Should Cannabis Be a Weapon Against America’s Opioid Addiction Crisis?

Few would disagree that there’s evidence of a crisis in the United State over high rates of opioid addiction. The US Center for Disease Control says “91 Americans die every day from an opioid overdose.”

Many call this a problem of epidemic proportions. The US Department of Health and Human Services calls it an “epidemic”; The US food and Drug Administration is “deeply concerned about the growing epidemic of opioid abuse, dependence and overdose in the United States.” And the NY Times calls it “America’s 50-state epidemic.”

Interestingly, some suggest that a powerful weapon in the fight against often-deadly, addictive opioids, is cannabis. We use the word ‘interestingly’, of course, because cannabis appears on the Drug Enforcement Agency’s Schedule I list of the most dangerous drugs which are characterized as having “no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse.” And people are still calling it a ‘gateway drug’… but more on those archaic cannabis canards later.

Regarding reducing the epidemic of opioid addiction nationwide, one critical question seems to be, “If opioid addicts replace their opiates with cannabis, would it reduce their rates of overuse, addiction, and death?” The answer seems to be “yes”, according to many including Yasmin L. Hurd, PhD, of the Friedman Brain Institute, Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, Center for Addictive Disorders, Mount Sinai Behavioral Health System, in New York City.

“Epidemics require a paradigm shift in thinking about all possible solutions. The rapidly changing sociopolitical marijuana landscape provides a foundation for the therapeutic development of medicinal cannabidiol to address the current opioid abuse crisis.” (links to research paper available behind paywall). Dr. Hurd also said “It is important to move with a deep sense of urgency to leverage the opportunity presented by increased legalization of medical marijuana to expedite the development of cannabidiol for therapeutic interventions for opioid use disorder, thus curbing the opioid epidemic."

Why would an opiate addict turn to cannabis? First, it has to do the primary job of providing pain relief. The “cannabis” used must be the right blend: heavy CBD, little or no THC. Cannabis’ use for pain is approved by several states that have a list of specific qualifying conditions, including Ohio, California, and Pennsylvania. So it’s well known even among lay people and (enlightened) politicians that high-CDB cannabis is a strong pain killer.

Would cannabis reduce the likelihood of addiction? A pilot study suggests CBD reduces the urge to seek more drugs. Harvard’s J. Wesley Boyd, MD/PhD quotes the National Institute on Drug Abuse - only 9% of cannabis users become addicted, versus 32% of tobacco users and 15% of alcohol users. 23% of heroin (also an opioid) users become addicted.

Last, by substituting opiates with cannabis, are deaths reduced? One important metric is death-by-overdose, and the history of cannabis shows zero overdoses in thousands of years. “The findings suggest that… marijuana could be a safer replacement for opioids, since marijuana doesn't induce overdose," according to Dr. Hurd.

So how about other manners of demise? Many studies of traffic deaths, hospital visits indicate they are reduced but perhaps the most compelling and easy to understand is from the Journal of the American Medical Association (JAMA) Internal Medicine, in which “Marcus Bachhuber, then at the Philadelphia Veterans Affairs Medical Center in Pennsylvania, examined death certificates in all 50 states between 1999 and 2010. They found that the annual rate of deaths due to overdose on an opioid painkiller was nearly 25% lower in states that permitted medical marijuana. In 2010, that translated into 1729 fewer deaths in those states. The researchers also found that the effect grew stronger in the 5 to 6 years after the states approved medical marijuana.”

What’s keeping larger studies from going forward? Politics. Because cannabis is on Schedule I, it can’t be acquired by qualified research facilities. So it can’t be studied, not can data be produced. Without data, it will be hard to get cannabis off Schedule I. Until it is off Schedule I, it can’t be studied, and round and round we have gone for the past 47 years.

"We are in a ridiculous catch-22 situation right now," Dr Hurd said. "We could actually move very quickly if there was a federal mandate to put together a consortium that can quickly investigate [cannabis] for opioid use disorder.”

Seems people will continue to die at a rate of 91 per day until data and results like the ones listed here can be broadly implemented.