CBD Reduced Heroin Craving and Anxiety in a Gold-Standard Clinical Trial
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.
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.
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).
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.
The Mechanism
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.
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Cite this study
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