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Can Legal Cannabis Help Slow the Opioid Drug Epidemic in the U.S.?

Imagine stopping 115 needless deaths in the U.S. every day. It’s not a guarantee, but with recent developments in cannabis research, experts believe it could be on the horizon.

Opioid drug overdoses claim those 115 lives every day in this country. About 60% of opioid addictions are rooted in prescription drug use for a number of ailments, ranging from chronic pain to sports-related injuries to personality disorders. That’s where many see cannabis products coming in to help.

“One-hundred fifteen people die every day as a result of opiates nationwide. So from our vantage point, we think cannabis is a sensible solve to a lot of issues,” said Acreage Holdings CEO Kevin Murphy. “I believe it’s going to be the silver bullet over the next 20 to 30 years as it relates to medical.”

According to the National Institute on Drug Abuse, 21% to 29% of patients prescribed opioids for chronic pain misuse them. Between 8% and 12% develop an opioid use disorder. Opioid overdoses increased 30% from July 2016 through September 2017.

But while the opioid epidemic picked up both momentum and national attention, so too did the spread of regulated medical-use marijuana. Medical cannabis is currently legal in 30 states in the U.S., and has been legal across Canada since 1999.

In a 2016 study by Dr. Dustin Sulak, 39% of opioid users who began using cannabis were able to completely stop opioid use and another 39% could reduce their opioid dosage. Sulak found that adding cannabis reduced pain by about 40% in nearly half the treated patients and improved function in 80% of them.

“As an effective treatment for chronic pain, it can stop opiod addiction before it occurs,” said Dr. Sherry Yafai, medical director of High Sobriety in Los Angeles.

Cannabidiol, or CBD, is one of at least 113 cannabinoids found in the cannabis plant. It’a not to be confused with tetrahydrocannabinol, or THC, the cannabinoid in the plant with psychoactive effects. CBD is largely thought to maintain properties of healing and pain relief.

But despite the anecdotal evidence from the likes of celebrities and viral social media apostles of the healing qualities of cannabis plants (see Kiss rocker Gene Simmons talk cannabis with TheStreet below), medical experts say there needs to be more research before cannabis can be billed as the solution to the opioid epidemic.

For one, the cannabis plant is a complex one. Research professionals haven’t yet identified all of the many, many compounds within the plant and how each may contribute to modern medicine. There’s reason to believe CBD and THC, taken separately and together, can help with opioid treatment, withdrawal symptoms and pain management.

As far as opioid use is concerned, cannabis compounds can enhance pain relief and other medical effects of opioid drugs. Taking cannabis with opioids also widens the therapeutic window, or the time between an effective dose of opioids and a lethal dose, Dr. Sulak said. But perhaps the biggest benefit of cannabis as a part of opioid treatment is that it doesn’t carry the risk of overdose.

“Most importantly, there’s no overdose risk. If you’re still in pain with cannabis, you can medicate until you see the desired effects,” said Lex Corwin, founder of cannabis company Stone Road Farms. “The worst case scenario is you’ll be glued to your couch for the night, rather than rushed to the ER.”

Dr. Tamas Biro, director of applied research for Phytecs, said that in areas where cannabis has been legalized to some degree, “Daily use of opiates reported by the patients significantly drops.”

Beyond its possibility as a means of replacing heavy-duty opioid drugs as a pain treatment, cannabis could also help those already addicted to opioids kick them.

“Cannabis can clearly alleviate symptoms of opioid withdrawal. This is a critical factor because withdrawal symptoms from opioids is one of the main reasons that users have such a hard time getting off the drugs,” said Dr. Scott Bienenfeld, medical director of the Recovery Spot.

Bienenfeld also pointed to another benefit of cannabis that opioids lack: THC doesn’t appear to be addictive.

“While for a minority of people cannabis use can lead to an addiction problem, most people never get addicted to cannabis,” Bienenfeld said. “While research clearly indicates that laboratory animals will repeatedly self-administer highly addictive drugs such as cocaine methamphetamine and heroin, the same is not true for THC.” Bienenfeld said that indicates that THC has a much lower addictive potential.

Yet still, there are those who disagree. Anti-cannabis lobbies have long billed the drug as a “gateway” to other, harder drugs. But according to the NIDA, “the majority of people who use marijuana do not go on to use other, ‘harder’ substances. Also, cross-sensitization is not unique to marijuana. Alcohol and nicotine also prime the brain for a heightened response to other drugs and are, like marijuana, also typically used before a person progresses to other, more harmful substances.”

“People believe cannabis is a gateway drug? We believe it’s an exit drug,” Murphy said. “We’re going to set out to prove that we can take opiate addicted patients and transition them to a cleaner life with cannabis.”

But Dr. Biro isn’t quite sold.

“As someone who believes in evidence-based medicine, we need more proof … We would love to state that this is an exit drug but we just don’t know yet,” Biro said.

Part of the problem in accessing research regarding cannabis as an opioid replacement is that cannabis research is relatively young. Only since regulation has eased have serious medical professionals reentered the space.

“There’s been a 100-year moratorium on this drug where you couldn’t test it. If you had received a grant and you were found to do testing on cannabis away from that grant, away from the study you were doing — you’d lose the grant,” Murphy said.

A search on government-run PubMed.gov, the database for the U.S. National Library of Medicine and the National Institutes of Health, for the term “medical marijuana” narrowed down to only human subjects yields 3,489 results. The same search narrowed down to the years 2000 through 2010 yields only 919 studies.

“I’m optimistic that we will soon find a solution for what is a burning, burning problem,” said Biro. “I think everyone is working now to go forward on it.”

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