Is Medical Cannabis a Potential Answer to the Opioid Epidemic?

The U.S. has evolved significantly since the era of Reefer Madness. Currently, 30 states, including West Virginia, along with the District of Columbia, have legalized marijuana for medical or recreational use. Surveys reveal that a record 61 percent of Americans now support nationwide legalization.

Amid ongoing discussions about the health benefits and risks of marijuana, recent studies have positioned cannabis as a key player in addressing what is often termed "the most severe drug crisis in U.S. history." This time, some experts believe cannabis could contribute to solving the problem.

As widely reported, opioid misuse — encompassing prescription opioids, heroin, and illicit fentanyl — is the primary cause of death in the U.S. The National Institute on Drug Abuse reports that approximately 90 individuals die daily from opioid overdoses, with 16,000 annual deaths attributed solely to prescription opioids.

Some analysts attribute the epidemic to pharmaceutical companies aggressively promoting highly addictive opioids since the 1990s, alongside doctors liberally prescribing them to chronic pain patients.

A 2014 study in JAMA Internal Medicine highlights that chronic noncancer pain is widespread in the U.S., with opioid prescriptions for such patients nearly doubling over the past decade. This surge in prescriptions has coincided with a sharp rise in opioid use disorders and overdose fatalities.

The Centers for Disease Control identifies methadone, oxycodone, and hydrocodone as the prescription opioids most frequently involved in overdose cases.

Additionally, a study in the October 2017 issue of Health Affairs reveals that while prescription opioid overdoses have declined following federal prescription regulations in 2010, heroin and fentanyl overdoses have surged. This underscores the core issue: opioid addiction, rather than chronic pain management, has become the primary concern. Restricting prescription opioids has merely driven addicts to seek more dangerous alternatives.

So, how does marijuana fit into this scenario? In some cases, it doesn’t — at least not legally. Federally classified as a Schedule 1 drug, marijuana is deemed to have no medical use. It remains prohibited for medical and recreational purposes in 20 states, while the 30 states that have legalized it in some form are still in the early stages of integrating it into medical and economic systems.

However, multiple studies have demonstrated that medical marijuana can effectively manage chronic pain, much like opioids. Notably, Nabiximols, a botanical extract containing CBD and THC, has shown potential. Researchers from the University of Pennsylvania also discovered that opiate-related fatalities dropped by nearly one-third in 13 states following the legalization of medical marijuana.

"Marijuana, similar to other pain medications, doesn’t completely eradicate chronic pain but makes it more tolerable," explains Dr. Beatriz Carlini, a senior research scientist at the University of Washington Alcohol and Drug Abuse Institute, via email. Carlini references a 2017 report by the National Academy of Medicine on cannabinoids, which compiled findings from various studies. The report concluded that "adults with chronic pain treated with cannabis or cannabinoids are more likely to experience a significant reduction in pain symptoms."

Additionally, substituting medical marijuana for opioids nearly eliminates the risk of overdose deaths, according to Michael Patterson, CEO of U.S. Cannabis Pharmaceutical Research and Development, a company openly dedicated to advancing the cannabis industry.

"In human history, cannabis has never caused a single fatality," Patterson asserts. "It’s time to wake up and reject the misinformation. When people are presented with the facts about cannabis, maintaining a prohibitionist stance becomes difficult."

Carlini acknowledges that cannabis can have adverse effects. "Chronic and heavy use may lead to 'cannabis use disorder,'" she explains, "and early exposure to cannabis might impact brain development. Additionally, for individuals genetically predisposed to psychosis, marijuana use can induce schizophrenia and other psychotic conditions."

Currently, chronic pain sufferers in the U.S. must choose between: 1) opioid prescriptions, which alleviate pain but are highly addictive and potentially fatal, 2) limited access to medical marijuana, whether legal or illegal, depending on their location, and 3) FDA-approved over-the-counter pain medications.

Carlini advocates for expanded access to medical marijuana and educational initiatives to inform patients and healthcare providers about its potential in managing chronic pain.

"In the long term, this approach can be beneficial," she notes. "However, recommending marijuana won’t significantly reduce overdose deaths among those severely addicted to opioids or help individuals already dependent on heroin. By that stage, their brains are already dominated by opiates."

Carlini suggests Medication Assisted Treatment (MAT) and access to Narcan, a prescription drug that counteracts opioid effects and can reverse overdoses, as key measures to assist those struggling with opioid addiction.