Opioids are ravaging our country. According to the Center for Disease Control (CDC), over 60% of drug overdose deaths involve opioids. These deaths have more than quadrupled since 1999; in 2014 alone, overdoses from opioids killed almost 30,000 people. Interestingly, prescription opioids accounted for over half of these deaths (CDC, 2016).
Individuals begin using opioids for a number of reasons, most often for treatment of postoperative pain, injury-related pain, and degenerative disc disease (Callinan & Neuman, 2017). Since opioids are extremely addictive, even individuals who were started on opioids by their physicians for legitimate reasons are at risk of becoming addicted. Indeed, research shows that 75% of heroin users began using opioids through prescription drugs (Cicero et al., 2014).
How do we stop people from becoming addicted to opiates, while still addressing their pain? One way might be to transition them early on in their pain course from opiates to medical marijuana.
In recent years, the general public has begun to voice support for medical marijuana. To date, 28 states and the District of Columbia have passed medical marijuana laws (Bureau, 2017). In 2015, Minnesota became the first state to add ‘chronic pain’ to the list of ailments that medical marijuana can treat.
Unfortunately, however, research on the medical efficacy of marijuana is severely limited. Although a majority of states have passed medical marijuana laws, the federal government still deems marijuana a Schedule 1 Drug, reserved for drugs like cocaine and heroin – with no medicinal value but the greatest potential for abuse (“Drug Classifications,” 2017). This rating greatly impedes clinical research on both the pharmacologic and behavioral benefits of the drug. As such, this is one of the first times in US history that the decision on whether a drug is an effective medicine has been answered in elections, rather than through preclinical and clinical trials (Hurd, 2017).
What we do know is that there are a number of different active ingredients, or cannabinoids, in marijuana. These cannabinoids are able to interact with receptors in pain activity centers in both the brain and spinal cord, through what is known as the endocannabinoid system. It is not surprising therefore, that utilizing this system can be therapeutic for individuals suffering from different types of pain. A study by Whiting et al. (2015), for example, showed moderate-quality evidence that, compared with placebo, cannabinoids were associated with a greater number of patients showing a reduction in pain compared to placebo.
Delta-9-tetrahydrocannabinol (THC), is perhaps the most common component, and is “the prominent psychoactive component of marijuana” (Hurd, 2017). Another cannabinoid is cannabidiol (CBD), which is known to have sedative and analgesic qualities. Because it is not psychoactive, neurobiologists believe that CBD is the component with the greatest potential for therapeutic use for pain because of its low potential for misuse and diversion (Hurd, 2017).
In addition to being a viable solution for pain management, medical marijuana also minimizes opioid use. States that have legalized medical marijuana have a reduced amount of opioid use; in these states, there is a lower number of opioid painkillers prescribed and a lower number of opioid overdoses (Hurd, 2017).
An article by Bachhuber et al. (2014) showed that states with medical cannabis laws had a lower mean opioid overdose mortality rate than states without such laws. The article hypothesized a number of potential reasons for this. First, individuals who are suffering from pain who would have started on opioid analgesics may instead be using cannabis to treat their pain. Second, it is possible that medical cannabis laws decrease what is known as polypharmacy, or using four or more drugs at once, especially with benzodiazepines; benzodiazepines, when combined with opioids can increase the risk of overdose significantly. Additionally, a study by Bradford and Bradford (2016) showed that the prescribing patterns of FDA-approved prescription drugs fell significantly in states that have passed medical marijuana laws, suggesting that individuals may be using medical marijuana in place of other prescription drugs.
Finally, there are important economic benefits to think about when considering using medical marijuana for pain instead of opiates. The burden of the opioid use disorder is currently estimated at $78 billion annually (Hurd, 2017). Between 2002 and 2012, the number of hospitalizations for opioid use disorder increased from 300,000 per year to over 500,000 per year (Crowley, Kirschner, Dunn, & Bornstein, 2017). Research has also shown that states with medical marijuana laws have savings of $165.2 million per year due to an overall reduction in Medicare spending (Bradford and Bradford, 2016). Although the economic reasons for utilizing medical marijuana as a therapeutic for pain are not sufficient to justify it on their own, they should be considered in the discussion.
Early research shows great potential for marijuana to combat the opioid epidemic, but more research is certainly needed. Adequate research will be contingent upon a change in marijuana’s drug classification. Hopefully, as more and more states permit medical marijuana, pressure will build on the federal government to loosen its regulations on marijuana, and permit the research that will set new prescribing patterns into motion.
- Bachhuber, M. A., Saloner, B., Cunningham, C. O., & Barry, C. L. (2014). Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010. JAMA Internal Medicine,174(10), 1668-1673. doi:10.1001/jamainternmed.2014.4005
- Bradford, A. C., & Bradford, W. D. (2016). Medical Marijuana Laws Reduce Prescription Medication Use In Medicare Part D. Health Affairs,35(7), 1230-1236. doi:10.1377/hlthaff.2015.1661
- Bureau, M. A. (2017, April 7). Other states have figured out medical marijuana rules. Why can’t Florida? Retrieved April 08, 2017, from http://www.miamiherald.com/news/politics-government/state-politics/article143332119.html
- Callinan, C. E., Neuman, M. D., Lacy, K. E., Gabison, C., & Ashburn, M. A. (2017). The Initiation of Chronic Opioids: A Survey of Chronic Pain Patients. The Journal of Pain,18(4), 360-365. doi:10.1016/j.jpain.2016.11.001
- Cicero, T. J., Ellis, M. S., Surratt, H. L., & Kurtz, S. P. (2014). The Changing Face of Heroin Use in the United States.JAMA Psychiatry,71(7), 821. doi:10.1001/jamapsychiatry.2014.366
- Crowley, R., Kirschner, N., Dunn, A. S., & Bornstein, S. S. (2017). Health and Public Policy to Facilitate Effective Prevention and Treatment of Substance Use Disorders Involving Illicit and Prescription Drugs: An American College of Physicians Position Paper.Annals of Internal Medicine. doi:10.7326/m16-2953
- Data Overview: Overview of an Epidemic. (2016, December 16). Retrieved April 08, 2017, from https://www.cdc.gov/drugoverdose/data/index.html
- Drug Classifications, Schedule I, II, III, IV, V. (2017, March 14). Retrieved April 09, 2017, from http://medshadow.org/resource/drug-classifications-schedule-ii-iii-iv-v/
- Graham, G. (2016, April 20). Advocates ask Maine regulators to consider marijuana to treat opioid addiction. Retrieved April 8, 2017.
- Hermann, D., Klages, E., Welzel, H., Mann, K., & Croissant, B. (2005). Low efficacy of non-opioid drugs in opioid withdrawal symptoms. Addiction Biology,10(2), 165-169. doi:10.1080/13556210500123514
- Hurd, Y. L. (2017). Cannabidiol: Swinging the Marijuana Pendulum From ‘Weed’ to Medication to Treat the Opioid Epidemic. Trends in Neurosciences,40(3), 124-127. doi:10.1016/j.tins.2016.12.006
- Scavone, J. L., Sterling, R. C., Weinstein, S. P., & Bockstaele, E. J. (2013). Impact of Cannabis Use during Stabilization on Methadone Maintenance Treatment. The American Journal on Addictions,22(4), 344-351. doi:10.1111/j.1521-0391.2013.12044.x
- Sifferlin, A. (2016, June 28). Medical Marijuana for Painkiller and Opioid Epidemic. Retrieved April 08, 2017, from http://time.com/4419003/can-medical-marijuana-help-end-the-opioid-epidemic/