CBD Gummies And Suboxone

There is no evidence yet that cannabidiol (CBD) is effective in treating heroin addiction, despite news headlines claiming this. CBD can act as a metabolic inhibitor as well as an agonist for the opioid painkiller buprenorphine, enhancing its effects. Is this a safe combination? The dangers of combining Suboxone with cannabis are not as significant as combining Suboxone with benzodiazepines (like xanax, klonopin, ativan, valium) or with alcohol. However, patients should be aware of this potential threat, especially if they take other sedatives or have underlying lung conditions.

Cannabis: Misinformation about CBD can be life-threatening

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Hyperbole can be rampant in health news, particularly with respect to cannabis. One recent headline declared: “CBD is effective in treating heroin addiction.” Another proclaimed: “New study finds CBD could curb heroin addiction.”

These stories were referring to a recent study in the American Journal of Psychiatry that found a short-term course of cannabidiol (CBD) reduced cue-induced cravings and anxiety in drug-abstinent individuals who were recovering from opioid use disorder, specifically heroin addiction.

This study is undoubtedly exciting and a welcome contribution to the scientific literature demonstrating the potentially helpful role of cannabinoids in the treatment of opioid use disorder.

That said, there is a mismatch between these headlines and the accurate interpretation of the findings from the study. And this mismatch is not trivial.

Medicinal uses of cannabidiol

CBD is one of many phytocannabinoid compounds found in the plant cannabis sativa. It is quickly gaining traction as a legitimate medicine in the medical community. For example, it has been associated with benefits in treating some neurological disorders and has recently been FDA-approved for the treatment of seizures in people with Lennox-Gastaut syndrome, a severe form of epilepsy.

Further, unlike its sister cannabinoid, delta-9-tetrahydrocannabinol (THC), CBD is largely non-intoxicating and therefore is thought to be non-addictive. It also appears to be relatively safe to use. It’s no wonder CBD has garnered so much excitement and positive attention.

Cannabidiol (CBD), a compound derived from hemp and marijuana that doesn’t cause a high, is now added to an array of products, from drinks to skin creams. (Jennifer Lett/South Florida Sun-Sentinel via AP, File)

That said, scientific enterprise is a slow-moving and cautiously critical machine, and we still have much to learn about the medicinal uses of CBD. In fact, there remains a substantial gap between the hype surrounding CBD and the actual evidence guiding its medicinal use.

Participants already abstinent

In the study published in the American Journal of Psychiatry, the researchers recruited 42 people recovering from opioid use disorder (specifically heroin) and randomly allocated them to either a treatment group (to receive 400 or 800 milligrams of CBD once a day) or a control group (to receive a placebo once a day).

An important aspect of the study is that participants were already abstinent, not actively using heroin, and not experiencing heroin withdrawal. In other words, the participants were in recovery and CBD was not used to treat their withdrawal or maintain tolerance. It was instead used to help treat cravings for heroin and anxiety that were experimentally induced (for example, by showing participants videos and objects related to heroin use) that could lead to relapse.

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The researchers concluded:

“CBD’s potential to reduce cue-induced craving and anxiety provides a strong basis for further investigation of this phytocannabinoid as a treatment option for opioid use disorder.”

It is worth reiterating and highlighting that the study compared CBD to a placebo group, and did not compare to other opioid agonist treatments, such as therapy with methadone (Methadose) or buprenorphine (Suboxone).

Additionally, and importantly, the participants were abstinent and not in active withdrawal.

Opioid agonist treatments are particularly helpful for the mitigation of opioid cravings and withdrawal. Another therapeutic effect of opioid agonist treatments is that they help people in recovery maintain some level of tolerance to opioids, which is helpful for preventing overdose in the event of relapse.

One particular opioid agonist medication, buprenorphine, even blocks stronger opioids like heroin from working as effectively. CBD, on the other hand, does not provide these important protective effects.

Further, to suggest that CBD is an effective treatment for opioid use disorder is misleading and harmful, as this misinformation could be used to justify not initiating, or discontinuing, opioid agonist medications.

Language matters

The findings from the opioid study are certainly important. Investigations into novel therapies that can help people manage cravings to use drugs such as opioids is a major advancement. If future studies can replicate these findings, especially among people who are experiencing difficulties with management of cravings, then this would lend stronger support to the idea that CBD could be used as an adjunctive treatment to opioid agonist therapies among people who are experiencing opioid use disorder.

Crucially, this means that we need many more studies and funded research to fully understand exactly how CBD might play a role in the treatment of opioid use disorder.

Despite what some headlines might have implied, this study does not indicate that CBD should replace first-line, evidence-based opioid agonist therapies such as methadone and buprenorphine.

These conceptual distinctions are not trivial because they may yield devastating consequences. When it comes to articulating the implications of scientific results that involve medical treatments, language matters. And so do headlines.

Does CBD Interact With Buprenorphine (Sublocade & Belbuca)

CBD can act as a metabolic inhibitor as well as an agonist for the opioid painkiller buprenorphine, enhancing its effects. Is this a safe combination?

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Buprenorphine is a partial opioid agonist used for managing severe pain and opioid withdrawal. It is mostly used in treating pain that has become unresponsive to other forms of treatment.

When used with buprenorphine, cannabidiol (CBD) can serve as a metabolic inhibitor, slowing down its metabolism and making it last longer in the body. Its effect can be enhanced by CBD, making it stronger but also producing additional negative effects.

Table of Contents

Does CBD Interact With Buprenorphine (Sublocade & Belbuca)?

Yes. CBD can interact with buprenorphine.

CBD can make buprenorphine act for a longer time in the body, making it more effective but causing more side effects.

It does this by two methods:

A. Buprenorphine’s Metabolism Can be Slowed Down by CBD (Metabolic Inhibition)

When two medications require the same enzyme to metabolize, metabolic inhibition occurs. As a result, they compete with each other, resulting in a slower metabolization of one or both medicines.

The CYP3A4 enzyme breaks down buprenorphine, but CBD can be metabolized by the same enzyme.

As a result, when they are consumed simultaneously, they compete for the same enzymes, causing an increase in buprenorphine levels. Its clearance is slowed, causing it to stay in the body longer, risking greater negative effects.

B. CBD Can Increase Buprenorphine’s Effects on the Body (Agonistic Interaction)

CBD and buprenorphine may interact agonistically as well.

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When two or more items have the same effect on the body, this is called an agonistic interaction. These chemicals may operate on the same or different receptors but have the same effect.

Buprenorphine produces analgesic and sedative effects by interacting with the opioid receptors of the nervous system and suppressing it.

CBD’s action on the endocannabinoid system can bring analgesic effects.

As a result, taking both medications simultaneously may cause negative effects related to the nervous system’s excessive suppression.

Sedation, loss of consciousness, dizziness, and inability to concentrate are all possible side effects of their interaction.

Other Names For Buprenorphine

Buprenorphine is sold under many different names. All share the same risk and potential interactions.

Other names for buprenorphine include:

  • Belbuca
  • Brixadi
  • Buprenex
  • Butrans
  • Probuphine
  • Sublocade
  • Suboxone
  • Subutex

Similar Medications: CBD & Buprenorphine (Sublocade & Belbuca)

Buprenorphine is classified as an opioid. CBD and opioids all share similar risks for interaction and side effects.

Here’s a list of similar medications that share a similar level of risk when combined with CBD:

Is It Safe to Take CBD & Buprenorphine (Sublocade & Belbuca) Together?

There may be a mild interaction between CBD and buprenorphine.

CBD enhances the effects of buprenorphine by slowing down the clearance time of buprenorphine. These acts may cause buprenorphine’s side effects to worsen.

To lessen the adverse effects of both medications, a low dose of each may be recommended.

Before consuming CBD while on buprenorphine, talk to your physician first. Do not take them by your own accord. If you experience any unusual side effects, contact your physician immediately.

Is CBD a Viable Alternative to Buprenorphine (Sublocade & Belbuca)?

CBD cannot be regarded as a perfect substitute for buprenorphine. While it has analgesic qualities, it may not be as effective as buprenorphine in certain cases.

However, CBD has the potential to be an extremely effective pain reliever, and it could be used as an adjunct to opioids such as buprenorphine.

In patients with chronic pain, CBD hemp extract is useful in reducing discomfort. It can also improve these patients’ quality of life [1].

CBD also possesses antioxidant and anti-inflammatory effects, further helping some painful conditions [2].

What is Buprenorphine (Sublocade & Belbuca)?

Buprenorphine is an opioid analgesic and is FDA-approved. Sublocade and Belbuca are two of the brand names and are used in the management of acute moderate to severe pain.

Buprenorphine Specs

Drug Name Buprenorphine
Trade Name Cizdol, Brixadi, Suboxone, Belbuca, Buprenex, Butrans, Probuphine, Sublocade, Suboxone, Subutex
Classification Opioid
CYP Metabolism CYP3A4
Interaction With CBD Metabolic inhibitor, Agonistic
Risk of Interaction Mild

What Does Buprenorphine Do?

Buprenorphine is a partial mu-opioid receptor agonist and a mild kappa-opioid receptor antagonist that is used to treat severe pain. It’s also a popular substitute for methadone in the treatment of severe opioid addiction.

Because buprenorphine has a low gastrointestinal absorption rate, it is available as a sublingual tablet.

Buprenorphine’s Method of Action

Opioids attach to specific opioid receptors in the nervous system. Opioid receptors are divided into three categories: μ, κ, δ (mu, kappa, and delta). An opioid’s capacities are determined by the receptor to which it binds, and each type of opioid receptor elicits a distinct set of neurological effects. Both the psychotropic and physical effects of opioids are mediated by these receptors. Opioid receptors are G-protein coupled receptors that positively and negatively influence synaptic transmission via downstream signaling.

Buprenorphine primarily interacts with the opioid mu-receptor in the central nervous system. These mu binding sites are found in the human brain, spinal cord, and other tissues. Analgesia and sedation are its major effects. Changes in mood, exhilaration, dysphoria, and tiredness are all possible side effects.

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Buprenorphine causes depression in respiratory centers, suppression of cough reflex, and constriction of pupils.

It is frequently taken with the medication naloxone to lessen the risk of misuse.

Buprenorphine takes a long time to disassociate from opioid receptors, resulting in a long duration of action and alleviation from pain — it can last for almost 24 hours or more. Individuals who have developed tolerance to other strong opioids and require bigger and more frequent doses may benefit from once-daily buprenorphine.

Buprenorphine vs. Other Opioids

Buprenorphine may also be preferable to methadone, a medicine used to treat severe pain and opioid use disorder. It has a lower risk of overdose and respiratory depression, has fewer drug interactions, and has a lower risk of sexual adverse effects.

When compared to other full mu-opioid agonists, buprenorphine operates as a partial mu-opioid receptor agonist with a high affinity for the receptor but lower intrinsic activity. This means that buprenorphine binds to the opioid receptor more and displaces lower affinity opioids without activating the receptor in the same way. This leads to what is clinically known as the “ceiling effect,” in which buprenorphine’s effects plateau once it reaches a particular dose.

When compared to methadone and other full agonist opioids, this effect can be helpful because it reduces the danger of overdose.

It also means that individuals who use buprenorphine do not feel the same levels of drowsiness or euphoria as the users using other opioids. This helps to reduce their drug-seeking behavior.

However, buprenorphine can cause both addiction and withdrawal symptoms as well and must be used very carefully.

Side Effects of Buprenorphine

  • Abdominal pain
  • Asthenia
  • Back pain
  • Chills
  • Constipation
  • Diarrhea
  • Dizziness
  • Dyspepsia
  • Fever
  • Headache
  • Hypotension
  • Hypoventilation
  • Hypersensitivity
  • Infection
  • Insomnia
  • Miosis
  • Nausea
  • Nervousness
  • Pain
  • Rhinitis
  • Runny eyes
  • Sweating
  • Vasodilation
  • Vomiting

Key Takeaways: Is it Safe to Take Buprenorphine (Sublocade & Belbuca) With CBD?

CBD can slow down buprenorphine’s metabolism in the body, making it last longer but with additional negative effects.

As a result, the ideal approach to reduce their interaction is to take them both in minimal doses.

Do not start taking these medications on your own; always consult your prescribing physician first.

Does Suboxone interact with cannabis?

Recent research suggests that cannabis can elevate the levels of buprenorphine/naloxone (Suboxone) in the blood. (1) We also know that both marijuana and Suboxone are depressant drugs, so they suppress the central nervous system and could potentially lead to respiratory depression (slowing or stopping breathing), coma, and even death. The dangers of combining Suboxone with cannabis are not as significant as combining Suboxone with benzodiazepines (like xanax, klonopin, ativan, valium) or with alcohol. However, patients should be aware of this potential threat, especially if they take other sedatives or have underlying lung conditions. If a patient is taking medical marijuana with Suboxone, it is important they let their providers know so that the patient can be appropriately monitored.

There is also some research that suggests that using cannabis can increase the risk for developing an opioid addiction (related to the way the brain processes dopamine). So patients using marijuana should be aware of this risk and reach out for help if they are concerned about developing an opioid addiction.

Citations:

(1) Vierke C, Marxen B, Boettcher M, et al. Buprenorphine–cannabis interaction in patients undergoing opioid maintenance therapy.European Archives of Psychiatry and and Clinical Neuroscience. 2020.