CBD for treating tobacco addiction?
By José Carlos Bouso
José Carlos Bouso is a clinical psychologist and a doctor of pharmacology. His areas of interest are psychopharmacology and the therapeutic properties of entactogens, psychedelics and cannabis. He has conducted therapeutic research with MDMA, pharmacological research with several substances of plant and synthetic origin and has also performed studies on the long-term neuropsychological effects of substances such as cannabis, ayahuasca and cocaine. He is author of the book “Qué son las drogas de síntesis” [What are synthetic drugs?], and co-author of “¿La marihuana como medicamento? Los usos médicos y terapéuticos del cannabis y los cannabinoides” [Marihuana as medicine? The medical and therapeutic uses of cannabis and cannabinoids] and “Ayahuasca y salud” [Ayahuasca and health]. His research has been published in scientific journals. He is currently the director of scientific projects at Fundación ICEERS.
Although cannabis has long been considered as a “drug of abuse”, in recent years an increasing number of studies published in the biomedical literature indicate that either the plant itself or some of its compounds may be of use in treating addictions. For example, a recent review sets out the current evidence on the involvement of the endocannabinoid system in modulating addictive behaviour, looking at the results of research with animals on the potential role of some cannabinoids in treating psychostimulant addiction 1 . More specifically, there is evidence to indicate that pharmaceuticals that are CB2 receptor agonists may be of use in treating cocaine addiction 2 . Certain observational studies have also been published showing that cannabis may be a substitute for more dangerous drugs, including alcohol 3 . Finally, another recent review compiled current studies focusing on the possible properties of CBD (cannabidiol) as an intervention for addictive disorders 4 . This article will review the current evidence for considering cannabis in general, and CBD in particular, as a possible aid for quitting smoking.
Tobacco in figures
According to a report published in 2014 by the World Health Organisation (WHO) 5 , tobacco smoke contains more than 7,000 chemical substances, of which at least 250 are known to be harmful for health and at least 69 are known to cause cancer. According to this report, the spectrum of medical problems that can be caused by smoking include: shortness of breath, exacerbated asthma, respiratory infections, cancer (larynx, oropharynx, oesophagus, trachea, bronchus, lung, acute myeloid leukaemia, stomach, pancreas, kidney, ureter, colon, cervix, and bladder), coronary heart disease, heart attacks, stroke, chronic obstructive pulmonary disease, osteoporosis, blindness, cataracts, periodontitis, aortic aneurysm, atherosclerotic peripheral vascular disease, hip fractures, infertility and impotence.
According to another WHO study, tobacco continues to be the principal preventable cause of death in the world, killing approximately 6 million people each year and causing economic losses estimated at over half a trillion dollars 6 . The latest report of the Global Tobacco Surveillance System, which gathers data from 22 countries representing nearly 60% of the world’s population, shows that there are approximately 1,300 million smokers in those countries, of whom 205 million had made some attempt to quit smoking in the last 12 months 7 . According to the American Cancer Society, only 4-7% of people are capable of giving up smoking in any given attempt without medicines or other help while around 25% of smokers using medication manage to stay smoke-free for over 6 months. Psychological counselling and other types of emotional support can boost success rates higher than medicines alone 8 .
Nicotine addiction or tobacco habit?
Although the accepted theory on drug addiction appears to be that it is a chronic, often relapsing brain disease that causes compulsive drug seeking and use, causing a deterioration in control of consumption despite harmful consequences to the addicted individual and to those around him or her 9 , an ever larger number of experts are beginning to challenge this view of addiction as a brain disease 10 . At least two studies have found that the percentage of people who recover from their addiction throughout their lives is, in nearly all cases, over 80% 11 . The results of these studies also indicate that tobacco addiction is the one of the forms of addiction with the lowest cessation rates.
One of these reasons may be the extent to which conventional wisdom in our society ascribes tobacco addiction to the pharmacological effects of nicotine. If attributing addiction to the substance used is a problem for understanding drug addiction in general, in the case of tobacco addiction it becomes especially paradigmatic. The problem with drug addiction in general, and tobacco addiction in particular, is, as we have explained, the problem tends to be attributed to a disorder of the brain caused by a pharmacological agent, when at the base of all addictive behaviour, what is actually introduced is a habit. And this habit is established, not so much by the effects of the substance itself, as by the behaviours involved in seeking and consuming the substance. And it is these habits, as forms of conduct, that are difficult to correct. Indeed, in the specific case of nicotine it is very difficult to train animal models to be addicted to the substance. And as we have seen, the rates of tobacco cessation by pharmacological means (including patches, gum and any other nicotine-based pharmaceutical preparation) are distressingly low 12 . Therefore, of all the reasons for which tobacco proves addictive for so many people, the fact that it contains nicotine is probably the least significant. It is precisely the fact that it is a habit, which is generally established over a long time –in most cases over several years– that makes it so difficult to correct. As humans, we establish our everyday behaviour by means of habits and the more ingrained a habit is, the more difficult it is to change. This is all the more true, insofar as the habit –as in the case of tobacco– offers such versatility for that the individual can indulge it when engaged in an animated conversation, in a state of depression or when waiting for a bus – in short, in nearly every aspect of his or her life, except sleep. This versatility and generalisation make the habit of smoking so especially difficult to correct.
Vaping cannabis as an alternative to smoking tobacco
As cannabis users increasingly become aware of the health dangers of smoking, some of them are trying to replace the smoking of cannabis (which involves combustion) with vaping (which does not). Indeed, it is well known that the risks of smoking derive precisely from the combustion of the material smoked, rather than the products smoked. Even so, surveys on preferred methods of consumption indicate that the immense majority (more than 90%) of cannabis users still prefer smoking, even though they recognise that vaping is the most effective way of reducing the harm 13 . Even in states like California, whose citizens are famous for their worship of healthy lifestyles, the preferred means of consuming cannabis in medicinal marijuana dispensaries is by smoking (86.1% of those interviewed), far ahead of vaping (used by 21.8%) 14 . These results may be somewhat skewed by the fact that so many of those surveyed started out as tobacco consumers who when they subsequently began to use cannabis, also preferred to smoke it. It is also well-known that many consumers manage to give up smoking not only “joints” but also tobacco when they start vaping cannabis. In a recent letter to the journal Addiction, Hindocha et al. set out a series of examples in which vaping cannabis is accompanied by a reduction in tobacco consumption. According to these researchers: “ there could be reason to be optimistic about the potential of vaporizers. If vaporizers can reduce cannabis and tobacco co-administration, the outcome could be a reduction of tobacco use/dependence among cannabis users and a resultant reduction in harms associated with cannabis. Indeed, if vaping cannabis becomes commonplace in the future, the next generation of cannabis users might never be exposed to nicotine or tobacco in the first place” 15 .
Use of CBD in treating the tobacco habit
CBD is in vogue. Whereas in the 1990s seed companies vied to obtain the strain with most THC, they are now competing for more narcotic varieties – in other words, those with the highest CBD content. We don’t know the reason for this change: whether cannabis consumers have grown tired of such a strong high (THC concentrations in Dutch marijuana have been falling by 0.22% per year since 2005 16 ); whether it is a result of the industry’s marketing campaigns attributing the medicinal effects of cannabis to CBD; whether it simply reflects a market in which consumers want a varied product offering different experiences depending on what they are looking for at any specific time, or whether it is combination of all of these factors, or even some other reason. One other possible reason is the fashion for CBD oils which –albeit the labels do no state as much– also contain sufficient quantities of THC to possibly cause a consumer to test positive in a roadside saliva test. Moreover, for reasons we shall not go into here, the legality of these oils is decidedly dubious.
The way CBD acts on the endocannabinoid system is not yet fully understood. Indeed, some articles discuss mechanisms of action that others ignore altogether, and vice versa. I will therefore leave it to readers to search for the mechanism of action of CBD. A recent review on the possible role of CBD as an anti-addictive pharmaceutical, quoted above 17 , after appraising this mechanism of action, concludes that “CBD has been associated with many neural circuits involved in the acquisition of addiction and subsequent drugseeking behaviors, making it an interesting pharmacological candidate to treat substance-use disorders”.
Only one study has researched the role of CBD as a treatment for addiction to tobacco smoking. In a pilot clinical study, the effectiveness of CBD was compared against a placebo in treatment of tobacco addiction. (A pilot study is one with a small number of subjects, used to test a working hypothesis before moving on to a larger, and therefore more economically costly, sample). It was double blind (neither researchers nor subjects knew who received what treatment), randomised (patients were assigned one or other treatment at random) and placebo controlled (the active pharmaceutical was compared with an inactive one). 24 subjects were recruited who smoked more than 10 cigarettes per day and given an inhaler to be used whenever they felt the urge to smoke. Twelve subjects (6 females) received an inhaler containing CBD and the other twelve (6 females) received an inhaler with a placebo. Treatment lasted one week. During this time, they recorded their cravings for tobacco and anxiety on a daily basis. A follow-up interview was conducted 21 days after treatment. Following the treatment week, cigarette consumption in the CBD group had fallen by 40%, a significant contrast with the placebo group, but these differences were not kept up after 21 days. Both groups reported the same reduction in craving and anxiety over the 7 days the treatment lasted, but, again, by day 21 they had returned to the initial conditions. The authors conclude: “the preliminary data presented here suggest that CBD may be effective in reducing cigarette use in tobacco smokers, however larger scale studies, with longer follow-up are warranted to gauge the implications of these findings. These findings add to a growing literature that highlights the importance of the endocannabinoid system in nicotine addiction” 18 .
In their article, the authors of the study offer a series of explanations, based on the effects of CBD on the Endocannabinoid system, which might explain the results. These include the action of CBD on CB1 receptors (as a weak reverse agonist), and its properties as an inhibitor of the enzyme that breaks down the anandamide (FAAH). These actions may be related to a reduction in the boosting properties of nicotine. They also offer some speculation on psychological causes, such as the possible action of CBD in reducing attention on contextual cues that may be involved in maintenance of nicotine consumption.
However, there are doubts that remain to be clarified. As explained, in this study, reported tobacco craving fell by the same amount in the CBD and placebo groups, as did anxiety levels. These scores were taken once a day, but not after the inhaler was used in response to the desire to smoke a cigarette. It is possible that in general terms the placebo is capable of reducing the desire for consumption and anxiety, since the scores had normalised by the 21-day follow-up assessment, when neither group was using the device. Perhaps the CBD, by acting as an anxiolytic 19 , might be a substitute treatment for progressively quitting tobacco, due to the fact that the subject is not as anxious. This study did not assess the possible anxiolytic effect following inhalations. Nonetheless, this pilot study provides more evidence that tobacco addiction is more a habit than a pharmacological effect of nicotine. If tobacco addiction were a matter of nicotine addiction, after a week, when the desire for consumption had already disappeared and where the number of cigarettes –and therefore the nicotine– has been considerably reduced, there would be no reason for the withdrawal symptoms to reappear, inducing subjects to start smoking tobacco again. Finally, as we saw in the previous section, many people quit smoking when they start vaping. It is therefore possible that cannabis and/or CBD inhaled by some means other than smoking might be of use for people who want to quit smoking. As Morgan and collaborators conclude, more studies are necessary in this regard. What does seem clear is that smoking, more than an addiction to a drug (nicotine), is a habit, and like all habits, its interruption causes anxiety. In this regard, replacing tobacco with vaporised cannabis and/or CBD may be a useful substitute measure, although this requires more evidence before it can be confirmed.Although cannabis has long been considered as a “drug of abuse”, in recent years an increasing number of studies published in the biomedical literature indicate that either the plant itself or some of its compounds may be of use in treating addictions. For example, a recent review sets out the current evidence on the involvement of the endocannabinoid system in modulating
CBD and Nicotine – November 2020
Does CBD interact with nicotine and other stimulants?
- According to Smokefree.gov of the National Cancer Institute (NCI), some people use smoking as a way to manage stress or other unpleasant feelings (1 ) . Unfortunately, nicotine, tar, and carbon monoxide (a toxic gas) are also released when tobacco is smoked (2 ) .
- Meanwhile, CBD might be useful for managing stress and emotions without the user having to experience a euphoric high. Research has shown that CBD possesses anti-anxiety and non-psychoactive properties (3 ) .
- A study found that CBD interactions with stimulants caused reduced appetite, weight decrease, and insomnia or sleep disturbance (4 ) . However, specific data on nicotine and CBD interaction is not available.
- In a 2013 study published in the Addictive Behaviors journal, it was noted that CBD might theoretically be a potential treatment for nicotine dependence (5 ) .
- Still, a consultation with a doctor experienced in cannabis use is advised before replacing nicotine with CBD or before trying to combat nicotine dependence with CBD.
Can CBD be taken with nicotine?
The effects of nicotine use in conjunction with other drugs, including over-the-counter or prescribed medications, can be unpredictable and cause reduced effectiveness of the drug or increased blood clots (6 ) . However, no data is available on the specific interaction between nicotine and cannabidiol.
Nicotine is a stimulant drug that accelerates the messages travelling between the brain and body. It may be more addictive than heroin, says the Alcohol and Drug Foundation of Australia (7 ) .
Products such as cigarettes, pipe tobacco, cigars, chewing tobacco and wet and dry snuff (ground tobacco leaves), and the dried leaves from the tobacco plant all contain nicotine (8 ) .
When tobacco is smoked, nicotine, tar, and carbon monoxide (a toxic gas) are released (9 ) .
Electronic cigarettes (also known as e-cigarettes) may still have some nicotine content, although they do not contain dried tobacco leaves (10 ) .
DrugBank’s BioInteractor utilizes data to provide information on drug-drug interactions (11 ) . However, in the case of cannabidiol-nicotine interaction, no specific data is available.
Meanwhile, there have been studies that demonstrate how marijuana interacts with nicotine (12 ) .
Although the studies are not specific to CBD, the data may offer insight into CBD-nicotine interaction given that cannabidiol may be derived from either a hemp plant or marijuana plant .
In a 2015 study funded by the National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH), scientists at the Center for BrainHealth at the University of Texas at Dallas have uncovered an association between smaller hippocampal brain volume and marijuana use (13 ) .
The hippocampus is a brain structure that has been studied extensively for its prominent role in memory and cognition.
Francesca Filbey, Ph.D., the study’s lead investigator and Director of Cognitive Neuroscience of Addictive Behaviors at the Center for BrainHealth reveals that approximately 70% of individuals who use marijuana also use tobacco.
However, most studies do not account for tobacco use, and the said research by Filbey and her team was the first to examine the unique effects of each substance on the brain as well as their combined effects.
Future studies need to address the cumulative effects of substances, as the interaction between marijuana and nicotine may be complicated due to several mechanisms at work.
Still, scientists said there was an association between smaller hippocampal brain volume and marijuana use.
Although the size of the hippocampus was significantly smaller in both the marijuana group and marijuana plus tobacco group compared to that of individuals who used tobacco exclusively, the relationship to memory performance was unique (14 ) .
What does a small hippocampal size mean?
According to researchers , recent human studies show smaller hippocampal volume in individuals with the stress-related psychiatric condition post-traumatic stress disorder (PTSD) (15 ) .
Animal research, meanwhile, has provided compelling evidence that exposure to severe and chronic stress can damage the hippocampal formation (16 ) .
Cannabis Use and the Brain
A study published in Drug and Alcohol Dependence examined the relationship between cannabis use and the brain.
However, the effect of cannabis on the brain was found to depend on various factors, including the ratio of THC to CBD, the two primary cannabinoids or constituents of cannabis.
Researchers noted that higher THC and lower CBD was associated with hippocampal volume reduction indicating neurotoxic effects of THC and neuroprotective effects of CBD (17 ) .
Can another stimulant be a substitute for nicotine so CBD oil can be taken?
In a study that examined the potential adverse side effects and drug-drug interactions with CBD use, results indicated that stimulants-CBD interactions caused reduced appetite, weight decrease, and insomnia or sleep disturbance (18 ) .
Sleep disturbances may also coincide with increased anxiety or mood changes, which should also not be managed by additional drugs as the potential for adverse side effects is high, the researchers of the same study said.
These effects should be considered in the assessment of risk vs. benefits of CBD therapy and those using CBD. Consumers are advised to be aware of potential safety issues with CBD use.
Thus, the best current strategy would be to avoid any stimulant when taking CBD.
Can CBD replace nicotine?
No study explicitly recommends CBD as a replacement for the stimulant, nicotine. However, CBD has been shown to possess some characteristics of nicotine as a stimulant.
Nicotine creates an immediate sense of calm and relaxation, so people smoke, believing that it reduces anxiety and stress.
This feeling of relaxation is transient and soon gives way to withdrawal symptoms and increased cravings, according to an article by the Mental Health Foundation (19 ) .
In the United States, more people are addicted to nicotine than to any other drug (20 ) . According to Smokefree.gov of the National Cancer Institute (NCI), some people use smoking as a way to manage stress or other unpleasant feelings (21 ) .
Meanwhile, CBD oil has been shown to be a promising health tool for managing stress and emotions. There have also been findings indicating the potential use of CBD oil to manage anxiety.
CBD has recently attracted interest for its anxiolytic (anti-anxiety) properties (22 ) .
CBD, although a component of the cannabis plant, has also been shown to be non-psychoactive (23 ) . This characteristic enables CBD to deliver its therapeutic benefits without the user experiencing a euphoric high.
More importantly, CBD has been shown as a potentially useful treatment in nicotine dependence.
A study published in the New England Journal of Medicine on nicotine addiction indicated that some ingredients of cigarette smoke, aside from nicotine, contribute to nicotine addiction (24 ) .
Study author, Dr Neal Benowitz of the University of California, San Francisco, noted: “In addition to delivering nicotine to the brain quickly, cigarettes have been designed with additives and engineering features to enhance its addictiveness.”
Similarly, results showed that nicotine’s fast absorption rates and access into the brain produced an intense ‘rush’, which strengthened the drug’s effects.
Inhaled nicotine rapidly enters the system through the lungs and goes into the brain within seconds. The fast absorption and entry into the brain cause a strongly-felt ‘rush’ and reinforce the effects of the drug, according to the researchers (25 ) .
In a 2013 study published in the Addictive Behaviors journal, researchers tested the efficacy of inhaled cannabidiol (CBD) on smokers who wanted to stop smoking cigarettes (26 ) .
The study was conducted on 24 test subjects over a period of one week. Twelve were given CBD, and the other twelve a placebo.
When the test subjects felt the urge to have a cigarette, they were told to first use the CBD or placebo inhalant provided to them.
Over the treatment week, placebo-treated smokers showed no differences in the number of cigarettes smoked.
In contrast, those treated with CBD significantly reduced the number of cigarettes smoked by about 40% during treatment.
The results of the studies suggest that CBD may be a potent stimulant that is non-addictive, unlike nicotine. However, further exploration is needed.
Still, a consultation with a doctor experienced in cannabis use is advised before replacing nicotine with CBD or before trying to combat nicotine dependence with CBD.
Smoking vs Vaping: Is one better than the other?
Some smokers might be enticed to use electronic cigarettes (e-cigarettes, vape pens, and other vaping devices) to ease the shift from smoking traditional cigarettes to not smoking at all (27 ) .
But is smoking e-cigarettes (vaping) a better method of using tobacco products?
Michael Blaha, M.D., M.P.H., director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, says, “Vaping is less harmful than smoking, but it is still not safe.”
E-cigarettes heat nicotine, flavorings, and chemicals to create an aerosol that vapers inhale. While e-cigarettes may contain fewer toxic chemicals than traditional cigarettes, the specific chemical constituents in e-cigarettes are unknown, says Blaha.
Also, there has been an upsurge of lung injuries and deaths linked to vaping. As of Jan. 21, 2020, the Centers for Disease Control and Prevention (CDC) has confirmed 60 deaths in patients with e-cigarette or vaping product use-associated lung injury (EVALI).
“These cases appear to predominantly affect people who modify their vaping devices or use black market modified e-liquids. This is especially true for vaping products containing tetrahydrocannabinol (THC),” explains Blaha (28 ) .
What is CBD vape juice, and how is it different from regular e-liquids?
CBD vape juice, CBD vape oil, CBD e-liquid, and CBD e-juice are different names used to describe a smokable CBD-based liquid that vapers can put into vaping devices.
A CBD vape pen, vaporizer, or e-cigarette are standard vape tools used when vaping CBD. Always use only high-quality CBD products to vape CBD.
A CBD tincture (also called CBD oil, hemp extract or hemp oil) is formulated to be used orally. It is typically hemp oil produced by extracting CBD from hemp plants using CO2 or alcohol extraction methods.
Then, the extract is diluted with a carrier oil like olive, hemp seed, or coconut. Other ingredients can be added for flavor, as well.
CBD vape juice is any vape juice that contains CBD instead of nicotine. A regular e-liquid usually contains propylene glycol, glycerin, nicotine, flavorings, and additives.
CBD vape juice may be a pure additive that mixes in with existing flavors, or it can be a pre-mixed blend.
What is sub-ohm vaping?
Sub-ohm vaping, also known as sub-ohming, is a style of vaping that produces massive clouds of vapor. Sub-ohm devices utilize low resistance coils that are less than one ohm, hence the name sub-ohm.
There are two types of vape tanks. The regular tank is excellent for vaping beginners, while the sub-ohm tank is recommended for the more experienced vapers.
Using a sub-ohm device is excellent for those who want an increased dose of CBD with every puff, although it is not a perfect system.
Giving up tobacco is one of the crucial steps people can take for their health, but it is also challenging.
UCSF (University of California, San Francisco) Health reveals that 70 percent of smokers report wanting to quit. However, many of them wait until they develop a significant tobacco-related disease such as heart disease, cancer, or stroke.
Fortunately, tobacco addiction is treatable, and tobacco users who receive counseling and medication during their attempts to stop smoking are much more likely to succeed than those who do not get such support (29 ) .
Meanwhile, CBD has been found to possess several health benefits. Aside from its anti-anxiety and antipsychotic characteristics, it is also non-addictive.
However, it is not advisable to combine CBD with stimulants, like nicotine, due to the potential adverse side effects that may be caused by their interaction.
Although research mentioned earlier indicated that CBD could also be a potentially useful treatment to nicotine dependence, there has been no study that explicitly recommends CBD as a nicotine replacement.
A consultation with a doctor experienced in cannabis use is the best course of action before deciding to replace nicotine with CBD or before trying to combat nicotine dependence with CBD.Nicotine is a synthetic chemical that contains nitrogen, which is produced by numerous types of plants, including the tobacco plant. When tobacco is smoked, nicotine activates the release of dopamine, the “happy” chemical in the brain. The hormone dopamine is a neurotransmitter that impacts the pleasure areas of the brain. Research also shows that nicotine may improve memory and concentration. Unfortunately, the nicotine in tobacco is an integral part of cigarette addiction. Someone who is addicted to the nicotine in tobacco continually craves nicotine to release the gratifying dopamine. As the addiction to smoking tobacco grows, so does the amount of nicotine required to stimulate and relish the sensations of dopamine. Once someone stops smoking, one’s nicotine levels drop immediately. This sudden decline in nicotine levels may cause withdrawal symptoms such as craving tobacco, anxiety, irritability, headache, weight increase, and difficulty concentrating. The side effects of nicotine can also affect the heart, hormones, and gastrointestinal system. ]]>