Saying that we need more research before accepting that cannabis can help reduce opioid abuse is like saying we need more research to prove the Earth isn't flat. Even the National Institute on Drug Abuse (NIDA) cites evidence that cannabis could play a role in addressing the opioid epidemic, and new studies continue to roll in faster than we can cover them. The findings range from cannabis as a pain reliever that can help prevent the onset of opioid abuse to cannabis as a tool to support opioid addiction recoveries. The following are recent clinical highlights:
Journal of the American Medical Association Internal Medicine: "This longitudinal analysis of Medicare Part D found that prescriptions filled for all opioids decreased by 2.11 million daily doses per year from an average of 23.08 million daily doses per year when a state instituted any medical cannabis law. Prescriptions for all opioids decreased by 3.742 million daily doses per year when medical cannabis dispensaries opened."
Pain and Research Management: "We conducted a pragmatic convenience study comparing patient reporting of previous and current prescription opioid usage to the opioid prescription records [among 131 patients seeking to renew enrollment in a medical marijuana program].... 35 (55%) patients reported having eliminated the use of prescription opioids by the time of license renewal."
Current Opinion in Pharmacology: "Animal studies show cannabinoids reduce osteoarthritis pain, inflammation and nerve damage."
Journal of the American Medical Association Internal Medicine: "In this population-based, cross-sectional study using the all-capture Medicaid prescription data for 2011 to 2016, medical marijuana laws and adult-use marijuana laws were associated with lower opioid prescribing rates (5.88% and 6.38% lower, respectively)."
Neuropsychopharmacology: "Cannabinoids combined with opioids produce synergistic antinociceptive effects, decreasing the lowest effective antinociceptive opioid dose…. Alone, 5.0 mg oxycodone increased pain threshold and tolerance (p ≤ 0.05). Although active cannabis and 2.5 mg oxycodone alone failed to elicit analgesia, combined they increased pain threshold and tolerance (p ≤ 0.05).... Cannabis enhances the analgesic effects of sub-threshold oxycodone, suggesting synergy, without increases in cannabis’ abuse liability."
Boston University doctoral dissertation: "Access to marijuana improves uptake and efficacy of opioid replacement therapy for the treatment of opioid addiction. These findings suggest that the expansion of medical marijuana access helps alleviate rather than exacerbate the opioid epidemic."
Minnesota Department of Health: "Forty-two percent of Minnesota's patients taking medical cannabis for intractable pain reported a pain reduction of thirty percent or more…. The study also found that of the 353 patients who self-reported taking opioid medications when they started using medical cannabis, 63 percent or 221 reduced or eliminated opioid use after six months. Likewise, the health care practitioner survey found that 58 percent of patients who were on other pain medications were able to reduce their use of these medications when they started taking medical cannabis."
Addiction Institute at Mount Sinai School of Medicine: "When we started investigating CBD, we hypothesized that perhaps it could decrease drug-taking behavior, but instead we saw that it actually decreased craving…. A small, preliminary pilot study in phase 2 proved that CBD did decrease craving, and now we are carrying out a larger phase 2 study."
Northwell Health: "When [elderly] patients were asked if they were able to curb their use of other painkillers after starting medical marijuana, 18 percent reported decreasing their use "moderately," 20 percent "extremely" and 27 percent "completely." An overwhelming number of subjects (91 percent) would recommend medical marijuana to others."
The use of medical cannabis to prevent opioid abuse and assist in recovery certainly makes more sense than Trump's idea to strap illicit opioid dealers to the electric chair. Speaking of the Trump camp, Secretary of Health and Human Services Alex Azar claims "there really is no such thing as medical marijuana," while opioid commission member Bertha Madras says "the marijuana movement is recapitulating the history of the opiophilia movement that has led to our current national crisis."
The latter comment is especially odd since the national opioid crisis is about addiction and overdose, and cannabis is not physically addictive and does not cause or contribute to overdoses. It's a bit like saying the government needs to prohibit Call of Duty because it recapitulates the horrors of World War II.
So, who to believe? This tweet summarizes the answer perfectly: "Who is right? It really depends on whether you believe the fire breathers on Fox News or the liberal elite types like doctors, researchers and medical professionals. Sure, Steve Duchi is not an 'expert' per se, but we'll go with the so-called elite just for fun."