CBD Did Not Outperform Placebo for Cocaine Craving or Relapse in This Trial

CBD did not outperform placebo on cocaine craving or time to relapse in a randomized trial involving people with cocaine use disorder. The negative result is specific to this treatment protocol and population; it should not be replaced by positive findings from another substance-use disorder.

Detoxification and follow-up were different phases

Mongeau-Pérusse and colleagues randomized 78 participants: 40 to CBD and 38 to placebo. The protocol began with ten inpatient days and continued with a 12-week outpatient phase for participants who completed detoxification.

The treatment targeted 800 mg oral CBD daily, with protocol provisions for lower dosing when poorly tolerated. Participants also received standard care. Sixty-two completed detoxification, and 50 completed the full study, so the randomized count was not the number contributing complete follow-up data.

The relevant treatment comparison was negative

Cocaine-cue and stress-cue imagery increased craving, but CBD did not establish superiority over placebo for the primary craving or relapse questions. Daily craving, withdrawal symptoms, sustained abstinence and cocaine use likewise did not supply a consistent treatment advantage.

CBD was detected in participants receiving it, so the result should not simply be dismissed as evidence that nobody received active exposure. At the same time, demonstrating exposure does not prove that the tested dose or dosing frequency was optimal.

What the findings do and do not exclude

The sample largely had severe cocaine use disorder. Enrollment ended at 78 because access to the oral solutions was interrupted, and attrition reduced later data. These features limit precision and generalizability. They do not justify claiming an unobserved benefit.

The authors discussed dose, frequency, severity and differences between substance-use disorders as possible explanations. These are hypotheses for future trials, not established reasons to override the randomized comparison. Adverse effects, including gastrointestinal symptoms, also belong in an assessment of any treatment proposal.

This human trial should be kept separate from animal relapse models and studies of opioid, nicotine or cannabis use disorder. Our discussion of CBD treatment outcomes and confounding explains why improvement, retention and a causal treatment benefit are different propositions.

Primary research

Violaine Mongeau‐Pérusse and colleagues. Addiction (Abingdon, England) (2021). Cannabidiol as a treatment for craving and relapse in individuals with cocaine use disorder: a randomized placebo‐controlled trial.