Marijuana and Opiates

Is medical and recreational marijuana use helpful in reducing the use of opiates?

Marijuana has been used for reported medical purposes for thousands of years, and it’s becoming more of a hot topic of its presumed benefits with 33 out of the 50 United States legalizing, decriminalizing and/or medicinalizing it (Berke Gould 1). The United States is currently in the midst of an opioid crisis which has been growing over the last 20 years and until recently opioid addiction was not recognized and this led to the number of opioid prescriptions increasing over time, also leading to more opioid overdoses and deaths, Every day, more than 130 people in the United States die after overdosing on opioids. (National Institute on Drug Abuse 1). With more states legalizing the use of cannabis its not wrong to question whether it could potentially end the war on opioids and in states with eazed weed laws, It has been reported that medical cannabis has significantly lowered opioid overdose mortality rates (Harris 1).

Other studies have shown that medical marijuana laws were associated with a decrease in Medicare prescriptions (which are commonly used for these expensive drugs). Legalized medical marijuana saved Medicare $165.2 million in 2013 by lowering prescription drug use (Schupska 1) but while marijuana has done that for insurance companies, that statistic is not an accurate representation of how many marijuana to opioid substitutions actually happened and In 2017 Colorado had a record number of over one-thousand opioid deaths, even though medical marijuana has been legal there since the early 2000’s so how credible is Marijuana in fighting opioids (Daley 1). To help fight the opioid epidemic, doctors should also consider other ways for people to avoid the use of opioids. Treatments such as physical therapy, chiropractic, yoga and meditation therapies are possible treatments in helping people who deal with pain.

In Marijuana there is 2 key compounds which produce the highs involved with its consumption, those being THC and CBD. There is evidence that Cannabidiol (CBD), a drug that’s non-intoxicating and does not have psychoactive effects, helps with not only pain but also anxiety and that Cannabinoids and opioids belong to the same receptor family and work together, known in medicine as Synergistic (HSDHS 1). Even though marijuana can be helpful, it is also outweighed by its lack of benefits and increased risk of harm, as its still being considered a gateway drug and federally scheduled class 1 drug contributing to ongoing opioid use, and subsequently, the opioid epidemic.

There is evidence that People who are addicted to Marijuana are 3 times more likely to become addicted to heroin (NSDUH 1). There is currently a concrete pool of evidence showing marijuana use increases harsh drug abuse, rather than decreases opioid use and opioid addiction based on follow up of more than 33,000 people.19 There is also people who suffer from chronic pain concurrently, that use both cannabis and opioids indicating a higher risk of opioid misuse.20 Closer monitoring for opioid-related aberrant behaviors is indicated in this group of patients and it suggests that cannabis use is a predictor of aberrant drug behaviors in patients receiving chronic opioid therapy.

Inhaled cannabis in patients with chronic low back pain does not reduce overall opioid use, and those patients are more likely to meet the criteria for substance abuse disorders, and are more likely to be non-adherent with their prescription opioids.21 It has been found that patients with chronic pain participating in an interdisciplinary pain rehabilitation program using cannabis may be at higher risk for substance related negative outcomes, and were more likely to report a past history of illicit substance, alcohol, and tobacco use.22 A more recent study of 57,000 people showed that medical marijuana users are more likely to use prescription drugs medically and non-medically, and included pain relievers, stimulants, tranquilizers, and sedatives.23 There is also evidence that state medical marijuana laws lead to the probability people will make Social Security Disability claims.24

There is sufficient and expanding evidence demonstrating that medical marijuana use will not curb the opioid epidemic. There is further evidence that marijuana is a companion drug rather than substitution drug and that marijuana use may be contributing to the opioid epidemic rather than improving it. Although there are patients who have successfully weaned off of their opioids and use marijuana instead, the evidence that marijuana will replace opioids is simply not there. Medical provider and patient awareness, utilization of prescription drug monitoring programs, widespread availability and use of naloxone, and increasing coverage for atypical opioids and abuse deterrent formulations are only some of the other factors which hopefully be contributing to any impact on the opioid crisis. Education and prevention efforts as well as medication assisted therapies will be additional benefits to impact the opioid epidemic. Physicians should continue to monitor their patients closely, perform random drug testing to detect opioid misuse or aberrant behavior, and intervene early with alternative therapies when possible. Marijuana alone is certainly not the answer.

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