SOLVING THe Opioid Crisis, One Hit at a time
By Alex Shazad
The Current Situation
Most people understand that heroin is a very addictive drug with great potential for abuse. What most individuals don’t realize is that prescription opioid abuse is far more common than heroin use. According to the U.S. Department of Health and Human Services, the United States is currently experiencing a prescription opioid epidemic . The National Survey on Drug Abuse and Health revealed in 2012 that 2.1 million Americans had a substance abuse disorder related to prescription opioids, while fewer than half a million were addicted to heroin . By 2013, overdoses due to prescription opioids reached over 16,000, a figure that had more than tripled since the year 2000 . Drastic increases in opioid prescriptions, intense advertising by pharmaceutical companies, and an increased social acceptability for consuming drugs for nonmedical use have been responsible for exacerbating America's opioid crisis . The crisis is likely to grow worse, and combatting this epidemic will require innovative solutions. Emerging research suggests that medical marijuana may be helpful in tackling this crisis due to its ability to alleviate opioid withdrawal symptoms and its potential to serve as a suitable substitute for treating chronic pain.
The Problem With Opioids
Opioids are addictive due to the unique way they affect the central nervous system. The body has its own endogenous opioid system that is important in regulating pain. There are three types of opioid receptors found in the body: mu, delta, and kappa opioid receptors. The body produces its own opioids, known as endorphins and enkephalins, which bind to these receptors to block pain signals. Prescription opioids work much like the body's own opioids, alleviating pain by binding to opioid receptors. Although, administration of synthetic opioids causes the body to greatly lower production of its own opioids. This lowered production, in turn, contributes to the severe withdrawal symptoms opioid addicts experience when they stop taking their medication. Chronic activation of opioid receptors by medication also leads to the adaptation and desensitization of these receptors, leading to tolerance. This phenomenon means that higher doses of opioids are needed to produce the same analgesic effect . However, using higher doses of opioids puts patients at a greater risk of an overdose, since higher doses can lead to respiratory depression . Prescription opioids are also addictive because they activate the brain's reward system, producing pleasure and a sense of well-being . Overall, the ability of prescription opioids to cause withdrawal, promote tolerance, and activate the brain's reward system explain why they are so addictive.
Increased opioid use has resulted in more overdoses among all races; however, Caucasians and Native Americans have experienced the greatest increases in overdoses. According to the New York Times, lower rates of opioid overdoses seen in Latino and African Americans may largely be due to racial stereotypes. Studies have reported that doctors are less likely to prescribe opioids to these two groups out of fear that they will become addicted to the drugs or sell them . Rates of overdose are still higher among men; however, rates of overdose among women have risen more sharply in recent years. A major reason why rates have risen faster for women is that they’re more likely to suffer from chronic pain than men. As a result, physicians are more likely to prescribe them opioids, are more likely to give them higher doses of opioids, and are more likely to keep women on opioids for longer periods of time .
The Potential of Pot
Recent research suggests that cannabis-based therapies are effective at alleviating pain and reducing dependence on prescription opioids. Many human studies have shown that cannabis-based therapies provide significant pain relief for those who suffer from cancer, rheumatoid arthritis, and chronic neuropathic pain (pain due to nerve damage or dysfunction) . There is also evidence that cannabis is effective at managing postoperative pain, pain due to multiple sclerosis, and migraine headaches. The anti-inflammatory properties of cannabis may even prove effective at treating fibromyalgia, a disease that causes generalized pain throughout the body .
Studies even show that cannabis use prevents opiate withdrawal and tolerance, offering a safe way to wean patients off of prescription opiates . Cannabis is much less addictive than opioids and is practically impossible to overdose on due to the lack of cannabinoid receptors in the cardiorespiratory areas of the brainstem. As a result, unlike in the case of opioids, high doses of cannabis do not produce respiratory depression. In fact, no deaths have ever been linked to cannabis use in the United States .
Despite all of the potential medical marijuana has in treating opioid abuse, the federal government has not focused its efforts on utilizing non-opioid treatments . There are no cannabis treatments approved in the U.S. to treat chronic pain. Instead, the federal government has focused on enhancing prescription monitoring programs, opioid education initiatives, and increasing access to naloxone, which is a drug used to treat opioid overdoses [2,8]. While these initiatives have shown some efficacy, they do not adequately explore alternatives to opioid medication.
At the state level, however, using medical marijuana as a treatment is being explored, and there is already evidence that cannabis is reducing opioid abuse in states with medical marijuana laws. According to a study by the University of Michigan, patients who used medical marijuana to control pain reported a 64% reduction in the use of prescription opioids . Additionally, states with medical marijuana laws have lowered rates of opioid overdoses compared to those without cannabis laws .
The Pharmacology of Weed
Cannabis's psychoactive ingredient, delta-9-tetradhydrocannbinol (THC), is a natural cannabinoid that exerts its effects on the body via activation of cannabinoid receptors. The cannabinoid system is very important in modulating neurotransmission and is key in regulating pain perception, mood, appetite, and memory. The body produces its own cannabinoids—anandamide and 2-AG—and expresses two main types of receptors: CB1 and CB2. Studies have shown that anandamide is very important in regulating pain. For example, a study from Nature demonstrated that rats treated with an anandamide blocker experienced more severe and extended pain responses . Other studies have also concluded that CB1 and CB2 receptor activation results in anti-inflammatory effects and other analgesic effects that result in pain reduction. Additionally, CB2 activation indirectly leads to activation of opioid receptors and the promotion of endogenous opioid synthesis . The ability of cannabis to increase the synthesis of endogenous opioids may account for why cannabis is able to alleviate opiate withdrawal, especially since prescription opioids lower endogenous opioid synthesis.
Cannabis may prove to be a useful drug in alleviating opioid dependence and could serve as a substitute to prescription opioids. Cannabis is much safer than prescription opioids, is much less addictive, and does not produce the severe withdrawal effects seen with opioids. As more states legalize marijuana for both medical and recreational use, more people will have the chance to benefit from its medicinal properties. Perhaps, with the help of cannabis, prescription opioid use will no longer be an epidemic.
1. U.S. Department of Health & Human Services. (2016). The opioid epidemic: by the numbers [Data file]. Retrieved from http://www.hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf
2. Volkow, N. D. (2014). America’s addiction to opioids: heroin and prescription drug abuse. Retrieved from https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse
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8. Bacchuber, M. A., Saloner, B., Cunningham, C. O., et al. (2014). Medical cannabis laws and opioid overdose mortality in the United States. JAMA Internal Medicine, 174(10):1668-1673. doi: 10.1001/jamainternmed.2014.4005
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