The Dark Side Of Opioids

Could Cannabis Be The Solution For The Opioid Epidemic?

Opioid addiction. Two simple words, coming together to expose a severe problem. When you hear these words, and close your eyes, what do you see? I see faces of pain and suffering, dreams shattered into pieces, families destroyed and lives cut short.

The Opioid Crisis

With over 47,600 deaths caused by opioid overdose in 2017 (1), we are unquestionably facing a public health crisis. For many victims, their tragic story of drug addiction starts with a sensible desire to live without pain. Millions of Americans suffer from chronic pain. If you’re one of them, you know how quickly your physical discomfort can hijack your entire life, stealing every bit of enjoyment out of it.

Pain will take your life hostage and never let it go.

In a hopeless attempt to get your life back, you seek out the help of your doctor.

Depending on the severity of your symptoms, you might receive a prescription for a painkiller, such as an opioid. You feel optimistic, hopeful and ready to start living again.

The Dark Side Of Opioids

Oxycodone (Oxycontin, Percocet) and hydrocodone (Vicodin) are the most widely prescribed and abused opioids. There are many others in this class of drugs, such as codeine, fentanyl, and morphine.

When you fill that prescription, you have no idea about the serious risks that are inherent to many opioid medications. There is a reason as to why opioids are one of the most abused drugs in the US today.

Opioids Are Dangerously Addictive

People who suffer from chronic pain, look for long-term relief. Most opioids provide pain relief for no longer than 12-24 hours at a time, requiring a constant supply of the drug in your bloodstream to maintain their effectiveness.

Unless you make dietary, lifestyle, health, or surgical changes you will likely need to take these meds weeks or months at a time.

But here is the catch, many of these drugs lead to addiction in just a few days (2). This means that even if you take the medication as prescribed strictly for the duration recommended by your doctor, you may still be walking down the path of addiction.

And even though the word addiction is often playfully combined with things like chocolate and Netflix, opiate addiction is no joke.

Fentanyl, for example, is 50 to 100 times more powerful than morphine, leading to a high potential for accidental overdose.

Opioids Have A High Risk Of Tolerance

The second characteristic that makes opioids so dangerously addictive is the fact that it is challenging to get the dose right to achieve and maintain the desired effects.

When you first start taking opioids, you will experience intense pain relief, but this powerful effect will quickly subside. To compensate for the diminishing effect, most will end up on dangerously high doses of the drug.

Opioids Are Unproven For Long-Term Use In Chronic Pain

The long-term efficacy of opioids for chronic pain management has never been proven.

In a study published in the Annals of Internal Medicine in 2015 (3), authors declared the available scientific evidence insufficient to determine whether opioids were effective on the long-term for the management of chronic pain.

Based on the review of several clinical trials they also found opioids likely to cause harm in higher doses.

What Does Science Say About Cannabis and Pain?

Several studies have been published on the effectiveness and safety of cannabis for pain. In a 2015 study (4) authors reviewed the history of medicinal cannabis use and found that cannabis “may have a therapeutic role in a multitude of diseases, particularly chronic pain disorders”.

Another study (5), published in the Journal of Neuroimmune Pharmacology concluded that cannabinoids are safe and reasonably effective at reducing pain and therefore provide a sound therapeutic option in chronic pain management.

Could Cannabis Replace Opioids?

Cannabis has an impressive amount of evidence to support its effectiveness in pain relief, and it comes with a significantly lower risk of addiction and no risk of overdose.

The question arose whether making cannabis more widely available could potentially reduce the demand for prescriptions written for opioids. This theory was put to the test in the Medicaid population, and results were reported in a recently published article in JAMA (6) in 2018.

Medical marijuana states saw a noticeable drop in the number of opioid prescriptions written in this segment of the population with a high risk for chronic pain.

This is huge, as the study clearly demonstrates how medical cannabis laws can serve as a valid tool to encourage lower prescription opioid use.

A second study (7) came to a similar conclusion and reinforced the results in the Medicare population, resulting in an 8.5% reduction in opioid prescribing.

Cannabis Helps Chronic Pain Patients Reduce Their Opioid Use

What about those already on opioids trying to cut back on their use? Can cannabis be helpful to them? This question was answered in a survey (8) of 244 medical cannabis patients conducted over a two year period. Participants reported an impressive 64% reduction in opioid use, a decrease in medication-related side effects and a striking improvement in their overall quality of life.

Cannabis For Opioid Withdrawal Symptoms

There is growing pre-clinical and clinical evidence that supports the use of cannabis to help reduce the symptoms of opioid withdrawal. (9)

While it isn’t fully understood how cannabis eases the uncomfortable symptoms of withdrawal, such as nausea and anxiety, we can unquestionably conclude that cannabis can assist with the opioid epidemic in various different ways.

Cannabis has a real potential to play an important role in halting the opioid crisis and become part of the solution. If you are someone who lives with chronic pain and you are ready to break free from the chain of opioid addiction, you may want to consider cannabis.

References:

1. https://www.cdc.gov/drugoverdose/data/statedeaths.html

2. https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-opioid-addiction-occurs/art-20360372

3. https://www.ncbi.nlm.nih.gov/pubmed/25581257, Ann Intern Med. 2015 Feb 17;162(4):276-86. doi: 10.7326/M14-2559. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop.

4. https://www.ncbi.nlm.nih.gov/pubmed/26015168, Headache. 2015 Jun;55(6):885-916, Comprehensive Review of Medicinal Marijuana, Cannabinoids, and Therapeutic Implications in Medicine and Headache: What a Long Strange Trip It’s Been ….,

5. http://cannabismedicinal.com.ar/images/documentos/Investigacion/dolorcronicoreviewlynch2015.pdf, J Neuroimmune Pharmacol, 2015, Cannabinoids for the Treatment of Chronic Non-Cancer Pain: An Updated Systematic Review of Randomized Controlled Trials

6. https://www.ncbi.nlm.nih.gov/pubmed/29610827, JAMA Intern Med. 2018 May 1;178(5):673-679. doi: 10.1001/jamainternmed.2018.1007. Association of Medical and Adult-Use Marijuana Laws With Opioid Prescribing for Medicaid Enrollees.

7. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2676999, JAMA Intern Med. 2018;178(5):667-672. doi:10.1001/jamainternmed.2018.0266, Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population

8. https://www.ncbi.nlm.nih.gov/pubmed/27001005, J Pain. 2016 Jun;17(6):739-44. doi: 10.1016/j.jpain.2016.03.002. Epub 2016 Mar 19., Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain.

9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135562/, Cannabis Cannabinoid Res. 2018; 3(1): 179–189. Published online 2018 Sep 1. doi: 10.1089/can.2018.0022, Emerging Evidence for Cannabis’ Role in Opioid Use Disorder