CBD Trial in Crack Use Disorder Shows Fewer Reported Side Effects, but No Clear Advantage in Reducing Use or Craving
A small randomized trial in Brazil found that cannabidiol (CBD) was generally well tolerated by people with crack use disorder, but it did not demonstrate a clear advantage over existing medication-based treatment in reducing crack use or cravings.
The study published in the International Journal of Mental Health and Addiction was designed primarily to assess the feasibility, safety and preliminary effectiveness of CBD in an outpatient setting. Researchers compared pharmaceutical-grade CBD with a treatment regimen consisting of fluoxetine, valproic acid and clonazepam—medications used in Brazilian clinical practice to address symptoms associated with crack use disorder, rather than an established, approved treatment for the disorder itself.
The trial recruited adults in Brasília, Brazil, who had used crack at least 20 times in the previous 30 days, had a history of regular use lasting at least a year, and wanted to seek treatment. Participants could also use other substances, reflecting the polydrug use often seen in real-world addiction-treatment settings.
Of 90 people who met the initial eligibility criteria, 73 were ultimately assigned to a treatment group: 36 received CBD and 37 received the comparison medications. The treatment lasted 10 weeks, with CBD administered at up to 600 milligrams per day. However, retention was a major limitation: only 34 participants reached the halfway point, and just 25 completed the full protocol.
Among participants who remained in the study, the researchers found no statistically significant difference between the groups in the reduction of crack use. There was also no clear between-group difference in self-reported craving. Crack use declined within the CBD group during parts of the trial, but similar within-group changes were also observed in the comparison group; these findings do not establish that CBD was responsible for the reduction.
CBD was associated with fewer reported adverse events than the comparison regimen. Participants in the CBD group reported fewer episodes of diarrhea, constipation, nausea, dizziness, memory impairment, reduced concentration, tremor, ataxia and nasal congestion. In contrast, the comparison group showed a greater reduction in combined clinical and psychiatric complaints during one study interval.
The researchers described the results as preliminary and emphasized the need for larger studies with stronger participant screening, closer monitoring and better retention. The study was also conducted at a single site, and its high dropout rate means the results may not represent people with crack use disorder more broadly.
Interest in CBD as a potential treatment for stimulant use disorders has partly come from animal studies and research suggesting that the compound may affect systems involved in reward, stress and drug-seeking behavior. But promising biological mechanisms and animal findings do not demonstrate clinical effectiveness in humans. Earlier human research on CBD for crack-cocaine craving likewise did not find a significant reduction in craving compared with placebo.
CBD is not an established treatment for crack use disorder. In the United States, the National Institute on Drug Abuse notes that no medication has been approved by the FDA to treat cocaine addiction. The FDA has approved one prescription CBD product for certain seizure disorders, but warns that CBD can cause liver injury, interact with other medications and produce side effects such as drowsiness and gastrointestinal problems. Those risks, along with the uncertain quality of many nonprescription CBD products, make medical supervision important.
The Brazilian trial provides a rationale for further research, particularly into whether CBD might have a role as part of a broader treatment program. It does not, however, show that CBD is a potent or proven therapy for crack use disorder. For now, its clearest finding is that CBD appeared tolerable in this small, high-dropout study while offering no demonstrated advantage over the comparison treatment in the main measures of drug use or craving.
