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Can Cannabis Reduce Opioid Use?

Drug overdose is now the leading cause of death for Americans under the age of 50, overtaking the number of deaths caused by guns and cars. In 2016, the death toll due to the ongoing opioid epidemic, which was roughly around 64,000, exceeded the number of casualties in both the Vietnam and Iraq wars. Then in 2017, drug overdose claimed the lives of over 72,000 people in the US, or an average of 200 deaths per day. In the same year, the U.S. Department of Health and Human Services (HHS) declared the national opioid crisis as an emergency and launched a 5-point strategy to combat it.

The staggering rate of rise in the number of deaths only shows that the opioid epidemic is likely to worsen with each passing year. As this decades-old crisis continues to ravage cities and communities, it inflicts more damage to families and negatively affects people from different generations. It’s a complicated issue, to say the least, from its origins down to the possible solutions. To make sense of the epidemic and what can be done to curb its effects, let’s take a good look at opioids and what makes them a pervasive presence in communities across the country.

What are Opioids?

Opioids refer to a broad group of drugs that interact with the opioid receptors in the body, an interaction that effectively relieves pain. Originally, opioids are derived from the opium poppy plant, but they can also be synthesized in the laboratory. It’s one of the world’s oldest-known drugs; there’s evidence of it in archeological sites that date back to the Neolithic period, and opium poppy seeds were used for medicinal, recreational, and religious purposes in 4BC and referred to as “Hul Gil” or “plant of joy” in Sumerian clay tablets.

Chronic pain is one of the most common reasons why adult Americans seek medical attention. In 2016, it has been estimated that more than 20% of the population or up to 50 million Americans suffer from it and 8% or around 19.6 million people experience pain that severely impacts their quality of life. While opioids are also used to suppress diarrhea, constipation, and cough, among others, they are primarily used for pain relief and anesthesia. Some examples of opioids are codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, and oxycodone.

Despite the many medical applications of this substance, it should be noted that anyone who uses opioids is at risk of being addicted to it. This is because opioids trigger the release of endorphins, which are neurotransmitters that relieve pain and boost the feeling of pleasure. After the effects of an opioid dose wear off, the user may want to repeat the feelings they got from the experience; this is one of the first signs of a potential addiction. As the person continues to take the same dose of opioids, the body becomes tolerant and slows down endorphin production. This, then, prompts the user to take a higher dose to get the same effect.

Opioids affect the part of the brain that control breathing. An opioid overdose can lead to slowing down or stopping one’s breathing and even death.

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A Brief Look at the Opioid Epidemic in the US

The history of opioid use in the US is as old as the country itself. Opium was used in the American Revolution to treat wounded and ailing soldiers, and opium pills were dispensed to soldiers during the Civil War. The effects of the latter highlighted how opioids can be addictive, and medical journals in the late 1800s were filled with warnings about morphine addiction. Still, the problem with opioid abuse persisted in different ways, and the image of a person addicted to the substance changed over the years.

The current opioid crisis may be divided into 3 waves. The first wave can be traced to the early 1990s when pharmaceutical companies began marketing opioids to doctors, claiming that the risk of addiction that comes with using the substance is quite low, and employing other paid doctors to boost this message. At the same time, there was also a push to prescribe opioids as a humane treatment option for chronic pain. The marketing strategy employed by the pharmaceutical companies and the influential “pain as the fifth sign of life” campaign helped relax the attitude towards prescribing opioids, and patients had easier access to it. The initial response to this cultural change was favorable, but the number of deaths due to overdosing on prescription opioids began to rise because of it.

The second wave began around 2010. During this time, the efforts to decrease opioid prescriptions were taking effect and it became more difficult to get them. People then turned to heroin, which is illegal, cheap, and widely available. Between 2002 and 2013, the number of deaths due to heroin abuse increased by 286%. Also, about 80% of the people who used heroin admitted that they misused prescription opioids before turning to heroin.

The third wave, which began around 2013, refers to the increasing number of deaths due to the use of synthetic opioids like fentanyl, which are illegally manufactured. It has been estimated in 2017 that over 2.1 million people had opioid abuse disorder. In the same year, 17,087 deaths were attributed to overdosing on prescription opioids, 15,469 deaths due to overdosing on heroin, and 19,413 deaths from overdosing on synthetic opioids except methadone. It’s easy to pinpoint the problem to pharmaceutical companies because they certainly played a big part in creating it. However, at this point, concerted effort from various government agencies and communities is needed to even begin to curb and address the effects of the ongoing epidemic.  

Ways to Combat Opioid Addiction

The numbers are alarming, and the damage the crisis inflicts can be felt just about anywhere. The Center for Disease Control and Prevention (CDC) has a 5-point strategy to address key aspects of the epidemic. To maximize the benefits of pain treatment options and to combat opioid abuse, the CDC implements strict guidelines for prescribing opioids and recommends the use of non-opioid treatments first in order to address chronic pain. At the same time, the HHS insists that it is crucial to avoid creating dependence in the first place.

But what other options do people have when it comes to pain management? And is there a way to alleviate pain without risking addiction? Surprisingly, one of the possible answers to these questions may be found in another controversial substance: marijuana or cannabis.

The Role of Cannabis in Pain Management

One of the reasons why opioids were readily prescribed to many patients was because it was marketed as a pain-management medicine that poses low risk for addiction. The former still holds true, while the latter was eventually proven to be false. Now, there are strict guidelines in place when prescribing opioids; the substance should only be dispensed if the pain and function outweigh the risks that come with it. An even then, non-opioid therapy is still preferred when addressing pain.

Cannabis is at the center of more than 45 studies related to chronic pain management. The plant and its products continue to attract the attention of researchers and scientists because of its potential to alleviate pain caused by or related to various diseases such as cancer, fibromyalgia, rheumatoid arthritis, and diabetes, just to name a few. Majority of these studies found that the use of cannabis significantly reduced the level of pain felt by the patients, which then allowed them to get better sleep, retain function and autonomy, and enjoy a better quality of life.

The specific mechanisms of how cannabis reduces pain is yet to be fully understood, but it is typically attributed to the interaction of the plant’s cannabinoids and the endocannabinoid receptors found in the human body. More studies need to be done to connect the dots, but there are also federal rules that prevent scientists from doing just that. With the changing stance on medical cannabis, however, there’s hope that scientists will be able to better understand how cannabis affects the body and one’s sense of pain, and how this effect can be harnessed to benefit many patients who are suffering from chronic, debilitating pain. 

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Addiction and Cannabis Use

Many people were misled about the risk of addiction brought about by using opioids; can the same be said for cannabis? Is cannabis addictive?

It’s important to know first that there are different types of addiction: physical dependence and psychological addiction. Physical dependence is marked by tolerance, wherein the body requires a larger dose of the substance to get the same effects, and withdrawals, or undesirable physical symptoms of discontinuing the use of the substance. Psychological addiction, on the other hand, refers to how the person develops emotional and motivational withdrawals when discontinuing the use of the substance.

To answer the question: Yes, cannabis can be addictive in that it can cause physical dependence. This means that overtime, people who use cannabis to relieve their pain will have to increase their dose in order to achieve the same level of pain relief that they are used to. To reset their tolerance level, patients only need to temporarily stop using cannabis products. Ceasing cannabis use can cause withdrawal symptoms such as nervousness and bad moods, but these are often quite mild and can be ignored. Marijuana is not likely to cause psychological dependence, meaning patients won’t crave for it or be compelled to prioritize cannabis use over their responsibilities and relationships.

In contrast, opioids are physically and psychologically addictive. Addiction to it is marked by the compulsive urge to use the drug, which often leads patients to abuse it and put it above their professional and personal relationships.

Then, there’s the issue of overdosing. Opioid addiction is so dangerous because overdosing on the substance causes so many deaths. Is it possible to overdose on marijuana? Yes, it’s possible to take too much marijuana, enough to cause negative effects like lethargy and paranoia that can last a few hours at most. However, overdosing on marijuana, by itself, has not caused any deaths— that makes it a lot safer than drinking too much alcohol.

To avoid using too much cannabis products, consumers should remember that there are many factors—like their current mood, the cannabinoids in the product, whether they have an empty stomach or not, just to name a few— that can affect their experience. For example, the effects of smoked marijuana can be felt almost immediately, while the effect of edibles cooked in cannabis oil take a bit more time. First-time users should do their research and start small so that they can gauge their dose and enjoy the full benefits of the experience.

Can Cannabis Reduce Opioid Use?

The fact that marijuana offers an effective way to manage chronic, debilitating pain with little risk of addiction is enough reason for people to consider it as a possible replacement or alternative to opioids. In places where it’s legal to access medical marijuana, there are anecdotes of patients who were able to use a consistent dose of opioids over the years by combining it with cannabis. What’s more, a 2014 investigation published in The Journal of American Medical Association notes that the mortality rate due to opioid overdose in states that have medical cannabis laws is 24.8% lower compared to states without medical cannabis laws.

A 2018 study reported in Science Daily shows that 65% of adults who used medical marijuana have reduced chronic pain levels as well as dependence to opioids. Twenty percent of the subjects reported extreme reduction in use of painkillers other than marijuana, while 27% stated that they completely cut back their use of other painkillers. More than that, 91% of the subjects stated that they would recommend medical marijuana to others.

The use of cannabis alone is far from the only solution to the widespread opioid crisis. However, it presents an effective yet safer option to those who are suffering from pain and those who want to break free from addiction.