The Deadliest Dose: Treating the National Opioid Epidemic with Cannabis

The opioid epidemic in the United States has been escalating since the early 2000’s and is now the #1 killer of Americans aged 50 and younger. Millions of Americans are suffering from substance use disorders related to prescription painkillers and now half a million have become addicted to heroin. However, with the legalization of medical cannabis in over 29 states, cannabis is quickly becoming a popular treatment for chronic pain and one that could potentially treat the opioid epidemic in the country.

More than 76.5 million Americans today suffer from some form of chronic pain [1]. Whether it be from headaches, toothaches or pain after a surgery, living with daily chronic pain can be debilitating and have a serious effect on a person’s mood and general well-being. Unfortunately, the drugs commonly prescribed for pain are not entirely effective and can have dangerous consequences, including addiction and increased risk of heroin use. The most common of these drugs are collectively known as opioids.

What exactly are opioids?

The most common form of treatment for chronic pain in the United States is with opioid medication, a form of narcotic medication. Opioid drugs work by binding to opioid receptors in the brain, spinal cord, and various other areas of the body. These drugs lower the amount of pain signals to the brain, leading to a decrease in pain or discomfort.

These opioids can be found in many different forms today, including Codeine, Hydrocodone, and Oxycodone.

Opioid medication is greatly over-prescribed in the United States, with over 289 million prescriptions written in 2016 alone [2].

Even though opioids are commonly prescribed by doctors as a way for patients to deal with pain, this does not mean that opioids are completely safe. Opioids have numerous side effects that can have a drastic impact on one’s daily life.

Dangers of opioid prescription

Opioids are dangerous because of their easy accessibility and their addictive nature. Just like candy given to kids on Halloween, opioid prescriptions are written at an enormous rate. In the United States, any type of serious long-lasting pain is treated with opioids.

As one begins to take opioids on a daily basis, they begin to develop a dependence on the drug. As their tolerance to the medication increases, they find that they need to consume more and more medication in order to garner the same positive effects. As a patient begins to increase their intake, their dependence on the drug rises until they have become addicted. Reportedly, 80% of opioid addicts became hooked after being prescribed opioid pain medication by their doctors [3].

Along with addiction and tolerance comes overdose. Opioid overdose has become the number one killer in the United States for Americans under 50. The number of deaths each year that are a result of drug overdose continues to rise every single year. In 2015, 52,000 Americans died from drug overdose and this number rose by approximately 19% in 2016 to 62,000 deaths. These numbers are a massive escalation from 4,000 deaths in 1999 [4].

What led to the over-prescription of opioid medication?

Before the 1990s, opioids were not over-prescribed to the general public. In 1973, Nixon declared the War on Drugs and formed the Drug Enforcement Agency. In a speech, Nixon once stated,

“America has the largest number of heroin addicts of any nation in the world. Heroin addiction is the most difficult to control and the most socially destructive form of addiction in America today” [5].

With warnings ringing in the minds of the American citizens, opioid usage was not an issue over the next two decades.

This changed during the 1990s, when clinicians backed by pharmaceutical funding and research, lobbied for the increased usage of opioid medication in order to treat pain of all types, not just pain due to terminal illness. As a result, many new opioid options flooded the market. By 1999, an estimated 4 million people (about 2% of the population age 12 and older) were using prescription drugs non-medically [6].

Various other factors besides increased prescriptions could have contributed to the severity of the opioid problem today. There is now greater social acceptability for using medication for a number of different purposes. In addition, since the 1990s, pharmaceutical companies became extremely aggressive in creating marketing strategies to promote their products.

For instance, Purdue Pharma, the company producing the opioid drug OxyContin, created a video promotion that detailed how the drug was able to deal with chronic pain. The advertisement went on to state false facts such as how “They don’t wear out; they go on working; they do not have serious medical side effects.” Opioid painkiller prescriptions skyrocketed by 11 million in just one year after this video’s release. Seven years after the video, the company and three of its executives were charged with misbranding its drug and downplaying the risk of addiction [7].

The Opioid Epidemic Today

The abuse of and addiction to opioids such as heroin, morphine, and prescription pain relievers continues to be a serious global problem. It affects countless aspects of society, regardless of health, social, and economic status.

In a 2012 estimate, 2.1 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers and an estimated 467,000 were addicted to heroin [8].

This number has only increased since then, with the number of unintentional overdose deaths from prescription pain relievers more than quadrupling since 1999. As stated earlier, 2016 saw approximately 62,000 deaths due to opioid abuse.

Opioid addiction can be incredibly dangerous, but the risks don’t end there. There are multiple sources of evidence that suggest a relationship between increased non-medical use of opioid medication and heroin abuse in the United States.

Opioids and the increased risk of heroin usage

There has been a recent trend of a switch from prescription opioids to heroin. Of particular concern has been the rise in the population of heroin users, especially among young people.

In a 2008–2009 study done by the National Institute on Drug Abuse, they found that 86% of young urban injection drug users had used opioid medication non-medically prior to using heroin [9].

The transition to heroin use stems from growing tolerance to pain medications and the increasing difficulty of obtaining opioid medications illegally. As one’s tolerance to pain medication rises, they find themselves needing more and more medication until the amount prescribed by a doctor is no longer enough. Looking for more accessible and cheaper options, people turn to heroin.

In certain communities, heroin can be cheaper and easier to obtain than prescription drugs. As a result, people who have generated an opioid addiction are drawn to heroin as an alternative to their pain medication since the molecular structures of heroin and Oxycodone are basically identical. These heroin users become very addicted to heroin and have an extremely high risk of overdosing.

Opioids can alter the course of your life

Anyone can be affected by opioid addiction, regardless of race, culture, or socio-economic status. It can affect someone across the country or someone right in your own neighborhood.

On Boston’s NPR station, a recovering addict Nick Roberts went into detail about how his opioid addiction affected his life. In the interview, Roberts states that he had an “all-American childhood” with a loving family and no traumatic events that resulted in hardship. Instead, his opioid addiction story starts off with the time when he had to get a minor surgery on his toe and was written a prescription for a heavy narcotic pain medicine. He stated that when taking this medication…

“this weird thing happened where, not only did the physical pain go away, but the mental feelings of inferiority and feeling less-than kinda subsided as well. I just remember that moment so clearly as for the first time, I imagined I felt like other people felt. I knew there was something out there that I could put into my body that would make me feel normal” [10].

Nick goes on to talk about how this addiction led to going to the streets to buy medication and even progressed to using needles just to maintain this addiction. Nick was lucky to be able to start recovery by going to a recovery program that helped him detox and reduce his addiction to opioid medication.

Opioid addiction can happen from even the smallest incident. It is imperative that people know exactly what the risks are with opioids and how this medication that is so easily obtainable can have drastic effects on one’s life. The road to recovery is hard for opioid addicts, but it can be done.

Cannabis: The Possible Solution to America’s Opioid Epidemic?

The unlikely hero that could save America from the Opioid crisis is one that many would not expect. A growing number of Americans who suffer from chronic pain have now begun to use cannabis as an alternative.

Many of the medical problems that are treated with opioid medication could instead be treated with medical cannabis. In a Harvard-led study examining the effectiveness of cannabis to treat pain, they found that the “use of marijuana for chronic pain, neuropathic pain, and spasticity due to multiple sclerosis is supported by high quality evidence.”

Cannabis is not only able to treat the same conditions as opioid medication, but it also is safer to use than opioids. While opioid medications are addictive and can lead to an overdose there are no records of anyone ever having overdosed on cannabis. In addition, while cannabis can be habit-forming, it is not physically addictive.

In addition to using cannabis as a separate medication from opioids, it also has success as a supplement to opioid usage.

A 2016 study in the Journal of Pain determined that patients experiencing chronic pain reduced their opioid usage by more than 60% after initiating medical cannabis therapy [11].

Patients who pair medical cannabis with opioids are able to decrease their opioid usage significantly, lessening the risk of addiction and other side effects.

A more recent study published in June 2017, examined the use of cannabis as a substitute for opioid-based pain medication for around 3,000 patients.

“cannabis provided relief on par with their other medications, but without the unwanted side effects. Ninety-seven percent of the sample ‘strongly agreed/agreed’ that they are able to decrease the amount of opiates they consume when they also use cannabis, and 81% ‘strongly agreed/agreed’ that taking cannabis by itself was more effective at treating their condition than taking cannabis with opioids” [12].

The move towards cannabis as a medicine has had huge results on opioid addiction in the states where medical cannabis has become legal. A 2014 study done by JAMA Internal Medicine determined that implementation of medical cannabis laws have a direct impact on opioid overdose mortality rates over time.

Mortality rates went down 19.9% in year 1 and down 25.2%, 23.6%, 20.2%, and 33.7% in subsequent years [13].

With opioid mortality rate having drastically risen since the turn of the millennium, it is imperative that states, lawmakers, and citizens have an open mind about the benefits that medical marijuana can bring to the people of the United States. Many people suffering today could benefit from cannabis as a healthier and safer substitute to medications such as opioids.

It is time for the stigma around cannabis to be eliminated and for people to see cannabis as a medication that can truly help.

If you or someone you know is suffering from chronic pain or has experienced negative side effects from using opioids, trying medical cannabis as a treatment could be a better solution.

MeadowMD sat down with Dr. Dan Price, their leading physician, to discuss how cannabis could be used to solve the national opioid crisis. Check out the podcast below for an experienced doctor’s analysis of using cannabis as an alternative to prescription pain killers.

Next Steps:

1. Determine if medical cannabis may be a treatment option for you.
2. Go through a reliable service provider to obtain a medical cannabis recommendation from trusted physicians.
3. Understand that having a medical cannabis recommendation will not put you on a government list and that your patient information remains confidential.
4. Once you get your recommendation, determine what strains and methods of consumption (i.e. smoking, vaping, edibles, etc.) will work best for you.
5. Seek out which local dispensaries near you may carry medical cannabis products you are interested in trying.
6. Try the medical cannabis to alleviate symptoms of chronic pain, but as always, it is advised to use discretion and consume cannabis responsibly.