By Marisa Pyle
Every day, 115 Americans die from opioid overdoses. This surge in prescription painkillers abuse has created an alarming epidemic, one that claims almost 60,000 lives each year. Government officials and health workers have scrambled to find a solution that can both significantly reduce addiction while also treating many conditions for which opioids are prescribed. However, the use of medical cannabis has appeared to be a promising solution to the raging American drug crisis. Combined with its non-addictive nature, cannabis’s medical properties show real promise as an alternative to the more addictive opioids.
Although cannabis remains prohibited under federal law in the United States, shifting public opinion and an increasing understanding of its pharmaceutical properties have led to an increasingly popular move to decriminalize it, as seen in many states’ successful campaigns to legalize it for medical use in spite of federal policy. In response, the Obama administration loosened enforcement policies and allowed states to formulate their own cannabis policies. However, in early 2018, Attorney General Jeff Sessions announced a reversal of this policy, opting to return to strict federal enforcement of cannabis as a Schedule I drug. Sessions’ made this decision in spite of cannabis’s, legality in 29 states as well as the District of Columbia, and recent scientific studies with extremely promising data concerning the use of cannabis as a pain reliever, especially as a substitute for opioids.
Most commonly, medical cannabis has been prescribed for epilepsy and other seizure disorders, with the non-psychoactive element functioning as a neurological calming agent that prevents seizures. As research has continued on its medical potential, however, it shows increasing importance as a pain reliever, especially for chronic pain. In a recent study by the University of California Berkley and Kent State University, 81 percent of participants reported medical cannabis as more effective than opioids for pain management, with 97 percent responding that they were able to significantly decrease or even completely discontinue opioid usage. In addition, other studies found that 98 percent of cannabis users experienced either no to very few adverse side effects, which have long been a problem for opioid pain relievers. Medical cannabis also has no addictive properties, making it an ideal prospect for long term use, especially for chronic conditions that require consistent medication.
Due to its chemical composition, the use of medical cannabis does not result in tolerance developing over time, a common phenomenon with opioid use which causes overdose deaths. Throughout long-term use of opioid pain relievers, the body builds resistance to the effects, requiring higher dosages to produce the same effect. Because of this effect, opioid patients often increase dosages themselves, which sharply increases their risk of developing an addiction or accidentally overdosing. The threat of an overdose is not present in medical cannabis use, which affects different tissues in the body and does not produce long-term tolerance. Instead, a Yale University School of Medicine experiment in 2016 reported tolerance to cannabis can be built slightly, but vanishes within two days, making long-term tolerance nearly chemically impossible. This alone has led to many researchers exploring it as a potential alternative treatment, because it alleviates many of the risks associated with managing chronic pain disorders.
In spite of recent assertions by Attorney General Sessions that medical cannabis is not a viable way to reduce the harm of the opioid epidemic – he stated in a press conference that he was “astonished” to hear the suggestion of legalizing it as a solution to the crisis – states that have already legalized medical cannabis have seen a significant decrease in hospitalizations related to opioid addiction or hospitalizations. An 18-year longitudinal study conducted by the University of California, San Diego found that in states with legal medical cannabis, hospitalization rates dropped by an average of 23 percent over that time span; another study reported that doctors wrote an average of 1,300 fewer opioid prescriptions in states with medical cannabis available.
In addition to its direct medical usage as a pain reliever, cannabis has also been shown to be effective as an “exit drug”, a drug used to treat addiction itself and help discontinue the use of opioids or even heroin. Because of its properties as an anti-inflammatory drug, it helps reduce opioid dependency, which has been found to create addiction via neurological inflammation among other changes. The non-psychoactive element in cannabis, CBD, has also been shown to reduce cravings and withdrawal symptoms during addiction recovery.
However, because of cannabis’ continued registration as a Schedule I drug, research and drug development is difficult within the United States. Classification as a Schedule I narcotic signifies “no medical use and high potential for abuse,” making any research very complicated due to federal laws. Institutions seeking to test medical cannabis risk losing federal funding for any future projects they may develop, leading to an unwillingness to risk future research for the studies. In addition, institutions that study potential uses for medical cannabis obtain their funding almost entirely from individual contributions and private donors, because no large-scale framework to fund this research exists within the pharmaceutical industry.
In spite of these barriers, researchers in the United States and internationally continue to investigate medical cannabis and work to develop new drugs that can be used to treat pain more specifically and efficiently. In addition to new data, the US Department of Veterans Affairs has published new guidelines in 2018, which while still prohibiting the prescription of medical cannabis for pain management, encourages providers to “discuss with the veteran marijuana use, due to its clinical relevance to patient care, and discuss marijuana use with any veterans requesting information” about its use. These steps show that while the future of medical cannabis is still uncertain, it shows great promise as an opioid alternative, and could help to resolve the fatal epidemic that has spread across the United States.