An honest look at whether cannabis can solve the opioid crisis

Last April, British Columbia declared the first public health emergency in the province’s history. That month alone, 71 people died from opioid overdoses. Some were the result of illicit drug use like heroin, and others were from prescription medications like fentanyl and methadone. In the end, the drug’s legal status is irrelevant.

Canada’s nationwide opioid overdose crisis claimed nearly 2500 lives last year.  By July of 2016 in British Columbia, 482 lives would be claimed by illicit drug overdoses, nearly doubling the death rate from the previous year. This year, during those same months, that number has nearly doubled again to 876 recorded deaths.

Across Canada and the United States, healthcare professionals are desperately searching for novel solutions to this unprecedented public health crisis. Dr. Philippe Lucas thinks he’s found one: cannabis. 

Earlier this year, Lucas released a research paper in the Harm Reduction Journal on the potential for “cannabis-based interventions in the opioid overdose crisis.” The study suggests that cannabis can make opioid medications more effective or, in some cases, replace them altogether in the treatment of chronic pain. 

Other studies from previous years have come to similar conclusions. A 2014 U.S. study, led by Dr. Marcus A. Bachhuber and published in JAMA Internal Medicine, found that while opioid overdoses have increased in all states, in states with medical marijuana, opioid overdoses were 25 percent lower than anticipated. 

“The part of that statistic I find most revealing is that the longer the medical cannabis program is in place in states, the greater the effect or impact on opioid overdose deaths,” says Lucas. 

These findings are significant. Currently, the U.S. is in the midst of its own opioid overdose crisis, claiming more than 33,000 people in 2015, according to the Centers for Disease Control and Prevention. And according to 2016 data, fentanyl overdose deaths alone have increased 540% in just three years.

In another recent study, researchers Jacob Miguel Vigil and Sarah See Stith also found that medical marijuana reduced patients’ reliance on dangerous prescription meds including opioids. While studies like this are promising, Vigil told Herb that, unfortunately, it’s difficult to source funding for significant medical marijuana research due to federal prohibition. Regardless, Vigil says he believes that results, like the ones from his study, will fuel a shift from prescription and over-the-counter drugs to cannabis.

Lucas also hopes to see this shift in Canada, when marijuana is fully legalized next year.

According to Lucas, there are three major opportunities in the prescription process for cannabis. The first is when patients see their physicians for the first time about a chronic pain issue. The second is when patients are already using opioids to treat chronic pain, but are still experiencing breakthrough pain and are looking to increase their dosage. And the third is for those who are currently in the grips of an opioid use disorder and are looking to wean themselves off of opioids, whether they be prescription drugs like fentanyl or illicit drugs like heroin.

“Right now, prescription guidelines in most of Canada suggest that you start with over-the-counter painkillers—that would be your Tylenol, Aspirin etc.—as kind of a frontline treatment, then you move on as a second line of treatment to opioids and non-steroidal painkillers, and then and only then if those are not effective do you move on to cannabis and cannabinoids as a potential treatment option. That simply is not in keeping with the available evidence on the safety and efficacy of cannabis and cannabinoids as a treatment for chronic pain,” says Lucas.

Instead, Lucas believes that cannabis should be used as the second line of treatment instead of opioids, which he says should be a last resort. “I think that that alone would go a long way to ensuring that when patients suffer from chronic pain that they don’t immediately start down a path that starts out with responsible prescription opioid use, and ends up with opioid use disorder and all too often now, leads to opioid overdose from the illicit drug supply,” he said.

Dealing with these high-level addictions is one of the more difficult processes for patients, who typically enroll in a course of treatment called Opioid Replacement Therapy (ORT).

Lucas is currently investigating the potential of cannabis as a substitute for opioids during ORT. In one such project, Lucas and his team are working on the largest survey of Canadian medical cannabis patients—2032 in all—ever conducted. 

According to Lucas, their pre-publication data found that 69 percent of respondents substituted a prescription drug for cannabis. (35 percent of these prescription drugs were opioids.) Of the 2032 patients total, the survey found that a staggering 610 people were substituting opioids for cannabis.

“The remarkable thing from this data from my point of view is this is largely ad hoc substitution,” says Lucas. “Most of these patients are seeing their doctor to talk about a chronic pain issue and they’re getting a prescription for cannabis. But the doctor’s not saying I also want to taper you off of your opioids.” In other words, if physicians were actively prescribing cannabis for the purpose of tapering patients off of opioids, the substitution numbers would likely be even higher. (Lucas hypothesizes one of the reasons that opioid use has gone down in states where cannabis is legal is because medical marijuana has become more normalized among physicians who feel comfortable discussing it with patients as a treatment option.)

All this promising research is invaluable in provinces like British Columbia, where illicit drug overdoses are now among the top 10 leading causes of death. The potential for Canada’s marijuana laws to influence drug policies south of the border is just as urgent: in the U.S., drug overdoses are now the leading cause of death for Americans under the age of 50.

Cannabis as a solution to addiction may sound strange to people who grew up with horror stories about marijuana as a gateway drug. It’s a myth that’s been reemerging in recent months as some prohibitionists seek to stop the progress of cannabis reform.  But as Lucas says, not only is cannabis not a gateway drug, it as an “exit drug.”