Is Medical Cannabis the Answer to the Opioid Crisis?
Medical Marijuana and the Opioid Crisis
OPIOID ADDICTION IS ONE of the leading health care crises of our time. It costs the U.S. economy more than $500 billion a year. It kills 115 people a day, more than gun violence or traffic accidents. It is at the center of almost every public policy and public health debate in thousands of cities across the country. The president and policymakers on both sides of the aisle have elevated it as a national priority. A recent report from the Centers for Disease Control found that emergency room visits due to opioid overdoses have climbed by about 30 percent in less than a year. As startling as the statistics are, it is just as heartbreaking to know that a safe and effective alternative is plentiful, yet inaccessible, because it is illegal at the federal level.
I am talking about cannabis. Whether you are a physician, policymaker, law enforcement officer, or a concerned parent, it is time to look beyond the decades of stigma. It is time to acknowledge the evidence, and advocate for what cannabis really can be: the exit drug from the opioid epidemic.
There is plenty of debate about how to combat the opioid crisis in our country, but there is certainly consensus on some fundamental public health tenets. We must treat and prevent addiction; reduce and eliminate overdoses; and develop sustainable strategies to provide relief to the 100 million Americans living with chronic pain.
Cannabis plays a critical role in each one of these goals.
An analgesic alternative to opioids.
Cannabis has been used as a pain reliever for thousands of years. The plant was included in the ancient Chinese pharmacopoeia for pain and many other purposes. The ancient Egyptians, Greeks and Romans used it for pain as well. Cannabis was even a part of mainstream American medicine throughout the 1800s.
Cannabinoids, the unique molecules found within the trichomes of the cannabis plant, are well known for their pain relieving properties. Cannabinoid receptors are widely expressed throughout the brain’s pain processing regions. Studies in animals show that when cannabinoids are administered directly to these brain areas, they produce profound pain relief.
Opioid receptors are also expressed in these exact same brain regions. Indeed, cannabis and opioids spark nearly identical reactions within our brains when it comes to pain relief. But the molecules in cannabis have anti-inflammatory properties (which opioids do not), and inflammation is often a huge part of pain. Although opioids may do a better job in alleviating the bodily sensation of pain, cannabis can improve the ability to cope with pain, which improves one’s function in daily life.
In addition, cannabis is less addictive than opioids, the undesirable side effects are fewer and more easily tolerated, and it appears much safer to take over the long term. Most importantly, a fatal overdose of cannabis is virtually impossible. Even when following doctors orders, the same cannot be said for opioids. Accidental overdose is rampant.
Treating and preventing addiction and relapse.
Opioid withdrawal is one of the most horrific experiences a human can endure. It is no wonder relapse is extremely common, given the severity of withdrawal, and the ease with which opioids eliminate it.
We have known for decades that cannabinoids lessen opioid withdrawal symptoms in animals. Recent anecdotal reports from addiction and recovery professionals have corroborated this. They, too, show that cannabis minimizes opioid cravings and the symptoms of opioid withdrawal.
One of the biggest triggers for drug relapse is negative mood or anxiety. Cannabis is well known to produce euphoria and promote positive mood. This could translate into fewer days of heightened anxiety, and fewer triggers for relapse. Even cannabidiol alone can prevent the anxiety that leads to relapse.
The hallmark of opioid therapy is that dosage must be increased over time for the drug to work as it initially did. Both the body and the brain quickly develop a tolerance for opioids, forcing patients to increase consumption to maintain relief. Tolerance, and the increased opioid consumption it drives, is a huge factor in opioid abuse.
There is no substitute for the powerful pain relief opioids provide. When used in conjunction with opioids, cannabis enhances the resulting pain relief. When patients are given access to cannabis, they require lower doses of of opioid medication to relieve their pain. In fact, patients can reduce their daily dose of opioids by half with supplemental use of cannabis. Anything that reduces patients’ opioid consumption minimizes their risk for overdose. This combination approach does exactly that.
But what about before patients start opioid therapy? Preclinical studies in animals show that cannabis could actually prevent the development of opioid tolerance. By using cannabis before opioid exposure, it could be possible to eliminate the risk for opioid abuse and overdose entirely.
Cannabis’ ability to relieve pain when combined with opioids, and to prevent the development of opioid tolerance warrants its use as a first-line treatment for chronic pain. In many cases, cannabis should not be considered an “alternative” — it should be the initial treatment.
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