- Researchers are studying how specific components of cannabidiol (CBD) may supplement the opioid overdose drug naloxone.
- The initial finding indicated that CBD derivatives made naloxone treatment more effective, even against the opioid fentanyl.
- This latest study adds to existing research suggesting that CBD may provide a benefit in treating opioid overdoses, addiction cravings, and withdrawal symptoms.
The drug naloxone is a life-saving antidote for overdoses of opiate drugs like fentanyl.
Research shows that 75-100 percent of overdose victims treated with naloxone
Now, researchers are studying whether derivatives of cannabidiol (CBD), a component of cannabis, can make naloxone even more effective.
Naloxone works by competing with opiate drugs, like heroin and morphine, for opioid receptor sites in the brain. The depressive effects of opioids on the central nervous system, which can lead users to stop breathing, are effectively blocked when naloxone occupies opioid receptor sites.
However, fentanyl is especially effective at binding with those receptor sites, sometimes requiring multiple doses of Narcan to prevent overdoses.
“CDC guidelines state that fentanyl overdose may require more than one dose of Narcan and synthetic opiates [like fentanyl] are now implicated in more than 80 percent of opiate overdoses,” Dr. Alex Straiker, the study’s co-principal investigator and an associate scientist in the Department of Psychological and Brain Sciences at Indiana University Bloomington, told Healthline.
“A higher dose of Narcan was also approved in an effort to address this. That ramp-up of deaths from synthetics was just starting when we initiated this project — at the time, front-line cities like Dayton were reporting bodies found with multiple expended ampoules of naloxone,” Straiker continued.
Past studies suggest that CBD can hamper opioid binding by altering the shape of receptor sites, making naloxone treatment more effective.
“Given that naloxone is the only drug available to reverse overdoses, I think it makes sense to look at alternatives,” said Straiker.
In a study presented at the spring meeting of the American Chemical Society, Straiker and colleagues looked at whether various derivatives and dosages of CBD — alone or in combination with naloxone — could be an effective adjunct or substitute for Narcan treatment of overdoses.
“Mostly we’ve been trying to figure out which parts of the CBD compound were relevant for these effects and building on that to find compounds that are more effective,” Straiker said.
The study found that several of the CBD derivatives prevented fentanyl from binding at opioid receptor sites, even at very low concentrations. Two of the compounds also enhanced the performance of naloxone when used in combination with the overdose antidote.
A follow-up animal study is now underway to test the most promising derivatives on mice.
Past studies have shown that CBD has effectively eased addiction cravings and withdrawal symptoms, Dr. Peter Grinspoon, an internist and medical cannabis specialist at Massachusetts General Hospital and an instructor at Harvard Medical School, told Healthline.
“CBD is a promising molecule, and cannabinoids have a huge role to play” in addressing opiate withdrawal,” said Grinspoon. “CBD can work synchronistically with naloxone.”
However, he also cautioned that CBD has been shown to raise serum levels of medications. “Wouldn’t it be ironic if CBD made naloxone more effective but also increases the serum levels of fentanyl and made it worse?” Grinspoon said in calling for further research.
“It’s not a big deal to have to give a second dose of naloxone,” Grinspoon added. “The real limiting thing is lack of access to Narcan.”
Dr. Daniele Piomelli, director of the University of California Irvine’s Center for the Study of Cannabis and a distinguished professor of anatomy and neurobiology at UC Irvine’s School of Medicine, said that it may not be “realistic to think of CBD as an alternative to naloxone.”
However, he told Healthline, “It may possibly work as an adjunct therapy if the data are convincing,” adding: “We need to explore every possible path to better anti-opiate therapies.”