Can Cannabis Help Alleviate the Opioid Crisis?

Cannabis and the Opioid Crisis

Within the last 12 months, we have lost more than 100,000 Americans to opioid overdoses. Countless others have been injured, remain addicted, and are in desperate need of effective treatment. Personally, I am 15 years into recovery from a vicious addiction to prescription painkillers, I could easily have become one of these statistics.

We have at our disposal proven, effective treatments for opioid addiction, such as the medications buprenorphine (Suboxone) and methadone. These have been proven to cut down the death rate from opioid overdoses by at least 50 percent. Tragically, access to these medications is difficult if not impossible for the majority of people who are suffering from opioid addiction. It has been extremely difficult, to get doctors to prescribe these (due to stigma), to get insurance companies to reliably pay for them, and to get residential treatment centers to embrace them (due to an anti-science culture and ideology).

Can cannabis help provide an accessible alternative treatment to people who are addicted to opioids? Can we use it to help treat chronic pain patients who are stuck on medicinal opioids get off of them? Can it help prevent future opioid addiction, by substituting for opioids?

New pain patients

Tens of millions of Americans are currently suffering from chronic pain. The current choices are acetaminophen (which does very little for pain but certainly can harm your liver), opioids (which have obvious dangers), or non-steroidal anti-inflammatory medications (NSAIDS). Increasingly, we are becoming aware of how dangerous daily NSAIDS use truly is, causing bleeding ulcers, chronic gastritis, heart attacks, and often resulting in permanent kidney damage. Tens of thousands of Americans die every year from NSAID ingestion.

The 2017 report from the National Academy of Sciences, Engineering, and Medicine concluded that there is substantial evidence that cannabis is effective for treating chronic pain, as well as the anxiety and insomnia that accompanies such pain. Pain patients have discovered this too. According to a 2023 recent study in the Journal of the American Medical Association, 31 percent of chronic pain patients in states with active medical marijuana programs have used cannabis to treat their chronic pain. They also reduced their usage of prescription opioids and other pain medications by more than half.

Obviously, these patients wouldn’t be using cannabis to treat their chronic pain if it didn’t help alleviate their symptoms. While not by any means harmless, cannabis will not destroy your kidneys like NSAIDS, which is a huge deal as you get older. It is impossible to die from a cannabis overdose. As such, as patients get older, portlier, and start to have cranky knees and backs, we ought to be offering them cannabis as a relatively non-toxic remedy for their pain before we offer opioids, and, I’d suggest before the patient destroys their kidneys with NSAIDs.

It is important to note that cannabis certainly is not without its potential harms, and its use, under most circumstances, should be avoided by teens, in pregnancy, while breastfeeding, before driving, and in people who have a history or family history of psychosis.

Existing pain patients

Many more chronic pain patients were started on opioids than truly need to be on opioids. Most of these patients remain on opioids, as it is extremely difficult to come off of them, due to withdrawal symptoms, and the need for continuing pain control.

I believe that doctors should offer to slowly and safely transition these patients from chronic opioid use onto cannabis therapy, which is near-universally associated with an improved quality of life. This needs to be a voluntary process because our society’s experience of trying to force people off of their opioids has been a disaster, with alarming reports of patient suicide and distress.

The transition from opioids to cannabis can be done via a slow, comfortable taper down off of the opioids, overlapping with a gentle taper up on the dose of the cannabis. I’ve been successful doing this and the patients are delighted – no longer needing to be treated like a criminal as an opioid patient, taking drug tests, having pill counts, signing treatment contracts, and dealing with insurance rejections. One obstacle to this is that health insurance doesn’t often cover medical marijuana and patients can find it difficult to afford.

Lowering the opioid dose

Some patients can’t or don’t wish to discontinue their opioid medications. Many find that the concurrent use of cannabis can help them lower their dose of opioids. Cannabis and opioids work via overlapping receptors and can work synergistically to control pain. Studies have shown up to an 80 percent dosage in opioid dose with the co-usage of cannabis.

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Helping those addicted to opioids

For those unfortunate enough to be addicted to opioids, a formidable obstacle to getting into recovery is the soul-crushing withdrawal symptoms. I have found personally, as well as professionally, that cannabis is often more effective than the traditional pharmaceutical medications we utilize, such as clonidine or lofexidine, which calm you down a little but don’t address most of the discomfort. Cannabis can help with symptoms such as anxiety, insomnia, restlessness, sadness, muscle aching, abdominal cramping, as well as nausea and vomiting.

Many people consider ongoing cannabis use to be consistent with being in a state of recovery from opioid addiction. This is called “Cali Sober.” I am a strong believer in the rights of people to choose their own recovery modality, and strongly condemn treatment programs that test for cannabis and then subsequently punish patients for having used cannabis, such as by denying them buprenorphine (Suboxone). These punitive policies are not based on science and only harm vulnerable patients.

Is cannabis on the same level as buprenorphine or methadone?

No. I treat people who are in active opioid addiction with buprenorphine (Suboxone) and solely use cannabis for withdrawal symptoms.

I’ve encountered thousands of people who have transitioned themselves off of opioids with cannabis. They view cannabis – stigmatized for years as a “gateway” to the use of other drugs, as a “gateway out of addiction.” That said, there just isn’t the same level of evidence that we have for methadone and buprenorphine (Suboxone) in terms of saving lives. Cannabis clearly works for some people, but there is too much at stake with this disease to make an unproven assumption that cannabis is as effective as buprenorphine (Suboxone) or methadone at saving lives. For active opioid addiction, I say, stick to the proven meds until we have the same level of evidence for cannabis.