A more recent yet ongoing and severe epidemic plaguing so many lives of those across the country is the Opioid Epidemic. Generally, opioids are prescribed by doctors to patients to help with serious pain, however increased prescribing of opioids since the late 1990’s has led to widespread misuse, addiction, and hundreds of thousands of opioid overdoses. It was only in 2017 that this epidemic was declared a public health emergency, and since then there have been a number of efforts to combat this epidemic and help those in need. One of those efforts includes medical marijuana. On May 17, 2018, Pennsylvania became the first state to approve medical marijuana for opioid use disorder, and it has demonstrated great potential to help those in need.
Opioids & The Epidemic
Opioids are a class of drugs used to reduce pain. They are generally classified into 3 categories: prescription opioids that you can only get from a doctor (i.e. oxycodone, vicodin, morphine), Fentanyl which is a stronger, synthetic opioid, and heroin, which is an illegal opioid. While prescription opioids and fentanyl were originally said to be safe for use by pharmaceutical companies, they do have clear and serious side effects, with anyone being able to become addicted to them. Opioids can help combat pain relief, but realistically, these “safe for use” drugs were touted by pharmaceutical companies because of their profitability, and the risk at this point frequently outweighs the reward. Side effects of opioid use include a continued increased tolerance, meaning patients have to take even more medication for the same pain relief, as well as physical dependence, which also means withdrawal when stopped, vomiting, depression, sleepiness, dizziness, an increased sensitivity to pain, and at worst, overdose and death.
Even today, opioids continue to be overprescribed, with over 191 million opioid prescriptions dispensed in 2017. This is not to say that there is no acceptable use of opioids, as it may be appropriately prescribed in certain situations, where patients are clearly in need and they can be closely monitored to ensure safe administration of such drugs (i.e. fentanyl can be used to help treat severe pain in patients with advanced form of cancer) . Most doctors are careful about such prescriptions, and as always will consider what is best for the patient’s well being before deciding to or to not prescribe a medication. That being said, the extent at which the pharmaceutical industry has pushed these harmful drugs has had lasting consequences, with almost 450,000 people in the U.S. dying from opioid overdoses between 1999-2018, and 50,000 people in the U.S. in 2019. While these companies mislead the medical community on the harm that could be caused by opioid use, many people have had to pay for this with their lives.
Opioid Use Disorder
Opioid Use Disorder is a form of addiction, which is a condition that manifests generally with substance use. It should be clearly noted that though addiction is unique and complex, it is an illness like any other, and should be treated as such. OUD is defined as a problematic pattern of opioid use leading to clinically significant impairment or distress. As previously mentioned, we know now that opioids can be addictive, and as per the National Institute of Drug Abuse, 21%-29% of patients prescribed opioids end up misusing them, and 8%-10% of patients using opioids for chronic pain develop OUD. Symptoms of OUD include taking larger amounts of opioids for longer than their intended use, unsuccessful efforts to cut down on opioids, craving, problems fulfilling obligations, problems in interpersonal relationships, higher tolerance, and physical withdrawal when cutting back.
Most dangerously, Opioid Use Disorder can cause individuals to overdose on opioids, which in turn, can kill them. With the number of lives derailed and deaths caused by opioids and the irreversible harm caused by this epidemic, it is clear that there is a lot of work to be done both to help those in need of pain relief, and to help those with OUD. Medical marijuana, is one such option.
How Marijuana Can Help
Not only is Opioid Use Disorder an approved condition for medical marijuana in PA, it also has become an alternative for some patients for pain relief as opposed to using opioids. The approval of this condition for medical marijuana allows for there to be another option for doctors to help treat patients with severe pain as well as allowing research on medical marijuana and OUD to be conducted within PA. There has been strong evidence that medical marijuana can help fight the opioid crisis. In one study, it was determined that in states that offer medical marijuana programs, there are nearly 25% fewer deaths related to opioid overdose. In many cases, patients in medical programs find that they prefer cannabis to opioids, due to lack of withdrawal, fewer side effects, and easier symptom management. This shows that cannabis is an effective medication and is already being used by many as a replacement medication. By allowing prescribers to first choose medical marijuana over opioids, the chance of addiction drastically falls.
Medical marijuana can also help those suffering from opioid-use disorder. One phytocannabinoid thought to have an anti-addiction effect is cannabidiol, or CBD. As CBD is non-psychoactive, it has little to no potential for abuse. When administered, CBD can decrease stress, anxiety, and the addiction potential of other drugs. In animal-based trials, researchers found that CBD successfully inhibited drug-seeking behavior, even for longer than two weeks after administration for some. When administered during active intake, CBD was found to inhibit relapse behavior. The neurobiological mechanisms behind this method of action are still being studied. In addition, CBD is extremely beneficial for symptoms of withdrawal, including wet shakes, abdominal pain and cramping, and ptosis. Research is currently being conducted to determine if CBD can help correct the reward pathway for patients with opioid-use disorder.
As one of medical marijuana’s most common means of use is pain relief, it has great potential as an opioid alternative, especially for patients with OUD who still need pain relief. Both THC and CBD have great pain relieving potential, as well as many of the terpenes in marijuana such as myrcene and caryophyllene. For many patients, this can make marijuana a much safer and more feasible option of use for their treatment.
The opioid epidemic is something that must be tackled, and as members of the medical marijuana community, we have the opportunity to both help those in need of pain relief and those struggling with this very real and very serious addiction. Patients should of course speak with their doctors about transitioning to medical marijuana or if considering medical marijuana as an alternate treatment for addiction. As research continues both in marijuana and opioid addiction, we hope to continue to be able to help those in need, and fight the opioid epidemic.
Disclaimer: These statements have not been reviewed for accuracy by the FDA. As always, seek the advice of your physician or other qualified health provider when considering trying a new treatment. Do not start or stop taking any medications without speaking to your doctor first.