For years researchers, journalists, and anti-drug organizations have touted that cannabis is the gateway drug to harder narcotics. Prominent studies have been published to support the claims such as the one in the Journal of Adolescent Health conducted by researchers at Yale University. This report studied data collected from the 2006-2008 National Survey on Drug Use and Health which showed that cannabis was associated with an increased likelihood of prescription drug abuse in men and women 18 to 25.
In 2016, The New York Times published an article saying, "People who are addicted to marijuana are three times more likely to be addicted to heroin. This was written by Robert L. DuPont which is the president of the Institute for Behavior and Health and the first director of the National Institute on Drug Abuse.
If this is true, why is it that states across the nation are initiating medical and recreational cannabis programs as if green is the new black?
Throughout prohibition, cannabis use has maintained a place in society. No matter the punishment set forth or the stigma passed on, subcultures have held this plant sacred. Some see this as a sign of addiction, others see it as a sign of worth. But, when the differences of minds fall, and science is left on the table what we start seeing is that cannabis is actually relieving people of addiction.
That may be a bold statement, but a trend is occurring, and it's sending opioid users to cannabis dispensaries. The reason for this is because of the success patients of medical marijuana are having using cannabis to end the use of opioids.
The way opioids work on pain is similar to the way tetrahydrocannabinol (THC) works on pain. THC is one of the two most prominent cannabinoids in cannabis. They mimic our own bodies endocannabinoids. Our endocannabinoid system is the system that regulates all other systems of the body.
Opioids work by inhibiting the message sent from your neurons to your spinal cord and up to your brain to say ouch. THC follows a similar pathway, but it has a very low amount of receptors in the brain stem which is the part of the brain that controls respiration. That is why cannabis is considered non-toxic.
Not only does cannabis act as an analgesic, but it also works in conjunction with opioids. It has been noticed that patients who use opioids and cannabis in conjunction feel comfortable extending the time between their opioid dosages and also decreasing the amount of the dosage.
It is thought that this is related to the fact that cannabis inhibits the P450 enzyme which metabolizes almost all pharmaceuticals. This makes some nervous, afraid people may create a buildup of opioid in the blood which could lead to an overdose. But, this is not what is being seen.
Donald Abrams, MD, Professor of Clinical Medicine at the University of California San Francisco and a general oncologist at Zuckerberg San Francisco General Hospital published a study in 2011 measuring the amount of opioid that stayed in the plasma associated with certain concentrations of THC. Pharmacokinetic investigations revealed no significant change in the area under the plasma concentration-time curves for either morphine or oxycodone after exposure to cannabis.
The publication concluded that vaporized cannabis augments the analgesic effects of opioids without significantly altering plasma opioid levels. The combination may allow for opioid treatment at lower doses with fewer side effects.
In 2009 in the Journal of Neuroscience, a study was published that concluded CBD (5-20 mg/kg) did not alter stable intake of heroin self-administration, extinction behavior, or drug seeking induced by a heroin prime injection. Instead, it specifically attenuated heroin-seeking behavior reinstated by exposure to a conditioned stimulus cue. The study suggests that CBD may be a potential treatment for heroin craving and relapse.
A most recent study published in 2017 in the Cannabis Cannabinoid Research examined the use of cannabis as a substitute for opioid-based pain medication by collecting survey data from 2897 medical cannabis patients. This was performed by University of California, Kent State University, and HelloMD.
Respondents overwhelmingly reported that 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.
There is over a hand full of peer-reviewed published studies that show the connection between decreased opioid use and cannabis use. And although some of these studies date back almost ten years ago, patients are still being thrown out of their pain management programs for using cannabis concurrently with other painkillers. It has been known that CBD helps alleviate the withdrawal symptoms of opioids, however, ignorance prevails amongst some of our best practitioners and doctors.
There are states taking charge in order to combat the opioid epidemic. Illinois has just recently passed a bill that allows people with a prescription to opioids to temporarily qualify for the state medical marijuana program, and on June 18th The New York State Department of Health announced it will develop a regulatory amendment to add opioid use as a qualifying condition for medical marijuana.
By allowing simultaneous use many sufferers of chronic pain will not be kicked out of pain management programs which send many of them to the streets for illicit opioids and heroin. With the initiation of medical marijuana programs long-term opioid users now have a new road of hope. One with safe products and educated prescribers to help them navigate a new realm. Often, when talking to patients enrolled in medical marijuana programs I hear, "I finally got my life back".
2017 Cannabis Cannabinoid Research, 2009 Journal of Neuroscience, NY Dept. of Health, 2011 Clinical Pharmacology and Therapeutics