Observatoire, Paris, France.,FHU NOR-SUD, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Mélina Fatséas
- University of Bordeaux, Bordeaux, France.,CNRS-UMR 5287- Institut de Neurosciences Cognitives et Intégratives d'Aquitaine (INCIA), Bordeaux, France.,Pôle d'addictologie, CHU de Bordeaux, Hôpital Haut-Lévêque, Avenue de Magellan, Pessac, France
| | - Florence Vorspan
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Lariboisière-Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, 200 rue du Fg St Denis, Paris, France.,INSERM UMRS1144, 4 avenue de l'Observatoire, Paris, France.,FHU NOR-SUD, Assistance Publique - Hôpitaux de Paris, Paris, France.,UFR Médecine, Université de Paris, 3 rue Thomas Mann, Paris, France
| | - Vanessa Bloch
- INSERM UMRS1144, 4 avenue de l'Observatoire, Paris, France.,FHU NOR-SUD, Assistance Publique - Hôpitaux de Paris, Paris, France.,Service de Pharmacie, Hôpital Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, 200 rue du Fg St Denis, Paris, France
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Abstract
COVID-19 pandemic has resulted in devastating mortality and morbidity consisting of socioeconomic and health effects that have included respiratory/pulmonary, cardiovascular, mental health and neurological consequences such as anxiety, depression, and substance use. Extensive efforts are underway to develop preventive vaccines and therapeutics such as remdesivir, dexamethasone, convalescent plasma, and others to treat COVID-19 but many report residual mental health problems after recovery. Cannabis products such as cannabidiol (CBD) are being advertised for the treatment of COVID-19 associated mental health problems and substance use disorders. This commentary will briefly clear the myth that CBD can ameliorate a wide range of COVID-19 associated health effects including anxiety, depression, or any substance use disorder, and show that there is a clear lack of sufficient unbiased clinical evidence from well-designed double-blind, placebo-controlled clinical trials to prove the antianxiety or antidepression therapeutic properties of CBD and support its wide use as medicine to treat COVID-19- associated mental health conditions or substance use disorders. Finally, we suggest that addiction physicians must play an important role in dealing with their patients requesting CBD prescription for treating any of these conditions.
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Sholler DJ, Huestis MA, Amendolara B, Vandrey R, Cooper ZD. Therapeutic potential and safety considerations for the clinical use of synthetic cannabinoids. Pharmacol Biochem Behav 2020; 199:173059. [PMID: 33086126 PMCID: PMC7725960 DOI: 10.1016/j.pbb.2020.173059] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/22/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023]
Abstract
The phytocannabinoid Δ9-tetrahydrocannabinol (THC) was isolated and synthesized in the 1960s. Since then, two synthetic cannabinoids (SCBs) targeting the cannabinoid 1 (CB1R) and 2 (CB2R) receptors were approved for medical use based on clinical safety and efficacy data: dronabinol (synthetic THC) and nabilone (synthetic THC analog). To probe the function of the endocannabinoid system further, hundreds of investigational compounds were developed; in particular, agonists with (1) greater CB1/2R affinity relative to THC and (2) full CB1/2R agonist activity. This pharmacological profile may pose greater risks for misuse and adverse effects relative to THC, and these SCBs proliferated in retail markets as legal alternatives to cannabis (e.g., novel psychoactive substances [NPS], "Spice," "K2"). These SCBs were largely outlawed in the U.S., but blanket policies that placed all SCB chemicals into restrictive control categories impeded research progress into novel mechanisms for SCB therapeutic development. There is a concerted effort to develop new, therapeutically useful SCBs that target novel pharmacological mechanisms. This review highlights the potential therapeutic efficacy and safety considerations for unique SCBs, including CB1R partial and full agonists, peripherally-restricted CB1R agonists, selective CB2R agonists, selective CB1R antagonists/inverse agonists, CB1R allosteric modulators, endocannabinoid-degrading enzyme inhibitors, and cannabidiol. We propose promising directions for SCB research that may optimize therapeutic efficacy and diminish potential for adverse events, for example, peripherally-restricted CB1R antagonists/inverse agonists and biased CB1/2R agonists. Together, these strategies could lead to the discovery of new, therapeutically useful SCBs with reduced negative public health impact.
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Affiliation(s)
- Dennis J Sholler
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| | - Benjamin Amendolara
- UCLA Cannabis Research Initiative, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Ryan Vandrey
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ziva D Cooper
- UCLA Cannabis Research Initiative, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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48
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Chesworth R, Karl T. Cannabidiol (CBD) reduces cocaine-environment memory in mice. Pharmacol Biochem Behav 2020; 199:173065. [DOI: 10.1016/j.pbb.2020.173065] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 12/24/2022]
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49
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Hawes EM, Lee CR, Brackney DE, Ensley TG, Kidd J, Page C. Cannabidiol Products: Review of the Regulatory and Clinical Considerations. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2020.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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50
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Luján MÁ, Cheer JF, Melis M. Choosing the right drug: status and future of endocannabinoid research for the prevention of drug-seeking reinstatement. Curr Opin Pharmacol 2020; 56:29-38. [PMID: 33068883 DOI: 10.1016/j.coph.2020.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/06/2020] [Accepted: 08/25/2020] [Indexed: 12/21/2022]
Abstract
Prolonged exposure to drugs of abuse leads to severe alterations in mesocorticolimbic dopamine circuitry deeply implicated in substance use disorders. Despite considerable efforts, few medications to reduce relapse rates are currently available. To solve this issue, researchers are uncovering therapeutic opportunities offered by the endocannabinoid system. The cannabinoid receptor type 1 (CB1R), and its endogenous ligands, participate in orchestration of cue-triggered and stress-triggered responses leading to obtain natural and drug rewards. Here, we review the evidence supporting the use of CB1R neutral antagonists, allosteric modulators, indirect agonists, as well as multi-target compounds, as improved alternatives compared to classical CB1R antagonists. The promising therapeutic value of other substrates participating in endocannabinoid signaling, like peroxisome proliferator-activated receptors, is also covered. Overall, a wide body of pre-clinical evidence avails novel pharmacological strategies interacting with the endocannabinoid system as clinically amenable candidates able to counteract drug-induced dopamine maladaptations contributing to increased risk of relapse.
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Affiliation(s)
- Miguel Á Luján
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joseph F Cheer
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Miriam Melis
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, Monserrato, Italy.
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