The rise in opioid prescriptions since the 1990s has led to a corresponding rise in opioid addiction and opioid overdose rates. America is in crisis and attempting to claw its way out. Could medical use of marijuana, a Schedule I drug, relieve addiction and prevent overdose deaths?
How Did America Reach This Crisis?
Towards the middle of the 19th century, cannabis found its way from India to the United States and was entered into the United States Pharmacopeia in 1850. Widely accepted as a treatment, and readily available in drugstores, cannabis was used to treat a range of afflictions such as tetanus, cholera, dysentery, leprosy, snakebite, convulsive disorders, gout, and opiate addiction. However, it was opiates that eventually played a role in cannabis falling out of favor.
The advent of the hypodermic syringe allowed physicians to inject opioids directly into the bloodstream. Pain relief and anticonvulsant benefits were nearly instantaneous, compared to the delay in the effects of cannabis, and the drug quickly fell out of favor. In fact, due to propaganda reports and active campaigns against it, the Marijuana Tax Act of 1937 effectively ended medical and recreational marijuana, paving the way for increased opioid prescriptions.
Where Are We Now?
Though the opioid crisis began in the 1990s, the rise of overdose deaths has experienced a recent spike. All told, overdoses have risen by over 30% in the past year, killing an average of 115 people every day. The discussion regarding what must be done to stop it is ongoing and spans a wide range of suggestions from further criminalizing certain opioids to increasing the availability of Naloxone.
However, one suggestion that hasn’t received wide circulation – probably because it’s still illegal in 17 states and under the Federal Government, as well as strictly limited in thirteen more – is medical marijuana. While cannabis is well-recognized as an appetite stimulant and has other qualities useful in medical applications, it isn’t as well studied in a medical setting as most medications, as it is a Schedule I drug. Are those addicted to opioids in non-legal states missing out on the best possible treatment for opioid addiction?
How Does Cannabis Work?
Cannabis first rose in popularity due to its anticonvulsant and pain relieving effects. Cannabinoid receptors abound in the pain-processing regions of the brain; when cannabis is ingested and reaches those receptors, the user experiences relief from the pain processed in that part of the brain. Opioid receptors exist in the same areas of the brain, allowing opioids to have the same analgesic effects. Though they may be faster acting and more potent – more effective – at pain relief, opioids lack the anti-inflammatory properties of cannabis, which may help the user to better cope with pain.
Cannabis can be delivered in multiple forms, including topical creams, pills, edible candies, tinctures, vaporizers, and by smoking the dried leaves. It can be difficult to determine the levels of THC and cannabidiol (CBD) in some of these forms, though patients often prefer inhaling either vaporized forms or smoke due to its quicker onset. States where medical marijuana is legal may allow a few, some, or all of these forms.
Currently, one of the markers of this opioid epidemic has been patients who receive an opioid prescription for pain, become addicted to the expensive medication, and seek cheaper forms such as heroin. Opioids suppress pain, but also suppress the respiratory and other bodily systems, leading to the dangers of overdose. The same issues do not exist with marijuana.
Besides its comparable pain relief benefits, perhaps the biggest selling point for cannabis as a replacement for opioids is the fact that it’s not physically addictive. Patients may enjoy the side effects of some forms of the drug, such as sleepiness or pleasure, and feel some sense of physical withdrawal when it is removed. However, the severe chemical dependency that can occur with drugs like opioids is not comparable.
In addition, it is estimated that a person would need to smoke nine pounds of marijuana in fifteen minutes in order to overdose, a physical impossibility. Also, some forms of medical cannabis remove the compounds that produce the “high” feeling, leaving addiction even further off the table. Overall, marijuana is a much safer alternative.
Can Cannabis Successfully Replace Opioids?
Cannabis has shown remarkable pain relieving benefits in animals, as well as by anecdotal evidence. Additionally, animal studies have shown cannabis to be an effective treatment for opioid addiction, but wide-ranging studies on humans are hindered by the drug’s illegality. However, evidence of falling opioid overdoses in states with legalized medical marijuana may show a correlation between access to cannabis and reduced opioid prescriptions, dependency and overdose.
The Journal of the American Medical Association (JAMA) reports a nearly 6% drop in opioid prescriptions once a state legalizes medical marijuana, a rate which approaches 7% if the state legalizes recreational and dispensary distribution. More intriguing is a nearly 25% drop in opioid overdose deaths when a state legalizes cannabis. These figures may likely be attributed to patients seeking cannabis instead of opioids for pain relief, patients using cannabis to combat depression and anxiety that often lead to opioid relapse, or patients using cannabis to reduce the withdrawal effects of quitting opioids.
Is Cannabis the Answer?
Cannabis is not without its skeptics. Researchers and doctors point to Colorado’s overall rise in opioid-related deaths in 2017, despite its having had medical marijuana laws in place since 2001. In addition, the lack of human study leaves the actual medicinal effects and the long-lasting health effects of marijuana use on the body in question.
Is cannabis the answer? It may be an effective part of an individual’s treatment, but it isn’t the only answer. Many physicians and medication assisted treatment facilities agree that cannabis finds its rightful place as a part of a range of effective treatments rather than as a stand-alone cure for opioid addiction.