Legal weed: An accidental solution to the opioid crisis?

Legalized marijuana offers chance to investigate substitution effects for people who use opioids

File 20170801 28766 1erdw7h

There is growing evidence for the use of cannabis in treating opioid addiction.

This piece first appeared at logo-6ed98023442246a1b432bd646eec8daf94dba5361825aeacd7d7ca488c268e96

It’s hard to go a day in Canada without hearing about at least one of two types of drugs – but for vastly different reasons. One class of drug — opioids — kills four people a day in British Columbia. The other — cannabis — will be legal for adult purchase and consumption by this time next year.

The opioid overdose epidemic is Canada’s gravest public health crisis since the emergence of HIV in the 1980s. With its roots in the over-prescription of high-potency painkillers, sparked by the contamination of the illicit drug supply with fentanyl and related drugs, the crisis has reached across demographic divides. Experts agree on the need for creative responses based in scientific evidence.

Could cannabis legalization be a part of this solution? Increasingly, this is what the latest scientific research indicates.

Fatal overdoses

The opioid crisis is a product of the medical system’s over-reliance on opioids for pain relief. Almost one in five Canadians live with some form of chronic pain. Twenty years ago, pharmaceutical companies began to develop slow-release formulations of opioids (e.g. OxyContin) and marketed them as safe and effective medications for the treatment of chronic non-cancer pain.

We know now that these drugs carry an extremely high risk of dependence and fatal overdose. Despite this, more than 20 million opioid prescriptions are filled each year in Canada. Drug overdoses are now the leading cause of death among Americans under the age of 50. And prescription opioids are involved in nearly half of these deaths. It is also becoming apparent that opioids might be less effective than initially thought in treating certain types of chronic non-cancer pain (e.g. neuropathic pain).

Canada will soon be the first country in the G-20 to legalize cannabis for non-medicinal purposes.

Cannabis, derived from the Cannabis sativa plant, contains several compounds. These include tetrahydrocannabinol (THC, the primary psychoactive component of cannabis) and cannabidiol (CBD). Beyond the well-known psychoactive effects of cannabinoids, new research has shown that they also interact with systems in the body involved in the regulation of pain.

This discovery has led researchers to investigate the potential for cannabis to treat various pain conditions for which opioids are currently first- or second-line therapies. High-quality clinical research involving cannabis has been stunted by its prohibited legal status. But a recent review of clinical studies involving cannabis-based medicines (including smoked or vapourized cannabis) found strong evidence for relief of chronic non-cancer pain.

Ground-breaking findings

The substitution effect is an idea from behavioural economics that describes how the use of one product might decrease when the availability of another increases. Substance use researchers have recently adapted this theory to understand the substitution potential between cannabis and opioids. In other words, does the use of opioids decrease with increasing access to cannabis?

In a landmark 2014 study, a team of researchers analzyed data from across the United States over a 10-year period. They found that states that had legalized medical cannabis saw 25 per cent fewer opioid-related deaths compared to states where medical cannabis remained illegal.

These findings broke ground for others in the field to find associations between U.S. medical cannabis laws and reduced state-level estimates of opioid use and dependence. But, because these population-level studies cannot observe individual-level changes in cannabis and opioid use, a closer look at these trends among different sub-populations of people affected by the opioid crisis is needed.

Legalizing cannabis will enable researchers to investigate the clinical and public health impacts of the drug.

Not surprisingly, findings from surveys conducted among patients using medical cannabis across North America demonstrate a clear preference for cannabis over opioids. For example, roughly one-third of a sample of patients enrolled in Health Canada’s Marihuana for Medical Purposes Regulations (MMPR) program in B.C. report substituting cannabis for prescription opioids.

For chronic pain patients, this substitution effect appears even more pervasive, with cannabis substitution occurring in roughly two-thirds of a sample of former prescription opioid patients in Michigan who started using medical cannabis.

In the most recent study, 80 per cent of medical cannabis patients in California reported that taking cannabis alone was more effective at treating their medical condition than taking cannabis with opioids. More than 90 per cent agreed they would choose cannabis over opioids to treat their condition if it were readily available.

Illicit opioid use

But what about the relationship between cannabis and opioids among some of those most affected by the opioid crisis — people with long-term experience using illicit opioids?

Untreated pain and substance use have a high degree of overlap. Pain was reported by almost half of people who inject drugs surveyed in a recent San Francisco study. Research from our colleagues in Vancouver found that under-treatment of pain in this population is common. It results in self-management of pain by obtaining heroin or prescription opioids on the street.

This means there could be a role for cannabis even among individuals with extensive experience using illicit opioids. A study from California of people who inject drugs found that those who used cannabis used opioids less often. It’s still unclear if this difference is directly due to cannabis use and more research is needed.

Potential as anxiety treatment

Even without chronic pain, cannabis may prove an effective alternative among individuals wanting to reduce or stop their opioid use. There is growing evidence for the use of cannabis in treating opioid addiction. CBD, the non-psychoactive component of cannabis, is known to interact with several receptors involved in regulating fear and anxiety-related behaviours. It shows potential for the treatment of several anxiety disorders.

Research is also investigating CBD’s role in modulating cravings and relapses — behaviours that are tightly linked to anxiety — among individuals with opioid addiction. Recent preliminary studies suggest that CBD reduces opioid cravings. A larger clinical trial is now underway in the United States.

A bold response?

Canada will soon be the first country in the G-20 to introduce a legal framework regulating the use of cannabis by adults for non-medical purposes. This will create a country-wide natural experiment for the world to observe. Legalizing cannabis will break down traditional barriers to understanding the clinical and public health impacts of the drug.

This massive drug policy change could not come at a more desperate time. By increasing access to the drug for therapeutic and recreational purposes, we will have the opportunity to investigate substitution effects within different populations of people who use opioids.

Protection of youth and removal of organized crime aside, the Cannabis Act may just be the unintentionally bold government response to the opioid crisis that our country so desperately needs.

Stephanie Lake, PhD student in Population and Public Health, University of British Columbia and M-J Milloy, Research Scientist, BC Centre on Substance Use and Assistant Professor in the Division of AIDS, UBC Department of Medicine, University of British Columbia

This article was originally published on The Conversation. Read the original article.


Legal weed: An accidental solution to the opioid crisis?

  1. ita not like people are finding these opioids lying around. Doctors were supposed to “cause no harm”.

    While an effective painkiller, higher doses are truly addictive with terrible withdrawal symptoms.

    But the solution isn’t legalizing the recreational use of the psychotic recreational drug cannabis which has been proven to cause mental illness.

    Cannabis stays in the brain for over a month so more frequent use ensures the user is NEVER SOBER.

    How will law enforcement perform consistent roadside testing for impairment when users experience the cumulative effect of the combination of cannabis and alcohol.

    Doctors and the government should know and do better!

  2. ————-
    “In this article, we argue that non-rigorous patenting standards and ineffectual policing of both fraudulent marketing and anticompetitive actions played an important role in launching and prolonging the opioid epidemic. We further show that these regulatory issues are not unique to prescription opioids but rather are reflective of the wider pharmaceutical market.”

  3. The current opiate addiction crisis was created solely by the over-prescribing of opiate painkillers for long-term pain relief.

    At the same time that this opiate addiction crisis was being created by the pharmaceutical industry, in conjunction with their representatives within the medical community, the use of cannabinoid therapy in pain management has been virtually ignored by our medical community!

    If medicinal cannabis had been legalized and studied decades ago we would not have the opiate addiction crisis that we are currently dealing with today!

    The so called ‘dangers of Cannabis’ have no basis in science and are the result of decades of a pervasive negative bias against all Cannabis use and the science and data do not match the current institutionalized mentality towards Cannabis use.

    • The dangers of future cannabis will be based in science. Government patents which create a legal foundation for synthetic deadly opioids like fentanyl, cancer causing gmo seeds, and the Pesticide industry has the potential of creating deadly new combinations of genetics based on Cannabis. Next thing you know we will have gmo nicotine/cannabis products marketed like cigarettes, and injectable cannabis 100x stronger than what nature intended, thanks to the gov$$$ streamline for corporate monopoly licensing. Who would have thought that banning Opium poppy plants would lead to deadly synthetic Opiates that can fit on the head of a pin? Tight regulation needs to fall on the patent office before all the natural seeds get bought up an we’re left with Monsanto terminator marijuana packed with weed killing pesticide. There’s a reason gmo is banned in other countries. And there is no reason health Canada needs to green rush synthetic cannabis products for medical or community use. Organic Cannabis needs to be a national goal. And the medical aspects of “recreational” weed needs to be recognized as serving a communal need, a bio/psycho/social connection to peace loving humanity.

      • Our Canadian Prime Minister promised to use best practices and best science in the formation of our government’s cannabis policy but that is not what is happening. Our government is being misinformed by organizations that are pervaded by negative bias against all forms of cannabis use and as a result, our legislation we will be full of flaws based on gross misconceptions regarding how cannabis affects individual human physiology. Current legislation seems more fixated on the profits generated by the recreational Cannabis industry than the many medical benefits that cannabinoid therapy could provide to a large segment of the Canadian population. Please research phytocannabinoids, the endocannabinoid system, and look up patent 6630507, just for starters, before making any assumptions about Cannabis Use and general health.