Just three days of CBD (400-800mg) significantly reduced heroin craving, anxiety, heart rate, and cortisol in response to drug cues — with effects persisting for at least one week — in a double-blind, placebo-controlled trial.
People with opioid use disorder; addiction medicine clinicians; harm reduction advocates; anyone interested in CBD's therapeutic potential beyond pain.
7 days — duration of craving and anxiety reduction after just 3 days of CBD
The Backstory
Addiction craving is one of the hardest things in medicine to treat. A recovering heroin user can be months into abstinence, feeling physically fine, and then encounter a cue — a street corner, a smell, a person — and experience a surge of desire so intense it overrides rational decision-making. Craving is the engine of relapse, and relapse from opioid use disorder kills.
The existing medications for opioid use disorder — methadone and buprenorphine — are effective. They save lives. But they carry their own dependence risks, face enormous stigma, and are inaccessible to millions who need them. The idea that a non-psychoactive, non-addictive cannabinoid might dampen the neural machinery of craving seemed almost too good to be true.
Yasmin Hurd's team at Mount Sinai tested it with the gold standard of clinical evidence: a double-blind, randomized, placebo-controlled trial. And the results were remarkable.
The Trial
Hurd enrolled individuals with heroin use disorder who were abstinent but not currently on medication-assisted treatment. They were randomized to receive CBD (400 or 800 mg) or placebo once daily for three consecutive days. Then they were exposed to drug cues — images, videos, and paraphernalia associated with heroin use — designed to trigger craving. Craving, anxiety, and physiological responses were measured at three time points: acute (1 hour after first dose), short-term (24 hours after last dose), and protracted (7 days after last dose).
Clinical Trial
CBD for Heroin Craving: Key Results
Significant
Craving reduction
vs. placebo during drug cue exposure
Significant
Anxiety reduction
vs. placebo during drug cue exposure
7 days
Effect persisted
after just 3 days of CBD dosing
Zero
Cognitive impairment
no adverse effects on cognition
Hurd et al. (2019), Am J Psychiatry 176(11):911-922
Why the Duration Matters
The most striking finding wasn't just that CBD reduced craving — it was that the effect lasted. A single three-day course of CBD produced measurable craving reduction that persisted for at least seven days after the final dose. This suggests CBD isn't just masking craving in the moment — it's modulating the underlying neural circuits that generate it.
7 days
the duration of craving and anxiety reduction after just three days of CBD — effects that persisted one week after the last dose, suggesting CBD modulates the underlying neural circuitry rather than providing momentary relief.
By comparison, a benzodiazepine's anxiolytic effect lasts hours, not days. The protracted effect of CBD suggests it may be reshaping the neural response to drug cues rather than simply dampening it acutely.
Hurd et al. (2019), Am J Psychiatry
The Physiology
CBD didn't just change how participants reported feeling — it changed their bodies' responses to drug cues.
Process
What CBD Changed During Drug Cue Exposure
Cue presentation
Participants were shown heroin-related images and paraphernalia — a validated method for inducing craving in controlled settings. Neutral images served as controls.
Craving response
The CBD group reported significantly less craving when exposed to drug cues compared to the placebo group. The reduction was consistent across both dose levels (400mg and 800mg).
Anxiety response
CBD significantly reduced the anxiety that accompanies cue-induced craving — a critical finding because anxiety is itself a relapse trigger.
Heart rate
Drug cue-induced heart rate elevation was significantly reduced in the CBD group — an objective physiological measure that can't be faked.
Cortisol
Salivary cortisol levels (a stress hormone marker) were reduced in the CBD group during cue exposure — confirming the anxiolytic effect at a hormonal level.
Cognition preserved
No cognitive impairment was observed — unlike many psychiatric medications used in addiction treatment, CBD didn't cloud thinking or impair function.
Hurd et al. (2019)
The Mechanism
Pharmacology
How CBD Might Reduce Craving
FAAH inhibition
CBD inhibits fatty acid amide hydrolase (FAAH), the enzyme that breaks down anandamide. Higher anandamide levels in reward circuits may normalize the dysregulated endocannabinoid signaling that drives craving.
5-HT1A activation
CBD acts as a partial agonist at serotonin 5-HT1A receptors — the same target as buspirone (an anti-anxiety drug). This may explain the anxiolytic effect.
Amygdala modulation
Preliminary imaging data suggests CBD reduces amygdala and prefrontal cortex activation in response to drug cues — the same brain regions that drive emotional reactions to triggers in addiction.
No reward activation
Unlike THC, CBD does not activate reward circuits. It reduces craving without producing any high — eliminating the risk of substituting one substance dependence for another.
Hurd et al. (2019); Leweke et al. (2012)
The mechanism parallels what Leweke found in schizophrenia: CBD appears to work by boosting the body's own endocannabinoid signaling (via FAAH inhibition) rather than by directly binding to cannabinoid receptors. Higher anandamide levels, maintained for longer, may help stabilize the reward circuits that are dysregulated in addiction.
The Bigger Picture
Yasmin Hurd has been studying cannabinoid-opioid interactions for over two decades. Her preclinical work showed that CBD reduced heroin self-administration in rats and attenuated heroin-seeking behavior after cue exposure. The human trial was the culmination of a systematic research program that moved from basic science to clinical application.
The significance extends beyond heroin. If CBD can modulate craving circuits for opioids, it might work for other substances too — alcohol, cocaine, even cannabis use disorder itself. The mechanism (endocannabinoid modulation of reward circuits) is fundamental enough to be relevant across substance types.
For the millions of people struggling with opioid dependence, and for the families and communities devastated by the opioid crisis, a non-addictive, non-psychoactive compound that reduces craving with a favorable side effect profile is exactly the kind of tool that's desperately needed. The trial was small, and Phase III trials are required before any clinical recommendations can be made. But the signal was strong, the mechanism is well-characterized, and the unmet need is enormous.
Related Research
CBD, Addiction, and the Endocannabinoid System
From craving reduction to the broader pharmacology of endocannabinoid modulation.
CBD as an antipsychotic
Leweke et al. (2012)
Same mechanism (FAAH inhibition → increased anandamide) applied to psychosis. CBD's therapeutic versatility stems from this endocannabinoid-boosting action.
Medical marijuana laws and opioid mortality
Bachhuber et al. (2014)
Population-level data: states with cannabis access have fewer opioid deaths. Hurd's trial provides one possible individual-level mechanism.
Patients substitute cannabis for opioids
Boehnke et al. (2016)
Patient-reported substitution patterns — Hurd's CBD-specific approach offers a non-psychoactive version of this harm reduction strategy.
Anandamide discovery
Devane et al. (1992)
The molecule CBD preserves — FAAH inhibition keeps anandamide active longer, the proposed mechanism behind craving reduction.
Can CBD help people quit heroin or other opioids?
In this gold-standard clinical trial, CBD (400-800mg) significantly reduced craving and anxiety in people with heroin use disorder when exposed to drug cues. Effects lasted at least 7 days after just 3 days of treatment. This is promising but preliminary — the trial was small, and CBD should not replace proven medication-assisted treatments (methadone, buprenorphine) without further evidence. Phase III trials are needed before CBD can be recommended for opioid use disorder.
How much CBD was used in the study?
Participants received either 400mg or 800mg of pharmaceutical-grade CBD once daily for 3 days. Both doses were effective. These are high doses compared to most commercial CBD products (which typically contain 10-50mg per serving). The quality and bioavailability of research-grade CBD differs substantially from over-the-counter products.
Does CBD work for other types of addiction?
The mechanism (FAAH inhibition and 5-HT1A modulation) is not specific to opioid craving — it affects general reward circuitry. Preliminary evidence suggests potential benefit for alcohol, tobacco, and even cannabis dependence. But clinical trial data beyond opioids is limited.
What the researchers found
CBD significantly reduced cue-induced craving and anxiety in heroin use disorder, with effects persisting 7 days post-treatment. Also reduced heart rate and cortisol responses to drug cues. No cognitive impairment.
Why it matters
First gold-standard clinical evidence that a non-psychoactive, non-addictive cannabinoid can reduce drug craving. Opens a new therapeutic avenue for opioid use disorder with a favorable safety profile.
How the study worked
Double-blind, randomized, placebo-controlled trial. Participants with heroin use disorder received CBD (400mg or 800mg) or placebo daily for 3 days. Outcomes measured at acute (1h), short-term (24h post-last dose), and protracted (7 days post) timepoints during drug cue exposure paradigm.
What this study cannot tell us
Small sample size. Short treatment period (3 days). Laboratory cue exposure differs from real-world triggers. Participants were not on MAT. Phase III trials needed. Commercial CBD products differ from research-grade formulations.
How to read the evidence
Double-blind, randomized, placebo-controlled trial — the gold standard. Small sample but strong design and consistent results across multiple outcome measures.
When this study was published
Published 2019. Phase III trials are underway.
The bigger picture
Addiction craving is one of the hardest problems in medicine. CBD offers a new mechanism (FAAH inhibition → increased anandamide) distinct from existing treatments. If Phase III trials confirm, CBD could become a non-addictive adjunct or alternative for medication-assisted treatment.
Questions still open
- Can CBD reduce craving for other substances? What is the optimal dose and duration? Can CBD be combined with methadone/buprenorphine?
Common questions
Read the original research
Cannabidiol for the Reduction of Cue-Induced Craving and Anxiety in Drug-Abstinent Individuals With Heroin Use Disorder: A Double-Blind Randomized Placebo-Controlled Trial.
American Journal of Psychiatry, 176(11), 911-922
Citation
Hurd, Yasmin L; Spriggs, Sharron; Alishayev, Julia; Winkel, Gary; Gurgov, Kristina; Kudrich, Chris; Oprescu, Anna M; Salsitz, Edwin. (2019). Cannabidiol for the Reduction of Cue-Induced Craving and Anxiety in Drug-Abstinent Individuals With Heroin Use Disorder: A Double-Blind Randomized Placebo-Controlled Trial.. American Journal of Psychiatry, 176(11), 911-922. https://doi.org/10.1176/appi.ajp.2019.18101191