Department of Psychiatry, Addiction Institute of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Mount Sinai Beth Israel Hospital, New York, New York, USA.
Cannabis Cannabinoid Res. 2022 Oct;7(5):569-581. doi: 10.1089/can.2021.0089. Epub 2021 Oct 22.
Opioid use disorder (OUD) is a major public health crisis worldwide. Patients with OUD inevitably experience withdrawal symptoms when they attempt to taper down on their current opioid use, abstain completely from opioids, or attempt to transition to certain medications for opioid use disorder. Acute opioid withdrawal can be debilitating and include a range of symptoms such as anxiety, pain, insomnia, and gastrointestinal symptoms. Whereas acute opioid withdrawal only lasts for 1-2 weeks, protracted withdrawal symptoms can persist for months after the cessation of opioids. Insufficient management of opioid withdrawal often leads to devastating results including treatment failure, relapse, and overdose. Thus, there is a critical need for cost-effective, nonopioid medications, with minimal side effects to help in the medical management of opioid withdrawal syndrome. We discuss the potential consideration of cannabidiol (CBD), a nonintoxicating component of the cannabis plant, as an treatment in managing the opioid withdrawal syndrome. A review of the literature was performed using keywords related to CBD and opioid withdrawal syndrome in PubMed and Google Scholar. A total of 144 abstracts were identified, and 41 articles were selected where CBD had been evaluated in clinical studies relevant to opioid withdrawal. CBD has been reported to have several therapeutic properties including anxiolytic, antidepressant, anti-inflammatory, anti-emetic, analgesic, as well as reduction of cue-induced craving for opioids, all of which are highly relevant to opioid withdrawal syndrome. In addition, CBD has been shown in several clinical trials to be a well-tolerated with no significant adverse effects, even when co-administered with a potent opioid agonist. Growing evidence suggests that CBD could potentially be added to the standard opioid detoxification regimen to mitigate acute or protracted opioid withdrawal-related symptoms. However, most existing findings are either based on preclinical studies and/or small clinical trials. Well-designed, prospective, randomized-controlled studies evaluating the effect of CBD on managing opioid withdrawal symptoms are warranted.
阿片类药物使用障碍（OUD）是全球范围内的一个主要公共卫生危机。患有 OUD 的患者在试图减少当前阿片类药物的使用量、完全戒除阿片类药物或试图转用某些阿片类药物使用障碍药物时，不可避免地会出现戒断症状。急性阿片类药物戒断可能会使人衰弱，并包括一系列症状，如焦虑、疼痛、失眠和胃肠道症状。虽然急性阿片类药物戒断仅持续 1-2 周，但在停止使用阿片类药物后，迁延性戒断症状可能会持续数月。阿片类药物戒断管理不足往往会导致灾难性后果，包括治疗失败、复发和过量用药。因此，迫切需要具有成本效益、非阿片类药物，且副作用最小的药物来帮助管理阿片类药物戒断综合征。我们讨论了将大麻植物的非致醉成分大麻二酚（CBD）作为治疗阿片类药物戒断综合征的潜在考虑因素。我们使用与 CBD 和阿片类药物戒断综合征相关的关键词在 PubMed 和 Google Scholar 上进行了文献回顾。共确定了 144 篇摘要，并选择了 41 篇评估 CBD 在与阿片类药物戒断相关的临床研究中应用的文章。CBD 已被报道具有多种治疗特性，包括抗焦虑、抗抑郁、抗炎、止吐、镇痛，以及减少对阿片类药物的线索诱导渴求，所有这些都与阿片类药物戒断综合征高度相关。此外，几项临床试验表明，CBD 耐受性良好，即使与强效阿片类药物激动剂同时使用，也没有明显的不良反应。越来越多的证据表明，CBD 可能被添加到标准阿片类药物解毒方案中，以减轻急性或迁延性阿片类药物戒断相关症状。然而，大多数现有发现要么基于临床前研究，要么基于小型临床试验。需要设计良好、前瞻性、随机对照研究来评估 CBD 对管理阿片类药物戒断症状的效果。
