This article outlines what opioids are, how they work, and the dangers of opioid addiction and abuse while also highlighting the benefits of medical cannabis as an alternative and effective form of pain management.
Today’s world faces the genuine health crisis of opioid drug abuse. What began as a seemingly well-intentioned drug movement to help millions manage their pain has devolved into a full-on nightmare scenario of rampant addiction, drug dependency, and countless deaths. In hopes of curbing the opioid epidemic, medical cannabis is being explored for its potential opioid reduction qualities.
What Are Opioids and Opiates and How Do They Work?
“Opioid” is a catch-all term used to describe a broad class of depressant drugs designed to relieve chronic and acute pain. Opiates refer to the naturally occurring compounds derived from the opium poppy. Examples of well-known opioids include morphine and codeine.
There are two main classifications of opioids: semi-synthetic and synthetic. Semi-synthetic opioids are hybrids that are composed of both natural and chemically manipulated opiate compounds. Well-known examples of semi-synthetic opioids are heroin, Percocet, and Vicodin. On the other hand, synthetic opioids are entirely human-made, and while they closely mimic the effects of opiates, they are not derived from the opium plant. Well-known synthetic opioids are methadone and fentanyl.
All opiates are opioids, but not all opioids are opiates. Both opiates and opioids work by binding to the brain’s opioid receptors and subsequently interrupt or completely halt pain messages from being transmitted from the body to the brain.
An easy way to think about this is to imagine your nervous system as an intricate network or highway and the cars on this highway represent various sensory signals. Opioids act as roadblocks that prevent those signals from travelling through your nervous system.
The Addiction Potential of Opioids
When opioids block pain signals, they also flood the brain’s reward center with copious amounts of “feel-good” hormone, dopamine. The resulting overstimulation produces intense feelings of calm, euphoria, and relaxation. It is these unnatural euphoric effects that can lead many people to crave this sensation over and over again and thus leaving them vulnerable to misuse and addiction.
Many doctors will abruptly discontinue a patient’s opioid prescription if they suspect that the patient is abusing their opioid medication. Sudden discontinued opioid use results in extraordinarily unpleasant and uncomfortable withdrawal symptoms. These symptoms include muscle cramps, insomnia, nausea, anxiety, and depression. This is the inflection point where some users resort to finding illegal opioid street drugs to alleviate painful withdrawal symptoms. Because the human body builds up a tolerance to opioids so quickly, this causes abusers to seek ever-increasingly stronger doses to attain the same “high,” which often results in accidental overdoses.
Given the status of legalized cannabis in Canada, patients currently prescribed opiate-based medications are exploring medical cannabis for their chronic pain needs. This article uses current scientific studies to demonstrate how medical cannabis can curb and even possibly replace opioids as a useful tool for managing chronic pain.
How the Opioid Crisis Began
The origins of the modern-day opioid crisis trace back to the early 1990s. Drug companies observed that over a third of the U.S population was suffering from some form of chronic pain.
One drug company, in particular, Purdue Pharma, saw the public chronic pain problem as a lucrative opportunity to aggressively push its own patented opioid, Oxycontin. They marketed Oxycontin as an effective cure-all for anything from lower back pain, arthritis to migraine headaches. The driving strategy behind Purdue Pharma’s marketing campaign was downplaying the true addiction potential of opioids.
Oxycontin’s promotional machine proved to be very successful and set global opioid production into overdrive. From 1991 to 2011, medical prescriptions for opioid-related painkillers shot up from 76 million to 219 million. From 1996 to 2012, worldwide sales of Oxycontin skyrocketed from USD 48 million to more than USD 2.4 billion. As of this writing, Oxycontin has made upwards of $35 billion since 1996. But the staggering profits came at an unbelievable price.
Over 200,000 American people have died from opioid-related deaths since Oxycontin was introduced to the market in 1996. The fears that drug companies like Purdue Pharma fought so diligently to suppress and contain soon came to light. It was clear that some patients were starting to abuse their opioid medication, as well as suffering from severe drug dependency, withdrawal, and incidents of overdosing.
All of the following contributing factors from doctors’ willingness to over-prescribe to millions of eager chronic pain sufferers, coupled with opioid misinformation, created the perfect storm of drug abuse and addiction.
Founders of Purdue Pharma Sued for Alleged Role in Opioid Crisis
The Sackler family, one of the wealthiest families in America and founders of Purdue Pharma, are currently being sued by the state of New Jersey as well as other states for intentionally deceiving the public about the real dangers of opioid use. Attorney General of the State of New Jersey, Gurbir Grewal places the blame squarely on the Sackler family in enabling the opioid crisis:
“The Sackler family built a multi-billion-dollar drug empire based on addiction. Despite knowing the harms that would result, the Sacklers drove Purdue to pursue deceitful sales campaigns for OxyContin and other highly addictive opioid painkillers, campaigns that were dutifully carried out by a small army of the company’s employees. Our communities are still reeling from the epidemic of addiction and overdose deaths caused by their misconduct.”
Back in 2007, Purdue Pharma, after pleading guilty to misleading doctors and patients about the dangers of Oxycontin, paid a whopping $600 million settlement.
Canada’s Opioid Problem
Canada is the second-highest consumer of opioids behind only the United States and faces its own dire issues with opioid misuse, addiction, and abuse. As per the government of Canada, there have been more than 9,000 opioid deaths since 2016 alone. The problem continually worsens, with approximately 11 deaths each day directly attributed to opioids. That’s not to speak of the countless hospitalized people from overdoses.
Provinces that have been burdened the most by opioid use, whether prescription or illegal, are western provinces, British Columbia and Alberta, as well as both the Yukon and Northwest Territories. In recent years, there has been an uptick in deaths from potent synthetic opioid, Fentanyl, which is 100 times stronger than morphine and 50 times stronger than heroin.
But hope is on the way. Cannabis legalization in Canada has steadily encouraged the study, usage, and application of medical cannabis in curbing opioid use and, in some cases, even outright replacing it. Rigorous scientific studies have already proven the efficacy of medical cannabis as a valid form of pain management.
How Medical Cannabis Can Help the Opioid Problem
The war on opioids is a battle waged on two fronts: reducing opioid use with current chronic pain patients and treating opioid addiction and withdrawal. The reason why some people form opioid addictions, while others do not, is dependent on individual factors like genetic predisposition, brain chemistry, and length of prescribed use. Opioids are meant for short-term pain treatment and have limited long-term efficacy due to rapid tolerance-building and growing physical dependence.
A study from an independent medical science publisher, Mary Ann Liebert, Inc., surveyed 2897 medical cannabis patients. Their goal was ascertaining how medical cannabis affected their pain treatment. 34% indicated using some form of opioid medication in the past six months to treat their pain. The results of the survey are as follows:
- 97% reported that they “strongly agreed/agreed” that they were able to reduce the number of opioids when taken alongside medical cannabis
- 81% said that they “strongly agreed/agreed” that consuming solely medical cannabis was more successful in managing their pain as opposed to taking cannabis and opioids.
- Respondents indicated that medical cannabis offered adequate pain relief without the undesirable side effects generated from opioids.
Presence of Dispensaries and Lower Opioid-related Deaths
In this intriguing 2016 study published in the National Institute on Drug Abuse, two American economists, Dr. David Powell, and Dr. Rosalie Pacula observed medical cannabis policies in different U.S states. What they found was that states with legally protected cannabis dispensaries reported lower opioid overdose deaths and lesser admissions to treatment for opioid dependence. This finding was in contrast to states with higher rates of opioid abuse who did not have legally protected cannabis dispensaries.
More research is required to determine if there is a clear correlation between cannabis dispensaries and lower rates of opioid-related issues. But there is strong reasoning that more chronic pain patients are discovering cannabis to be more appealing and advantageous for their pain. Patients can benefit from the analgesic effects of medicinal cannabis without the egregious side effects that come with opioids.
The Cannabis Substitution Effect
Inspired by Rosalie Pacula’s findings on opioid reduction, a team of researchers led by Brian J Piper wanted to see if other medications would experience a decline. The Cannabis Substitution Effect hypothesizes that using medical cannabis can decrease a patient’s overall reliance on different drugs and substances. In a 2017 study published in the Journal of Psychopharmacology, Piper’s team of researchers asked New England cannabis dispensary members to fill out an extensive online survey. Here’s what they discovered:
- 7% reported that they decreased their opioid usage since starting to use medical cannabis
- 6% reported decreases in using anti-depressants
- 42% reported using less alcohol
- 8% reported using fewer anti-anxiety medications
- 2% indicated using fewer sleeping medications
Due to the self-reporting nature of this study, additional research is required to confirm the “substitution” effect of medical cannabis concretely, but early indications are promising.
Case Study with Medical Cannabis Patients Dealing with Chronic Pain
A similar study published on peer-reviewed research platform, ScienceDirect, collected retrospective surveys from 244 medical cannabis patients with chronic pain. Researchers followed up with patients using a comprehensive survey that sought to detect any personal changes to chronic pain levels before and after medical cannabis use. Participants reported that medical cannabis use was responsible for a 64% decline in opioid usage as well as a decline in the number of medications used and side effects. Users also reported a 45% increase in overall quality of life.
Medical Cannabis in Palliative Care
One of the few scenarios where opioids are considered very useful is in the case of managing cancer-related pain or pain resulting from a terminal illness. When patients are facing a life-threatening illness, a palliative care approach is usually taken to ensure a certain quality of life. The goal of palliative care isn’t curing the patient or prolonging their life. It’s about helping the patient be as comfortable as possible with the time they have left. This stage usually involves prescribing potent opioid-based painkillers to reduce pain so that the patient can function and live their life. However, some prescribed opioids can cause more harm than good. Palliative care patients can suffer from unwanted side effects, such as:
- extreme constipation
- nausea
- vomiting
- drowsiness
- dizziness
- itching
- confusion
- shallow breathing
- difficulty urinating
- hallucinations
Israeli Case Study with Cancer Patients
A study, published in ScienceDirect, analyzed 17,000 Israeli cancer patients to determine the efficacy of medical cannabis in treating their symptoms of pain, depression, anxiety, confusion, fatigue, nausea, and anorexia. The median age of medical cannabis patients was 60 years of age. Here are the findings:
- 70% reported improvement in pain management
- 70% reported improvement in general well-being
- 60% reported an increase in appetite
- 50% reported an increase with nausea
Israeli researchers concluded that medical cannabis was a highly effective form of treatment for some advanced cancer patients and should be a vital component of palliative care.
How Medical Cannabis Can Fight Opioid Addiction and Withdrawal
Opioid addiction doesn’t discriminate. It affects everyone from blue-collar to white-collar, from poor to rich, from young to old. Drug addiction, as framed by The Centre for Addiction and Mental Health, is any behaviour that is “out of control in some way.” Some addictions can be rather innocuous like being “addicted” to coffee, while other addictions like opioid addiction are destructive and life-threatening.
The following are the 4 C’s used to describe serious addiction:
1.) Craving
2.) Loss of Control of the amount
3.) Compulsion to use
4.) Use despite Consequences
The state of opioid addiction has led to some U.S states like New York, Pennsylvania, New Jersey to designate opioid use disorder as a qualifying condition for medical cannabis. The belief isn’t that medical cannabis can single-handedly solve the opioid crisis, but it can act as a powerful ally in the overall battle. Well-respected cannabis science researcher and recipient of the Queen Elizabeth II Diamond Jubilee Medal, Phillipe Lucas, makes it very clear that medical cannabis is a real option for those seeking to solve their opioid dependence.
“Once individuals have become dependent on opioids and they recognize that dependence and are seeking treatment for it through opioid replacement therapy like methadone and suboxone, you can potentially introduce cannabis as an adjunct treatment to increase the success rate of the methadone or suboxone treatment. The reason this point is so important is that when people with an opioid dependence fail out of treatment, that’s the period where they become the most vulnerable to potential overdose…and they go back to the illicit drug market, potentially risking overdose.”
The Final Word
No matter how dark the opioid crisis becomes, it just makes the light at the end of the tunnel more clear to see. To fix this problem, we need to recruit all of the help we can muster and apply it with compassion and education. As modern studies indicate, medical cannabis can potentially help loosen the stranglehold that opioids have over humanity. Medical cannabis can aid in reclaiming the precious quality of life for suffering patients and their families.
It’s time to trade in our old habits and old way of thinking and consider new solutions. In the wake of this opioid pandemic, let’s begin healing without adding further to the disease.
