Since 2000, there has been an increase of opioid misuse and abuse, whichled to an opioid drug crisis in the United States. In fact, the rate of fatal overdoses of opioids was more than heroin in 2017. With opioids being prescribed at a dangerous rate and the increased risk of abuse potential to these types of medications, many providers and patients are searching for alternatives to limit their exposure to individuals. Cannabidiol, also known as CBD, is one possible alternative people could use to help relieve pain symptoms.Since CBD is closely related to tetrahydrocannabinol (THC), many think the product is associated with the same abuse potential. The purpose of this article is to offer background about the opioid epidemic, inform about the abuse potential of CBD, and explain the role that CBD could possibly have in the opioid epidemic.1

What is the opioid epidemic?

In the late 1900’s, opioid pain relievers were believed to not have addiction or abuse potential.3 As a result, opioids were prescribed at high rates as they were extremely effective in alleviating pain symptoms.3However, these medications showed significant abuse potential and addiction patterns in individuals. As physicians kept ramping up opioid prescriptions due to their excellent results in relieving a patient’s pain, more people became exposed to them and their addictive properties. Once individuals start to become addicted, they continue to use the agent without concern for the consequences. Opioids have severe side effects that can potentially be life threatening, especially if continuously abused. Since the early 1900’s, opioid use has been consistently increasing, thus increasing associated deaths, which resulted in declaring a public health emergency in 2017.2

CBD Abuse Potential

As CBD consumption and sales areon the rise, many people ask the question, is CBD addictive? According the World Health Organization (WHO), the answer is a simple no. CBD has shown to have little effect on conditioned place preference or intracranial self-stimulation and exhibits no effects indicative of any abuse or dependence potential. This is largely due to the compounds non-psychoactive properties and lack of central effects on the body. Unlike THC, CBD does not produce euphoric effects on the body or cause an individual to feel “high.”The effects that CBD places within the body are mainly peripheral. The lack of central activity CBD places on the brain contributes to the extremely low abuse potential of the compound.3,4

CBD’s Role in the Opioid Epidemic?

As previously mentioned, CBD does not have high risk for addiction. It works on different areas and receptors in the brain that are not directly involved with addiction patterns. Also, it does not contain any of the psychoactive properties that THC, opioids, alcohol, and other substances do. In fact, CBD contains certain aspects that aid in an individual’s willpower to break their substance addiction. In one study evaluating patients addicted to heroin, it was found that CBD reduced heroin craving and relapse. In another study analyzing CBD’s use against opioid relapse, CBD was found to be beneficial. Specifically, CBD was beneficial as a treatment option for opioid abuse through its ability to alter certain parts of the brain’s addiction pathway. In fact, CBD used in animal studies showed a raise in reward activity threshold. In comparison, drugs such as opioids lower the reward activity threshold making them more addictive substances. However, more studies need to be conducted in order to clearly validate CBD’s benefit against substance abuse.3,5,6,7,8

Are there any significant side effects?

CBD tends to be a non-toxic compound and individuals generally tolerate it very well. However, there is the possibility of experiencing side effects, although normally mild in severity due to its lack of a psychoactive component. Some possible side effects of CBD include drowsiness, decreased appetite, increased liver enzymes, nausea and rash. Ultimately, CBD is typically an extremely safe product that rarely causes toxicity to the consuming individual.9,10,11

Are there any drug interactions?

Once CBD is consumed, it is readily absorbed within the body. After absorption occurs, the compound then begins to be metabolized through an abundance of different pathways. The metabolism of the drug mainly occurs in the liver and gut by CYP2C19 and CYP3A4 enzymes, as well as UGT1A7, UGT1A9, and UGT2B7 isoforms. Due to this specific metabolism, it potentiates many drug-drug interactions that include interactions with valproate, propofol, fenofibrate, diflunisal, gemfibrozil, lamotrigine, morphine, lorazepam, phenytoin, theophylline, caffeine, bupropion, warfarin, and efavirenz. Any other drug or compound that utilizes the same metabolic pathways that was mentioned above for CBD, increases the risk for a drug interaction. The resulting effect usually is a lack of metabolism of the concomitant medication, or vice versa, and can increase the likelihood of experiencing side effects.10,11


The opioid epidemic remains an ongoing crisis in the United States.1Due to the lack of abuse potential and beneficial effects seen with CBD, ithas grown popularity as an effective approach in the fight against opioid addiction.4As shown through several studies, CBD has low toxicity and abuse potential.5Due to the fact that the compound has low toxicity potential, it is generally well tolerated among consumers and can potentially produce beneficial effects without the worry of debilitating side effects. With more research to be conducted, CBD may prove to be an unexpected solution to the current opioid epidemic.

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1. Scholl, Lawrence et al. “Drug and Opioid-Involved Overdose Deaths - United States, 2013-2017.” MMWR. Morbidity and mortality weekly report vol. 67,5152 1419-1427. 4 Jan. 2018, doi:10.15585/mmwr.mm675152e1
U.S. Department of Health and Human Services. “What is the U.S. Opioid Epidemic?” HHS.GOV/Opioids, Sept 2019,

2. Kogan NM, Mechoulam R. Cannabinoids in health and disease. Dialogues Clin Neurosci. 2007;9(4):413‐430.
3. Grinspoon P. Cannabidiol (CBD) - what we know and what we don't. Harvard Health. Published April 22, 2020. Accessed September 1, 2020.
4. Volkow ND, Baler RD, Compton WM, Weiss SR. Adverse health effects of marijuana use. N Engl J Med. 2014;370(23):2219-2227. doi:10.1056/NEJMra1402309
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Office of the Commissioner. FDA Regulation of Cannabis and Cannabis-Derived Products: Q&A. Aug. 2020,

6. Expert Committee on Drug Dependence. “Cannabidiol (CBD).” World Health Organization, June 2018,
7. Millar SA, Stone NL, Bellman ZD, Yates AS, England TJ, O'Sullivan SE. A systematic review of cannabidiol dosing in clinical populations. Br J Clin Pharmacol. 2019;85(9):1888-1900. doi:10.1111/bcp.14038
8. Epidioloex [package insert]. Cambridge, UK: GW Pharmaceuticals; 2018
9. Iffland K, Grotenhermen F. An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. Cannabis Cannabinoid Res. 2017;2(1):139-154. Published 2017 Jun 1. doi:10.1089/can.2016.0034. In the “Results” section of the abstract.

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