Yasmin Hurd, PhD, is currently conducting a clinical trial of CBD for treating opioid use disorder, a neuroimaging study of CBD’s effects on the human brain, and a study looking at neurodevelopmental effects of cannabis and its epigenetic regulation.
Yasmin Hurd, PhD, Director of the Addiction Institute of Mount Sinai (AIMS), has been at the forefront of cannabidiol (CBD) research for the past decade, particularly its effects on those struggling with addiction. In May 2019, she published study results from a clinical trial showing that CBD reduced cue-induced craving and anxiety in individuals with a history of heroin abuse, suggesting it could help break the cycle of addiction. Below, she breaks down five things psychiatrists need to know about the potential for using CBD to treat psychiatric disorders.
1. What it is. CBD is one of 140 components—known as cannabinoids—in the cannabis plant. Tetrahydrocannabinol (THC) is the most prevalent cannabinoid and is the main psychoactive agent of the plant (causing the cannabis “high”). CBD, on the other hand, does not cause intoxication, and is not “medical cannabis,” which generically refers to THC-containing products. However, each state has its own distinct medical cannabis program, and some include CBD-only treatments. The full mechanism of CBD’s pharmacological actions is still being investigated, but it’s clear that unlike THC, CBD is not an agonist at cannabinoid receptors.
2. Conditions it may help treat. CBD has been studied for various disorders including anxiety, cannabis use disorder, Crohn’s disease, diabetes, epilepsy, graft versus host disease, Huntington’s disease, opioid use disorder, Parkinson’s disease, and schizophrenia/psychosis. Several open label studies have also been conducted in relation to autism, cancer, pain, and sleep. To date, the U.S. Food and Drug Administration (FDA) has only approved CBD for the treatment of Dravet syndrome and Lennox-Gastaut syndrome, two rare and severe forms of childhood epilepsy. CBD has not been FDA-approved to treat any disorders in adults.
3. The evidence. In limited clinical trials—many related to psychiatric illnesses—CBD was found to reduce social anxiety, PTSD, and cue-induced craving in opioid addiction. It was also found to lessen the activation of brain areas altered by emotionally fearful conditions. CBD can have anti-psychotic effects primarily reducing positive symptoms and may be effective as an adjunct to current FDA approved anti-psychotic medications. Pretreatment with CBD may also block the induction of psychosis induced by THC. Most of these clinical studies have been small; to make conclusive decisions regarding treatment for specific psychiatric disorders, large-scale double-blinded trials are needed.
4. What to tell patients. Many individuals are using CBD despite the lack of definitive clinical insights or FDA approval for any psychiatric disorder. Because of this, it is critical for clinicians to have an open rapport with their patients to document any CBD use. This rapport will also be important to guide patient education about the potential for CBD to interact with medications they are currently taking. Additionally, it is important to have patients keep a log of their daily activity including aspects of any change in physiological state, mood, and sleep. Patients should be educated about the source of their CBD, as many products sold as “pure CBD” contain THC and other adulterants that can affect overall health such as lead, mold, and psychosis inducing synthetic cannabinoids.
5. The dose range and side effects. The typical daily dose studied ranges from approximately 100 to 600 mg and is normally taken orally. However, doses up to 6,000 mg have been investigated in healthy subjects, resulting in no severe effects. Although CBD has been implicated in a large spectrum of biological effects, a consistent finding in clinical studies is that it is safe, generally well tolerated, and lacks toxicity in adults. The most notably adverse events are gastrointestinal including diarrhea, but with low severity. Additionally, an increase in liver enzymes has been reported in combination with anti-epileptic medication in children. We still lack systematic studies to determine whether general safety extends beyond oral routes of administration or how CBD may interact with medications like benzodiazepines, which are metabolized by the same cytochrome P450 enzymes as CBD. It is possible that this could affect the therapeutic levels of each drug. The therapeutic dose range is also still unclear for psychiatric illnesses given the limited clinical studies for most of these indications.
Dr. Hurd is currently the principal investigator on a clinical trial of CBD for treating opioid use disorder, a neuroimaging study of CBD’s effects on the human brain, and a study looking at neurodevelopmental effects of cannabis and its epigenetic regulation.
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Dr. Hurd is Professor of Psychiatry, Neuroscience, and Pharmacological Sciences and Ward-Coleman Chair of Translational Neuroscience at the Icahn School of Medicine at Mount Sinai. She is also the director of the Addiction Institute of Mount Sinai, and director of the Hurd Lab.