The pharmacopoeia dedicated to relieving the symptoms of opioid withdrawal and so-called "drug-resistant" or "refractory" epilepsies could be enriched with the inclusion of drugs based on cannabidiol or CBD, a non-psychotropic and non-addictive molecule extracted from industrial hemp. A look back at these studies that offer hope...
A real public health problem in OECD countries, opioid addiction is a major concern for health authorities.
According to figures from the National Agency for the Safety of Medicines and Health Products (ANSM), the prescription of these analgesic drugs with codeine, fentanyl or even methadone more than doubled (+150%) between 2006 and 2017.
Also, the number of hospitalizations linked to the consumption of opioid analgesics obtained on medical prescription almost tripled (+ 167%) between 2000 and 2017, going from 15 to 40 hospitalizations per million inhabitants. The number of deaths attributed to the overuse of these powerful painkillers has increased by 146%, now standing at “at least one death every 42 hours » , can we read in a communication from the Health Insurance.
Part of the increase in the consumption of opioids can be explained by the ministerial plans for the improvement of pain management implemented from 1998. On the other hand, opioids are known to be addictive , with moderate to heavy withdrawal symptoms. It is therefore quite natural that the scientific community tests and evaluates new therapeutic protocols to facilitate the management of cases of addiction to these analgesics. With its analgesic, relaxing and anti-inflammatory properties, CBD and medical cannabis were logically considered.
"Legal cannabis is not the hoped-for anti-opioid weapon", headlined the magazine Slate.fr in July 2021, echoing a publication in the journal Health Economics. We learn that the number of emergency room admissions related to opioids has actually decreased (-7.6%) in several American states (California, Maine, Massachusetts and Nevada) after the legalization of recreational marijuana , but not over time, the decline being limited to the first six months following legalization.
Other studies have shown more encouraging results. This is particularly the case of a survey published in the British Medical Journal, which explains that deaths by overdose of opioids could be reduced by 17% with the establishment of “one or two cannabis dispensaries per county ". Finally, a study published in the journal "Addiction" explains that subjects with an addiction to heroin, which is a non-medical opioid, are less likely to consume this substance if they consume recreational cannabis as part of a weaning protocol.
Discontinuation of opioid medication after a certain period of "use" usually results in the same symptoms seen in opioid withdrawal , certain drugs or even nicotine.
The subjects indeed report psychic symptoms (dysphoria, cravings, stress, anxiety, episodes of insomnia, fatigue or even asthenia), and flu-like symptoms with in particular myalgia, chills, nausea, and transit disorders (especially diarrhea). Stopping opioids is also accompanied by a number of signs that can impact the daily life of the subject:agitation, nervousness, sweating, piloerection (goosebumps) and tachycardia. These symptoms usually occur between 12 and 24 hours after the last dose and reach a peak on the third day. Insomnia, stress and cravings can persist for several weeks.
A meta-analysis published on October 22, 2021 looked at the potential of cannabidiol in relieving symptoms of opioid withdrawal by reviewing 144 previous studies. Here is a summary of its main conclusions:
Despite these encouraging results, further studies are still needed to assess the therapeutic potential of CBD in opioid withdrawal.
This neurological disease affects more than 700,000 French people, making it the most common neurological disorder after migraine . On February 8, 2021, on the occasion of World Epilepsy Day, the Epilepsie France association denounced "the ordeal of families for lack of follow-up .
Despite encouraging advances in the management of patients with this convulsive disorder, between 20 and 30% of cases of epilepsy do not respond to accessible treatments . This is called “drug-resistant” or “refractory” epilepsies.
In search of innovative treatments to improve the daily lives of patients, the Ministry of Solidarity and Health has launched a major experiment to assess the potential therapeutic use of cannabidiol and THC in the management of refractory forms of epilepsy. More broadly, this clinical trial, which will last two years, will align with the indications defined by the ANSM, namely:
In March 2021, the Minister of Health Olivier Véran attended the very first prescription of medical cannabidiol to a patient suffering from epilepsy at Clermont-Ferrand University Hospital. The therapeutic protocol generally consists of a 100% CBD drug in oil form, which can optionally be substituted with a 50% CBD and 50% THC drug depending on the evolution of the patient's condition.
The experiment will focus both on the effectiveness of these two molecules, but also on the minimum effective doses. Remember that if CBD is generally well tolerated , with mainly temporary digestive side effects, THC is a psychotropic and highly addictive molecule. The results of this unprecedented experiment should be communicated in the second half of 2023. Although on a smaller scale, previous studies predict convincing results.
Work published between 2017 and 2018 by Professor Orrin Devinsky, a leading seizure disorder researcher and director of NYU Comprehensive Epilepsy Center, highlighted the ability of cannabidiol to improve the daily patients suffering from certain forms of severe epilepsy.
In a randomized, controlled, double-blind study, 10% cannabidiol oil reduced the frequency of atonic seizures (-42%) in children with Lennox–Gastaut syndrome, a progressive epileptic syndrome that manifests as tonic absence seizures and intellectual disability. The side effects observed were described as "mild" by the researchers, with in particular transient transit disorders and daytime drowsiness, no doubt linked to the relaxing effect of cannabidiol.
Another randomized, double-blind study evaluated the potential of CBD (in the form of a 10% controlled-manufacture oil) in relieving the symptoms and manifestations of Dravet syndrome in children . This severe form of epilepsy, also called severe myoclonic epilepsy of infancy, results in uncontrolled seizures and developmental problems. CBD oil 10% reduced the number of seizures by 50%, but only in 43% of patients (compared to 27% for patients on placebo).
Finally, a non-randomized study highlighted a 50% reduction in monthly seizures in 52% of patients supplemented with cannabidiol and suffering from drug-resistant epilepsy.
In view of all these elements, and if cannabidiol cannot be qualified as a miracle cure , it seems to add value to the pharmacopoeia dedicated to neurological disorders and to the therapeutic arsenal for the relief of pain, stress and anxiety. The experiment carried out by the Ministry of Solidarity and Health should provide more answers and enrich the knowledge of the scientific community in this area.
With nearly 7 million consumers, cannabidiol-based products are arousing a certain enthusiasm in France. According to figures from the association Interchanvr relayed by the media LSA Conso, the French cannabidiol market would amount to 300 million euros , and the number of stores specializing in CBD-based products would have increased from 400 in 2020 to more than 2,000 at the end of 2021… A performance that is all the more impressive since the legal status of the molecule has changed twice in recent years. month.
Indeed, a ministerial decree had banned the marketing of pure CBD leaves and flowers on December 31, 2021, arousing the anger of professionals in the sector threatened with putting the key under the doormat . Seized by the latter, the Council of State temporarily lifted this ban which it described as "unjustified" and "disproportionate", insofar as the CBD authorized for marketing has less than 0.3% THC. and therefore has no psychotropic effect . Let us recall here the position of the Scientific Committee of the World Health Organization (WHO), which considers that cannabidiol “does not present a risk of abuse or harm to public health .
The French CBD market seems to be boosted by several factors :