What are the hypothesized neurobiological mechanisms that support the use of cannabidiol (CBD) as a treatment for opioid use disorder (OUD)? How does CBD influence cue-induced craving in OUD? What are the challenges and opportunities in further exploring the use of CBD as a potential treatment for OUD?
In Episode 224 on the NEI Podcast, we are joined by Dr. Joji Suzuki who is the Director of the Division of Addiction Psychiatry and Director of Addictions Education in the Department of Psychiatry, Brigham and Women’s Hospital, and an Assistant Professor of Psychiatry at Harvard Medical School. His areas of clinical and research interests are the assessment and management of substance use disorders and related conditions in general medical settings, motivational interviewing, office-based opioid treatment, implementation of collaborative models of care, and medical education. He is the site director for the Partners Addiction Psychiatry Fellowship, and is involved with teaching medical students, residents, and allied health professionals. He has authored over 30 peer-reviewed manuscripts and book chapters related to addiction psychiatry.
Transcript Excerpt:
Dr. Joji Suzuki: When you think about pharmacotherapies for all kinds of chronic illnesses, the norm for most conditions is to begin targeting multiple mechanisms of action. You know, so whether it's diabetes, hypertension, cancer, asthma, you're never satisfied with just one mechanism. So, you know, if it's hypertension, you don't just push diuretics. And if it doesn't work, you think, okay, let's try another diuretic. And let's go up with a dose. Let's try another diuretic. I mean, at some point you realize pretty quickly that let's try other approaches.When it comes to OUD, that's really not been the case. We do buprenorphine. If it doesn't work, we recommend methadone. If it doesn't work, we use naltrexone. And that's about it.
Dr. Andrew Cutler: I was going to ask about naltrexone. You know, again, it's still an opioid manipulation.
Dr. Joji Suzuki: Yeah, technically, pharmacologically, it is an opioid. It's an opioid antagonist. People get confused because, well, it's not an opioid, right? But it is an opioid. It just has, you know, provides no activity, but still an opioid, you know. So it's really all the main options are opioids. And when agonist, antagonist, and that's it. And now, of course, I would strongly argue that the those agonist therapies are quite effective. But the reality is we need to do better. And as the statistics around overdose status, etc. are clearly indicating, we're barely keeping up if in fact we're falling behind.
Dr. Andrew Cutler: Yeah, there's still certainly quite a bit of risk, I would say, even if there's decent efficacy.