Can CBD Help in Giving Up Smoking? Exploring the Potential of CBD in Smoking Cessation

You may be surprised to learn that CBD is being investigated for smoking cessation. On the occasion of World No Tobacco Day, we bring you a post where we address this issue in depth.

Tobacco addiction is a global health problem that causes numerous diseases and is responsible for millions of deaths each year. Despite efforts to find effective methods to overcome this addiction, success rates remain low. In this context, there has been a growing interest in the use of cannabidiol (CBD), a compound present in the cannabis plant, with therapeutic potential to become a possible tool to help people quit smoking.

Let’s see what is currently known about the subject and whether it is true that CBD can be a promising ally in a tobacco-free life.

What is CBD and how can it help overcome tobacco addiction?

CBD: A cannabis compound to say goodbye to tobacco?

The CBD or cannabidiol is a non-addictive compound in cannabis that has gained popularity in recent years due to its potential therapeutic properties and low toxicity compared to other cannabinoids, such as tetrahydrocannabinol (THC), which is responsible for the psychoactive effects of marijuana.

Several studies have explored the role of CBD in the treatment of different addictions, including tobacco addiction. Among its potential benefits studied, CBD may help reduce cravings and alleviate withdrawal symptoms.

It is important to mention that tobacco addiction requires a comprehensive approach to treatment. Consultation with professionals to quit smoking.

How big is the smoking problem in Spain?

Smoking is a public health problem worldwide. It is closely related to numerous serious diseases, such as lung cancer, cardiovascular diseases and chronic respiratory diseases. Tobacco addiction is the leading preventable cause of death and disability worldwide.

According to data from the National Plan on Drugs (1), 33% of citizens between 15 and 64 years of age smoke tobacco on a daily basis. Smoking is the leading cause of mortality and preventable disease. In Spain, smoking has a devastating impact, causing between 50,000 and 60,000 deaths annually (2). This is equivalent to the population of a city the size of Malaga, Palma de Mallorca or Murcia disappearing every year.

How does CBD work for smoking cessation?

CBD has pharmacological properties that make it a good candidate as a drug to treat addictive disorders:

Reduction of anxiety symptoms

CBD modulates cannabinoid receptor activity, and has been shown to have anxiolytic and anti-stress properties, which may help reduce the unpleasant symptoms of anxiety and stress experienced when quitting tobacco smoking (3).

Decreased nicotine cravings

CBD interacts with the brain’s reward circuits, helping to reduce the pleasurable effect of drugs and decreasing the motivation to use them, which may reduce cravings for smoking (4).

Some of the components of the endocannabinoid system, such as FAAH (fatty acid amide hydrolase enzyme), play an important role in the reinforcing and pleasurable effects of nicotine (5).

Alteration of consumption associations

CBD acts on brain areas related to memory and learning, which may help break associations between smoking and stimuli that trigger cravings (6).

Anti-inflammatory and neuroprotective properties

CBD has anti-inflammatory and antioxidant properties, which may contribute to reducing neuroinflammation and neuronal damage associated with substance dependence, including tobacco (7).

Scientific studies on CBD for smoking cessation

There are a growing number of studies suggesting that CBD may have some utility in the treatment of nicotine addiction.

Basic research studies have shown that cannabidiol and one of its metabolites (7-OH-CBD) interact with the body’s mechanisms for nicotine elimination (8). It has also been observed that CBD has specific effects inhibiting the action of the enzyme FAAH, which could reduce the activation of the brain reward mechanism circuits on which nicotine acts (9). In animal models commonly used to study nicotine dependence, CBD has been shown to be effective in acute withdrawal syndrome (9, 10).

Smoking cessation with CBD: human studies

In a small study (11), researchers examined whether cannabidiol could help smokers who wanted to quit smoking. Twenty-four smokers were divided into two groups: one group received a inhaler with CBD while the other group received an inhaler with a placebo (inactive substance). Participants were instructed to use the inhaler when they felt the desire to smoke for one week.

The results showed that smokers using the placebo inhaler did not reduce the number of cigarettes smoked during the treatment week. However, the group using the CBD vape significantly reduced their cigarette consumption by approximately 40% during the treatment period. The positive effects of CBD appeared to persist even after treatment ended.

In another study comparing CBD and placebo (12), results showed that when smokers went without smoking during the night, their attention was more focused on things related to smoking and they experienced more intense cravings. However, when they took CBD, their attention was diverted from smoking-related cues and cravings were reduced. CBD also made images related to smoking less pleasurable for them. In addition, CBD reduced blood pressure.

These findings suggest that CBD could potentially be helpful for smokers who wish to quit smoking by reducing their focus on smoking-related cues and making the experience less pleasurable.

How to use CBD to quit smoking

CBD can be found in CBD flowers, CBD oil, CBD e-Liquid and CBD vapes. Depending on the country, it can also be found in capsules and edibles such as jelly beans. The regulation of these products depends on the country: find out more.

Studies have used oral or vaporized CBD. Although the potential of cannabidiol to treat addictions has been demonstrated and there is preliminary evidence of its effectiveness in smoking cessation, CBD is not currently an approved drug to treat tobacco addiction. Therefore, it is not possible to indicate one method that works better than another.

CBD dosage

CBD for smoking cessation is in the research phase and it is not possible to extract a standard dose that works for everyone. In the study using CBD inhalations (11), a vape liquid with a 5% concentration of CBD was used. Most studies that have explored the potential of CBD as a drug for the treatment of addiction have used doses between 300 and 600 mg of CBD per day.

Can vaporizers help to quit smoking?

For the past two years, a sort of “witch hunt” has been raging around electronic cigarettes and vaporizers. The official argument supports assertions that are not compatible with rational thinking, such as, for example, that smoking and vaping “are the same thing”.

However, the reality is more complex. One of the most prestigious and rigorous sources of analysis of scientific studies in medicine, the Cochrane Collaboration, considers e-cigarettes to be at least as effective as nicotine replacement therapy (14). As a risk reduction strategy, the electronic cigarette is part of the Public Health strategies against smoking accepted by the Ministry of Health in countries such as Canada (15), New Zealand (16) or the United Kingdom (17).

Benefits of quitting smoking

What are the benefits of quitting smoking?

In terms of health, quitting smoking is the most important decision a person can make at any time in his or her life. No matter the age or physical condition. The benefits of quitting tobacco become evident soon after quitting (18):

  • After 20 minutes: Blood pressure and heart rate begin to decrease.
  • After 8 hours: Carbon monoxide levels in the blood decrease and oxygen levels normalize.
  • After 48 hours: Nicotine is eliminated from the body and the senses of taste and smell begin to improve.
  • After 72 hours: Lung capacity increases and breathing becomes easier.
  • After 2 to 3 months: Blood circulation improves, reducing fatigue and shortness of breath.
  • After 1 year: The risk of heart disease is reduced by half compared to a smoker.
  • After 5 years: The risk of cancer of the mouth, throat, esophagus and bladder is reduced by half.
  • After 10 years: The risk of lung cancer is reduced by half compared to a smoker, and the risk of stroke decreases.
  • After 15 years: The risk of heart disease is equal to that of a person who has never smoked.

Current approved treatments for tobacco addiction

Understanding tobacco addiction

Tobacco is addictive mainly due to the effects of nicotine on the brain. Nicotine activates nicotinic acetylcholine receptors, located in brain reward areas, producing the release of neurotransmitters associated with pleasure, such as dopamine.

Tobacco addiction develops because the brain becomes less and less sensitive to nicotine, and a greater amount of nicotine is required to obtain the same effect. As a result, smokers tend to increase the amount of tobacco to obtain the pleasurable effects (19).

Moreover, although tobacco addiction has been attributed primarily to nicotine, increasing evidence suggests that smoking is rooted in behaviors acquired over time. This suggests that the approach to smoking as an organic brain disease caused by nicotine is insufficient. Nicotine addiction should be approached in a comprehensive manner, considering biological, psychological and social aspects. For this reason, it is recommended to consult a professional specialized in addiction treatment.

What drugs are currently approved for smoking cessation?

In 2023, the options available in Spain are:

  • Nicotine replacement therapy: In the form of gum, candy, patches or sprays (20)
  • Bupropion (Zyntabac, Elontril): An amphetamine derivative with antidepressant properties and stimulant profile (21).
  • Cytisine (Todacitan): An alkaloid extracted from trees of the genus Laburnum approved in February 2023. The evidence on its efficacy is of “moderate quality” (22).
  • Varenicline (Champix): The manufacturing laboratory decided to suspend its production definitively in September 2021 due to the presence of carcinogenic substances (nitrosamines) in the manufacturing process. Interestingly, the laboratory was to lose exclusivity rights to this drug two months later. The experts considered that “one steak has as many nitrosamines as 3000 Champix tablets”.

How effective are current smoking cessation treatments?

It is often said that these drugs “double or triple the chances of success of a quit attempt” (20, 21, 22). This statement is true, but it should be added that:

  • The probability of achieving smoking cessation with placebo is 8-10%. In other words, doubling or tripling this effect means a real efficacy of 16-30% (20, 22).
  • Most of the available studies are designed to measure efficacy over a 6-month period. That is, they consider people to have “quit smoking” after 6 months of abstinence. But when their efficacy is assessed over longer periods (5 to 10 years) the results are considerably poorer (23).

In short, smoking is a major public health problem for which treatment options are scarce and ineffective. For this reason, it is essential to explore alternatives to alleviate its consequences, such as CBD.

With respect to CBD for smoking cessation, larger scale research with longer follow-up is required to fully assess the potential of this substance in the treatment of smoking. Consult with your physician before using CBD.

Referencias
  1. Spanish Ministry of Health. EDADES 2022 National Report. Available at: https://pnsd.sanidad.gob.es/profesionales/sistemasInformacion/sistemaInformacion/pdf/2022_Informe_EDADES.pdf
  2. Pérez-Ríos M, Fernández E, López MJ. Mortality attributed to smoking in Spain: Quo vadis? Archives of Bronchopneumology, Editorial, 2021. DOI: 10.1016/j.arbres.2020.12.035
  3. Campos AC, Moreira FA, Gomes FV, Del Bel EA, Guimarães FS. Multiple mechanisms involved in the large-spectrum therapeutic potential of cannabidiol in psychiatric disorders. Philos Trans R Soc Lond B Biol Sci. 2012 Dec 5;367(1607):3364-78. doi: 10.1098/rstb.2011.0389. PMID: 23108553; PMCID: PMC3481531.
  4. Galaj E, Bi GH, Yang HJ, Xi ZX. Cannabidiol attenuates the rewarding effects of cocaine in rats by CB2, 5-HT1A and TRPV1 receptor mechanisms. Neuropharmacology. 2020 May 1;167:107740. doi: 10.1016/j.neuropharm.2019.107740. Epub 2019 Aug 19. PMID: 3143743333; PMCID: PMC7493134.
  5. Muldoon PP, Lichtman AH, Parsons LH, Damaj MI. The role of fatty acid amide hydrolase inhibition in nicotine reward and dependence. Life Sci. 2013 Mar 19;92(8-9):458-62. doi: 10.1016/j.lfs.2012.05.015. Epub 2012 Jun 12. PMID: 22705310; PMCID: PMC3477273.
  6. Uhernik AL, Montoya ZT, Balkissoon CD, Smith JP. Learning and memory is modulated by cannabidiol when administered during trace fear-conditioning. Neurobiol Learn Mem. 2018 Mar;149:68-76. doi: 10.1016/j.nlm.2018.02.009. Epub 2018 Feb 9. PMID: 29432803.
  7. Jîtcă G, Ősz BE, Vari CE, Rusz CM, Tero-Vescan A, Pușcaș A. Cannabidiol: Bridge between Antioxidant Effect, Cellular Protection, and Cognitive and Physical Performance. Antioxidants (Basel). 2023 Feb 14;12(2):485. doi: 10.3390/antiox12020485. PMID: 36830042; PMCID: PMC9952814.
  8. Nasrin S, Coates S, Bardhi K, Watson C, Muscat J, Lazarus P. Inhibition of Nicotine Metabolism by Cannabidiol (CBD) and 7-Hydroxycannabidiol (7-OH-CBD). Chem. Res. Toxicol. 2023, 36, 2, 177-187 Publication Date:January 10, 2023. DOI: https://doi.org/10.1021/acs.chemrestox.2c00259
  9. Saravia R, Ten-Blanco M, Pereda-Pérez I, Berrendero F. New Insights in the Involvement of the Endocannabinoid System and Natural Cannabinoids in Nicotine Dependence. Int. J. Mol. Sci. 2021, 22(24), 13316; https://doi.org/10.3390/ijms222413316
  10. Smith LC, Tieu L, Suhandynata RT, Boomhower B, Hoffman M, Sepulveda Y, Carrette LLG, Momper JD, Fitzgerald RL, Hanham K, Dowling J, Kallupi M, George O. Cannabidiol reduces withdrawal symptoms in nicotine-dependent rats. Psychopharmacology (Berl). 2021 Aug;238(8):2201-2211. doi: 10.1007/s00213-021-05845-4. Epub 2021 Apr 28. PMID: 33909102; PMCID: PMC8295227.
  11. Morgan CJ, Das RK, Joye A, Curran HV, Kamboj SK. Cannabidiol reduces cigarette consumption in tobacco smokers: preliminary findings. Addict Behav. 2013 Sep;38(9):2433-6. doi: 10.1016/j.addbeh.2013.03.011. Epub 2013 Apr 1. PMID: 23685330.
  12. Hindocha C, Freeman TP, Grabski M, Stroud JB, Crudgington H, Davies AC, Das RK, Lawn W, Morgan CJA, Curran HV. Cannabidiol reverses attentional bias to cigarette cues in a human experimental model of tobacco withdrawal. Addiction. 2018 May 1;113(9):1696-705. doi: 10.1111/add.14243. Epub ahead of print. PMID: 29714034; PMCID: PMC6099309.
  13. Gournay LR, Petry J, Bilsky S, Hill MA, Feldner M, Peters E, Bonn-Miller M, Leen-Feldner E. Cannabidiol Reduces Nicotine Withdrawal Severity and State Anxiety During an Acute E-cigarette Abstinence Period: A Novel, Open-Label Study. Cannabis Cannabinoid Res. 2023 May 11. doi: 10.1089/can.2022.0317. Epub ahead of print. PMID: 37167367.
  14. Hartmann-Boyce J, Lindson N, Butler AR, McRobbie H, Bullen C, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Fanshawe TR, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2022, Issue 11. Art. No.: CD010216. DOI: 10.1002/14651858.CD010216.pub7
  15. Health Services of Canada Government of Canada. Available at: https://www.canada.ca/en/health-canada/services/smoking-tobacco/vaping.html
  16. Ministry of Health of New Zealand. Tobacco control Program, information for practitioners. Available at: https://www.health.govt.nz/our-work/preventative-health-wellness/tobacco-control/tobacco-control-information-practitioners/vaping-products-information-health-care-workers-and-stop-smoking-services
  17. NHS, National Health Service of England. Quit Smoking: Using e-cigarettes to stop smoking. Available at: https://www.nhs.uk/live-well/quit-smoking/using-e-cigarettes-to-stop-smoking/
  18. National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2014. 4, Advances in Knowledge of the Health Consequences of Smoking: From 1964-2014. Available from: https://www.ncbi.nlm.nih.gov/books/NBK294317/
  19. Mansvelder HD, McGehee DS. Long-term potentiation of excitatory inputs to brain reward areas by nicotine. Neuron. 2000 Aug;27(2):349-57. doi: 10.1016/s0896-6273(00)00042-8. PMID: 10985354.
  20. Stead LF, Perera R, Bullen C, Mant D, Hartmann-Boyce J, Cahill K, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2012 Nov 14;11:CD000146. doi: 10.1002/14651858.CD000146.pub4. Update in: Cochrane Database Syst Rev. 2018 May 31;5:CD000146. PMID: 23152200.
  21. Guo K, Wang S, Shang X, E F, Hou L, Li J, Li Y, Yang K, Li X. The effect of Varenicline and Bupropion on smoking cessation: A network meta-analysis of 20 randomized controlled trials. Addict Behav. 2022 Aug;131:107329. doi: 10.1016/j.addbeh.2022.107329. Epub 2022 Apr 5. PMID: 35397262.
  22. Livingstone-Banks J, Fanshawe TR, Thomas KH, Theodoulou A, Hajizadeh A, Hartman L, Lindson N. Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews 2023, Issue 5. Art. No.: CD006103. DOI: 10.1002/14651858.CD006103.pub8.
  23. Rigotti NA, Kruse GR, Livingstone-Banks J, Hartmann-Boyce J. Treatment of Tobacco Smoking: A Review. JAMA. 2022 Feb 8;327(6):566-577. doi: 10.1001/jama.2022.0395. PMID: 35133411.

Dr. Fernando Caudevilla
Family Physician | Expert in Drug Addictions. He works in different assistance, research and training projects related to drugs, including therapeutic cannabis.

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