There is no question the US has a serious opioid problem. Opioid overdoses are at an all-time high, with over 130 overdose deaths every day. You may make the assumption that because cannabis can help relieve pain, medical marijuana is the answer.
However, replacing prescription painkillers is more complex than just substituting with cannabis. We’re going to explore the relationship between marijuana and opioids, but first, let’s cover some background information on the opioid crisis.
The US Opioid Crisis in 2019
From an economic standpoint, the US opioid crisis is crippling. On top of the turmoil it causes amongst families and communities, this epidemic is costing upwards of $78.5 billion a year. This includes healthcare, criminal justice, incarceration, lost wages/productivity, and addiction treatment.
Some of the most commonly abused opioids include codeine, hydrocodone, morphine, fentanyl, and oxycodone. It is far too easy to misuse these prescription drugs, and in fact, 20-29% of those prescribed opioids will do just that. Another staggering figure, 8-10% of those prescribed opioids may become addicted.
How Has the Opioid Crisis Reached This Level?
When opioids made their rise to fame in the ’90s, it was thought that addiction was not possible. It was reported, falsely, that people in pain simply could not become addicted to opioids. This obviously proved to be false, but alas, there was money to be made and much of the damage was already done.
At the end of the day, chronic pain is no joke, and opioids work. The problem is, they don’t work forever, and have nasty side effects. Not to mention prescription painkillers are one of the most addictive substances and are widely known as a gateway drug.
Opioid vs Opiate
Before we proceed, let’s clear up a common misconception: that opioids and opiates are the same things. An opioid differs from an opiate, and these terms should not be used interchangeably. An opiate is defined as a naturally derived drug from the poppy plant. On the other hand, an opioid is any substance (natural or not) that interacts with our opioid receptors.
Is Marijuana an Opiate?
Many people ask if marijuana is an opiate. After all, they both are natural painkillers that grow from the ground. But, the answer is no, marijuana is not an opiate.
How Opioids and Marijuana Work Together for Pain Relief
There is no doubt that you can use marijuana to alleviate pain. But, you may not have known that there is actually a synergistic relationship between marijuana and opioids.
That’s right, inhaled marijuana complements prescription opioids, increasing the efficacy of treatment and reducing withdrawal symptoms.
When used in conjunction with opioids, marijuana has been shown to:
- Increase analgesic effects (pain relief)
- Lower side effects, cravings, and severity of withdrawal symptoms
- Decrease the risk of overdose death
The Endocannabinoid System and Opioids
To understand why marijuana and opioids may work well together, you need a basic understanding of our endocannabinoid system. Our endocannabinoid system consists of CB1 and CB2 receptors, which interact with cannabinoids. These interactions provide profound benefits, one of which is pain relief.
Opioids may also partake in these interactions with CB1 receptors. In a recent study conducted to examine the relationship between marijuana and opioids, patients were given low-dose cannabis (<6% THC) and oxycodone (2.5mg). These low doses had no effect on pain individually.
However, when combined, participants showed higher pain tolerance. They also showed significant reductions in overall pain. To back this theory up, it has been shown that blocking CB1 receptors decreases the efficacy of the opioid Morphine.
To make things even more interesting, CB1 and opioid receptors are often found expressed together in the spinal cord. The specific region they are found is considered the brain’s “reward center,” a region responsible for pain relief. Since they both help with pain relief, this makes sense.
Bridge City Collective Study on Marijuana and Opioid Withdrawal
Hoping to discover that marijuana can help with this national crisis, we have decided to take matters into our own hands. We have funded a study investigating medical marijuana’s ability to treat opioid withdrawals. The study will last 10 years, with results being shared with the DOC annually. On top of this, results may be permitted after years 1, 5, and 10.
This study will consider three different data points:
- Individuals withdrawing from opioids using drugs such as methadone or suboxone, with no medical marijuana supplementation.
- Individuals withdrawing from opioids using drugs such as methadone or suboxone and supplementing with medical marijuana.
- Individuals withdrawing from opioids using only medical marijuana.
On top of this, research is broken down further into the type of marijuana being used:
- CBD and THC combination
How the Study Works
The study will take place in the heart of a location struggling with its own opioid epidemic, Springfield Ohio. Participants in the study must first obtain a doctor’s recommendation for medical marijuana. They will be administered marijuana at the first sign of withdrawal symptoms, usually 48 hours after last opioid ingestion.
Hopefully, the results of this study can help put a dent in the opioid crisis, while making prescription drugs more effective. If the research has a positive outcome, it could also lead to:
- A decrease in crime
- Less opioid-related death
- Smooth integration for former addicts into society
Can Medical Marijuana Replace Opioids Altogether?
With the drastic rise in medical marijuana patients across the nation, and more following rapidly, it raises the question: can medical marijuana replace opioids?
It is a fair question, considering cannabis’ well-documented pain relief properties. Many are using medical marijuana for chronic pain, including arthritis, cancer, surgery recovery, and more. These are many of the same issues that opioids are prescribed for, so can’t we just start prescribing people marijuana instead?
Due to the federal regulation of cannabis, it has been tough to find conclusive results regarding efficacy, dose, consumption method, or side effects. This is what makes it tough to strongly consider medical marijuana as a legitimate alternative to opioids. Regardless of the overwhelming anecdotal evidence available, we need cold, hard studies. Currently, there are none directly comparing marijuana vs opioids for pain.
As laws regarding research continue to advance, Colorado has funded one such study, set to take place in 2020. And when it does, we can begin to take steps to amend our country’s opioid crisis.
How Has Marijuana Legalization Affected the Opioid Crisis?
As more and more states continue to implement medical and recreational marijuana laws, we are seeing a decrease in some of the harms caused by the opioid crisis. This includes overdoses and untreated addictions.
In fact, states with medical marijuana laws report almost 25% fewer deaths caused by overdose. On top of this, those same states are seeing a 23% reduction in opioid addiction and abuse-related hospital visits. This is encouraging, as conquering the opioid crisis is going to be an uphill battle.
As cannabis research advances, and we learn more about how this medicine can help us, hopefully we can see these positive results increase across the nation.
Grinspoon, Peter. “Access to Medical Marijuana Reduces Opioid Prescriptions.” Harvard Health Blog, 25 June 2019, www.health.harvard.edu/blog/access-to-medical-marijuana-reduces-opioid-prescriptions-2018050914509.
Kaplan, Josh. “How Cannabis Enhances the Effects of Opioids.” Leafly, 29 Mar. 2018, www.leafly.com/news/health/how-opioids-marijuana-work-together-for-pain-relief.
Wiese, Beth, and Adrianne R Wilson-Poe. “Emerging Evidence for Cannabis’ Role in Opioid Use Disorder.” Cannabis and Cannabinoid Research, Mary Ann Liebert, Inc., 1 Sept. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6135562/.