Is There a Role for Medical Cannabis in Combating the Opioid Epidemic?

[Guest post by Cliff Mintz who writes for Cannabis Science Blog. Mintz has an extensive background in biopharmaceutical drug development and Cannabis science. He received a BS degree from Cornell University and a PhD degree from the University of Wisconsin-Madison.]

While the exact causes of the current opioid academic are uncertain, a variety of factors including job loss, chronic unemployment, financial hardship and over-marketing/over-prescribing of opioids have been suggested (read "Former Insys Sales Reps Bribed Docs To Prescribe Opioids To As Many Patients as Possible"). It is important to note, however that between 1981 and 2011 the number of opioid prescriptions in the US tripled from 76 million to 219 million per year. According to a recent survey, over 97 million people took prescription opioids in 2015 and of these, roughly 12 million used opioids without being directed by a doctor.  Interestingly, because of recent state legislative initiatives that restrict the opioid prescribing habits of physicians, the number prescription opioids deaths appeared to level off in 2011. However, since 2011 the number of heroin overdose deaths and those related to illegal “black market” synthetic opioids like fentanyl has skyrocketed (CDC) in many hard hit states. This is because heroin and fentanyl are now much cheaper and more available than prescription opioids.

The current opioid epidemic is forcing many physicians to reevaluate their use of prescription opioids for pain control and to consider alternative pain management strategies. There is an emerging body of evidence that suggest that medical cannabis (smoked, vaporized or ingested) can effectively manage and control chronic non-cancer pain, reduce opioid consumption and help to lower opioid overdose deaths.

Cannabis Reduces Opioid Consumption

While cannabis is not approved as a treatment for pain in the US, there is a growing body of evidence from states where medical cannabis is legal that cannabis reduces opioid consumption in chronic pain patients. Several studies in the US and around the world showed that opioid use dropped by as much as 50% among chronic pain patients when they were given access to cannabis.

A study that researched the association between the existence of state medical marijuana laws and opioid overdose deaths from 1999 to 2010 found that opioid overdose deaths declined by as much as 25% in states that had medical cannabis laws in effect (Bachhuber MA, Saloner B, Cunningham CO, Barry CL. Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010. JAMA. Intern Med. 2014; 174:1668-1673). Other research showed that reductions in opioid overdose deaths tend to improve in states where medical cannabis laws have been in effect the longest. For example, in California, where medical cannabis laws have been in effect since 1996, there has been a 33% drop in the number of opioid overdose deaths (op. cit.). Similar reductions were also observed in other legacy medical cannabis states such as Oregon, Colorado and the State of Washington.

Other Efforts

Several biotechnology and pharmaceutical companies are attempting to develop cannabis –derived drugs and mimetics that treat pain by binding to certain types of cannabis receptors found throughout the body. Removing cannabis’ psychotropic effects and preserving its pain-relieving benefits is the major objective for this new class of drugs. Although these drugs are still in early stages of development, using them rather than addictive opioids to manage chronic pain would be an important step in curbing opioid over use and abuse.

A Path Forward

Physicians play a critical role in prescription drug misuse and abuse prevention. To that point, continuing medical education programs that help raise awareness and educate physicians about the benefits of cannabis for pain management represents and important first step to curb over-prescription of opioids. Further, ongoing political and financial support for recent federal initiatives such as enhancing access to prescription drug monitoring using health information technology, formalized collaborative efforts between insurers, health care providers, and employers to combat opioid misuse and abuse and community-based programs like the national take-back initiative—which provides a safe, secure, environmentally-responsible plan for disposing of prescription opioids and educates the public about the potential for abusing and trafficking prescription medications—will also be critical. Finally, new federal and state legislation that offers counseling and medical solutions to treat opioid abusers rather than punish them will be vital to control America’s epidemic opioid crisis.

[Under Act 16 of 2016 (the Pennsylvania Medical Marijuana Act or the Act), the term “medical marijuana” refers to marijuana obtained for a certified medical use by a Pennsylvania resident with a serious medical condition. More about medical marijuana in Pennsylvania here.]

Posted on 24 Oct 2017, 11:58 - Category: Opioid Epidemic