Cannabis and the Opioid Crisis in America
Reading the statistics associated with the American opioid crisis is a staggering endeavor. According to the Center for Disease Control (CDC), almost 50,000 people died of opiate-related overdoses in 2017. That translates to 130 deaths every day from drug addiction and marks a 10% increase from the previous year. Since 1999, addiction and overdose rates have multiplied at an alarming rate, increasing six-fold in less than two decades. The most tragic part of this epidemic is that many of these deaths are the direct result of misused prescription pain medication.
Opioid misuse has caused a shocking wave of heroin addiction, and with it an increase in HIV infection and a decrease in life expectancy. As reported by the New England Journal of Medicine, it is estimated that 80% of intravenous heroin users began their descent into addiction from prescription opioid abuse. These frightening statistics have led some policy-makers to call for imposing greater regulation and oversight in dispensing practices, and this is certainly a necessary measure to prevent the creation of new addicts. However, there is a difficult catch. For those who are already opioid-dependent, reduced access to prescription pain medication may propel them to seek an alternative: heroin.
This is the vicious domino-effect of the American opioid crisis: unethical marketing and prescribing practices for genuine physical conditions causes a wave of opioid addiction, prescription drug addicts turn to heroin when their supply dries up, and the contamination of heroin by illicit synthetic opioids like fentanyl kills with impunity. This begs the question what can be done to halt this epidemic. Any response must address two key factors. The first is providing pain management while reducing access to opioids, and the second is treating addiction. Recent research has indicated that cannabis may be the key to both of these requirements.
The positive effects of cannabis on pain management are well-known and widely documented, and the growing use of legal, medically prescribed marijuana has bolstered this research. The prescription of cannabis in lieu of addictive opiates is associated with up to 70% lower rate of opiate addiction, and by extension of opiate-related death. When people are able to manage pain with medical marijuana, they simply don’t need opiates and therefore do not get addicted to them – this nips addiction in the proverbial bud.
What is less known is that cannabis has been found to be effective in opioid addiction treatment. Apart from the preventative effect of prescribing cannabis as a first-line analgesic, the use of medical cannabis in treating opiate addiction shows great promise. The most common treatment for opiate use disorder is methadone maintenance treatment (MMT). This approach replaces heroin and other opiates with the controlled delivery of a synthetic opiate to mitigate the effects of withdrawal and reduce physical craving. However, MMT is often regarded as a short-term harm reduction strategy and patients frequently relapse. In the same vein, pre-clinical studies on the effect of cannabis on opioid withdrawal symptoms have demonstrated positive outcomes. Furthermore, when used in conjunction with medication-assisted detoxification, treatment adherence and outcomes improved. One example of how this might work is that when cannabis is available when methadone levels dip or are insufficient, cravings and withdrawal symptoms are managed thereby reducing the risk of relapse. Although there is still a long way to go in demonstrating medical cannabis’ potential in treating opiate addiction, qualitative evidence indicates that increased access to medical cannabis reduces rates of opiate addiction and overdose. In states with medical marijuana dispensaries, addiction and overdose are lower relative to states without medical marijuana laws.
While further research is needed, these positive results indicate that the answer to America’s opioid crisis may be growing in the backyard. Medical marijuana can improve MMT outcomes, reduce the symptoms of withdrawal and craving, and can be prescribed for pain to prevent addiction before it even starts. What is needed is more investment and access to cannabis research and development – this crisis must be addressed, too many lives are in the balance.