Cannabis as an Alternative to Opioids

How Cannabis Can Combat Addiction

The opioid epidemic is arguably the greatest healthcare crisis of the 21st century. In 2015 alone, its economic cost in the United States of America was estimated at more than $500 billion (largely driven by healthcare costs, criminal justice expenses and lost productivity).

The magnitude and indiscriminately mortal nature of this crisis are unprecedented; for the first time in US history, drug overdoses are killing more people than gun violence or motor vehicle accidents. In fact, 91 Americans die from an opioid overdose every day. These fatalities are tragic enough, but the residual effects on surviving children, family members, and communities are no less devastating.

A major contributor to the overdose crisis is the doctor’s prescription pad. Over-prescription of narcotics (too many pills or refills) and “doctor shopping” (finding another doctor when one won’t refill a prescription) are common.

In 2016, the Centers for Disease Control (CDC) issued a new set of opioid prescription guidelines for physicians to try to remedy these issues. A recommendation to treat most cases of chronic pain with non-opioid drugs was included (and especially notable since opioids are least effective and most dangerous when taken long-term).

In January of 2017, the National Academies of Science and Medicine (NASEM) reviewed more than 10,000 studies in humans to evaluate the safety and efficacy of cannabis for dozens of different diseases and symptoms. The NASEM definitively concluded that cannabis, a non-opioid pain-relieving drug, is indeed safe and effective for the treatment of chronic pain.

Source: National Academies of Science and Medicine – The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research

What’s more, scientists have studied the combined administration of opioids and cannabinoids — active molecules from the cannabis plant — for decades. Across all species, all routes of administration and nearly every specific opioid and cannabinoid molecule studied, these drugs produce synergistic pain relief when taken together.

In other words, cannabis enhances the pain relief provided by opioids. That means patients should need lower doses of opioid-based medicines to relieve their pain.

In fact, studies have found this is exactly what happens when chronic pain patients are given access to cannabis. All over the world, time and time again, experts have found that patients reduce their daily dose of opioids by half after they start using cannabis. Patients also reported a huge improvement in their day-to-day lives due to cannabis’ ability to minimize the mental fog and other unpleasant side effects of opioids.

And when a US state enacts a medical cannabis law, the opioid mortality rate drops by 24.8% — and that percentage goes up the longer cannabis has been legal in a state. Furthermore, non-fatal opioid hospitalizations also go down by 23% (and that’s true whether people are using prescription opioids or illicit drugs like heroin and fentanyl).

These findings aren’t entirely surprising to the addiction recovery community, where anecdotal reports of using cannabis to wean off opioids are quite common. Cannabis is said to minimize the chills, nausea, excruciating pain and mental anguish associated with opioid withdrawal. This makes the first few days of opioid detox far more tolerable, boosting the likelihood of staying sober.

We also know that one of the biggest relapse triggers is negative mood or anxiety, and that CBD alone has powerful anti-anxiety effects. In preliminary studies at Mt. Sinai hospital in New York, renowned researcher Yasmin Hurd has shown that even a single dose of CBD can inhibit the anxiety that leads to drug craving and relapse in opioid users.

In our daily lives, we all experience fluctuations in our mood — sometimes a bit higher than usual, sometimes a bit lower. But with chronic drug use, that “baseline” continually drifts downward, and despite attempts to restore it with drugs, it never gets back to normal. Cannabis is “rewarding” in that it produces euphoria and promotes a positive mood, so it could be a critical tool that helps return mood to a more normal baseline. This means fewer days of heightened anxiety that would normally trigger a relapse.

It’s really in the long-term phase of addiction recovery that cannabis has the greatest potential to improve well-being. Although decades of addiction research have accurately correlated cannabis use with the use of “harder” drugs like heroin, correlation is not causation. So cannabis is not the “gateway” drug it’s been demonized to be. Rather, it could very well be a humane “exit” from the suffering that is opioid withdrawal, dependence, and addiction.