Many doctors and medical cannabis advocates are saying that medical cannabis is the solution to the United States opioid epidemic, also called the opioid overdose crisis.
In this special report, we will explore this concept. We will take a look at the opioid crisis that is currently grappling the U.S. and how it came to be. We will take a look into what it’s doing to American families.
Then we will take a look at what cannabis can do. Can it really help solve the problem brought about by opioid addiction and opioid overdose deaths?
First, what are opioids?
Opioids are drugs that act on opioid receptors in order to create morphine-like effects. Medically, opioids are mainly used for pain relief. Other medical uses of opioids include the suppression of diarrhea, suppressing cough, suppressing opioid-induced constipation, reversing opioid overdose, and replacement therapy for opioid use disorder. Opioids are also used frequently for non-medical purposes, specifically for their euphoric effects.
Opioids, according to the National Institute on Drug Abuse (NIDA), are a class of drugs that include:
- pain relievers that are legally available and accessible by prescription, such as
* oxycodone — sold under brand names like OxyContin (R) and Percocet (R)
* hydrocodone — sold under brands like Vicodin (R) and Norco (R)
- synthetic opioids such as fentanyl
- illegal drugs such as heroin
Opioids also include endogenous peptides such as endorphins and antagonist drugs such as naloxone.
Opioids are addictive
Opioids are addictive and using them too much can result in fatal overdose. This is why most opioids are controlled substances.
In its latest report on the opioid overdose crisis, the NIDA states that in the U.S., more than 115 people die every day due to opioid overdose. The misuse of and addiction to opioids is considered a serious national crisis affecting both public health and social economic welfare.
According to estimates by the Centers for Disease Control and Prevention, the total economic burden of the misuse of prescription opioid alone is $78.5 billion a year. This includes the costs of health care, criminal justice involvement, addiction treatment, and lost productivity.
How the opioid crisis came to be?
Pharmaceutical companies assured the medical community in the late 1990s that prescription opioid pain relievers. Because of this assurance, healthcare providers started prescribing these drugs more and more.
This ever-increasing rate of prescription led to widespread diversion and abuse of these medications. It then became clear that these pain relief medications are indeed highly addictive.
The widespread misuse of opioids resulted in an increase in overdose rates.
According to the NIDA, more than 33,000 Americans died in 2015 as a result of opioid overdose, including heroin, prescription opioids, and illegally manufactured fentanyl.
That same year, around 2 million Americans suffered from substance use disorders that are associated with prescription opioid pain relievers. Additionally, nearly 600,000 suffered from heroin use disorder.
The numbers associated with opioid misuse and overdoses continue to rise each year and this issue has already escalated to become a public health crisis. There is also a rising number of cases of neonatal abstinence syndrome or newborns experiencing withdrawal syndrome due to the use and misuse of opioids during pregnancy.
What’s more, the increase in the use of injection drugs has also contributed to the spread of infectious diseases such as hepatitis C and HIV.
Statistics related to the opioid crisis
Here some relevant figures related to the opioid crisis as gathered by NIDA
- An estimated 21% – 29% of patients who are prescribed opioids for chronic pain misuse them.
- Between 8% and 12% of patients who are prescribed opioids develop opioid use disorder.
- An estimated 4% – 6% of people who misuse prescription opioids transition to using heroin.
- An estimated 80% of those who use heroin started by first misusing prescription opioids.
- Cases of opioid overdose increased 30% in the period starting July 2016 to September 2017 in more than 50 areas in 45 U.S. states.
- In the Midwestern region, opioid overdose cases increased 70% from the same period (July 2016 through September 2017).
- Opioid overdose cases increase by 54% in large cities in 16 states.
According to 2016 and 2017 data gathered by the U.S. Department of Health and Human Services (HHS):
- An estimate of 130+ people died every day from opioid-related overdose (3)
- 11.4 million people misused prescription opioids (1)
- 42,249 people died from overdosing on opioids (2)
- 2.1 million people had an opioid use disorder (1)
- 886,000 people used heroin (1)
- 81,000 people used heroin for the first time (1)
- 2 million people misused prescription opioids for the first time (1)
- 17,087 deaths are attributed to overdosing on commonly prescribed opioids (2)
- 15,469 deaths are attributed to overdosing on heroin (2)
- 19,413 deaths are attributed to overdosing on synthetic opioids other than methadone (2)
(1) 2017 National Survey on Drug Use and Health, Mortality in the United States, 2016
(2) NCHS Data Brief No. 293, December 2017
(3) NCHS, National Vital Statistics System, Estimates for 2017 and 2018 are based on provisional data
You can download the HHS infographic “The Opioid Epidemic by the Numbers” here.
What is the U.S. federal government doing to address the problem?
In 2017, the HHS declared the opioid problem a public health emergency and set up a 5-point strategy to combat the crisis.
The five major priorities for addressing the issue are:
- improving the access to treatment and to recovery services
- promoting the use of drugs that reverse the effects of overdose
- strengthening understanding of the opioid epidemic through better public health surveillance
- advancing better practices for pain management
- providing support for cutting-edge research on pain and addiction
The National Institutes of Health (NIH), which is a component of HHS, is the leading medical research agency in the U.S. helping solve the crisis by coming up with new and better ways to manage pain, prevent the misuse of opioids, and treat opioid use disorders.
In 2017, the NIH met with pharmaceutical companies, as well as academic research centers, to discuss safe, non-addictive, and effective strategies to manage chronic pain. The also discussed improved overdose prevention and reversal interventions to support recovery and save lives. Also on the agenda were new and innovative technologies and medications to treat opioid use disorders.
How does cannabis fit in the picture?
Many in the cannabis community believe that legalizing medical cannabis is the best and most effective way to solve the opioid epidemic.
How? Researchers found that legalized medical cannabis can reduce opioid use.
A study published in May 2018 in JAMA Internal Medicine found that states in the U.S. that have legalized medical cannabis and opened a medical cannabis dispensary saw a drop in opioid prescriptions. More specifically, researchers found that Medicare Part D prescriptions for opioids dropped an average of 3.7 million daily doses per year, showing a nearly 15 percent decline.
The authors of the study suggested that opioid prescriptions drop because patients who are in states where medical cannabis is legal can switch to cannabis products when it comes to managing their pain.
Do all studies point to cannabis as a better alternative?
A paper published in the Journal of Addiction Medicine in April 2018 contradicts the notion that easy access to cannabis could reduce opioid consumption.
The study’s authors looked into data from a 2015 national survey on drug-use habits among Americans 12 years old and up. The researchers found that medical cannabis users were about twice as likely to misuse prescription medications — including opioids — as people who do not use medical cannabis.
According to the authors, these associations persist after they have made adjustments for population or demographic differences (age, sex, race, family income, self-reported health status, and whether they live in states that legally allows medical cannabis).
Cannabis for pain relief
Medical cannabis is fast becoming a popular alternative to traditional pain-relief medications, including opioids. It has proven to significantly ease certain types of chronic pain, including those that result from inflammation and nerve damage.
Anecdotal evidence suggests that active chemicals found in cannabis, which are called cannabinoids, connect to pain receptors that are found in the central nervous system. This is known to relieve pain even when stronger opiate painkillers are not effective.
It is worth noting, though, that different strains of cannabis may have slightly different effects on users.
The role of THC and CBD in pain relief
Most studies relating to cannabis and pain relief focus on tetrahydrocannabinol (THC) and cannabidiol (CBD).
When users inhale or ingest THC, it stimulates the cannabinoid receptors in the brain. This activates the reward system of the brain and reduces pain levels.
THC is a psychoactive chemical component and as it binds to cannabinoid receptors, it produces a high, or an elevated state of mind.
CBD also interacts with the brain’s pain receptors and has anti-inflammatory and pain-relieving properties. However, it does not create a high.
What research says about cannabis and pain relief
There are many studies that have looked into cannabis and its effects on chronic pain.
For one, a 2015 review of research on cannabis and chronic pain found several trials to have positive results. Researchers suggest that cannabis may be effective in treating certain types of chronic pain, including nerve pain or neuropathy.
There was also a 2016 research paper that found that cannabis use for cancer pain led to a 64 percent reduction in opioid use.
Meanwhile, smaller studies have reported the benefits of cannabis when it comes to other types of pain.
These studies found that:
- Of about 17,000 people suffering from cancer, 70 percent experienced improved pain and general well-being after using weed.
- People who have chronic migraines experience a decrease in migraine episodes after using cannabis.
Cannabis vs. opioids
While opioids are strong medications that can relieve pain by acting on our nervous system, they are also highly addictive. Getting off them also bring about awful withdrawal symptoms.
Medical cannabis may offer a way safer and a more effective alternative to addictive opioids.
Researchers had conducted a survey of nearly 3,000 medical cannabis users and found that 30 percent of these patients had used prescription opioids in the last six months. Of these patients who had used opioids before switching to cannabis, 80 percent strongly agreed that cannabis was more effective by itself than when combined with opioids.
What’s more, 97 percent of these patients agreed that they could decrease their use of opioids when taking medical cannabis.