Replacing Opiates with Cannabis: Studies, Findings & Understandings
Everything we know thus far about using cannabis to substitute opiate-based pharmaceuticals.
Whether or not you're familiar with the anecdotal testimonies that cannabis effectively replaces opiate-based pharmaceuticals, while also acting as the opposite of a gateway-drug, the following information will help you decide if the plant can offer a solution for you regarding pain management.
The Problems with Opiate-Based Drugs
"If I had a patient who was suffering from severe intractable pain and had tried everything, I would sooner try marijuana on a patient than heroin. When you are prescribing opioids, you are essentially giving them heroin." - Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University.
It's been in the media for the past few years - the U.S. is suffering from an opioid crisis. Last year the government officially proclaimed a "Public Health Emergency" in regards to the number of people overdosing and dying from opiate use.
"Ending the [opioid] epidemic will require mobilization of government, local communities, and private organizations. It will require the resolve of our entire country," President Donald Trump, October 26, 2017.
In fact, the number of deaths involving prescription opioids has quadrupled since 1999 - now being about 16,000 unfortunate patients per year. It's taken less than two decades for deaths to quadruple, and now it's the number one cause of accidental death, more so than traffic accidents. Not only this, but every hour in the U.S. a baby is born addicted to opiates needing medical attention from the moment they open their eyes as they suffer the pains of withdrawal. Isn't that hard to believe, in this day and age of profound technology and scientific discovery? Not when a plant remains unjustifiably illegal, limiting the research and understanding of its potential as a non-fatal medicine.
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The addiction rate of those prescribed opiates currently rests at 32% according to a Castlight Study - meaning about 2.1 million people in the U.S. are abusing their opiate pharmaceuticals. Baby Boomers are 4x's more likely to abuse, those with a behavioral health diagnosis are 3x's more likely to abuse, those with multiple conditions are 2x's more likely, and those in the lowest income areas are also 2xs more likely.
And the interesting fact the Castlight Study uncovered: States that have legalized medical cannabis have lower opioid abuse rates than states that haven't. The Johns Hopkins School of Public Health supports this notion, with research of their own, stating opioid overdose deaths have decreased by 25% in legalized states:
"In absolute terms, states with a medical marijuana law had about 1,700 fewer opioid painkiller overdose deaths in 2010 than would be expected based on the trends before the laws were passed." - Marcus Bachhuber, MD, of the Philadelphia Veterans Affairs Medical Center and the University of Pennsylvania.
Not only did the Castlight Study uncover these truths, but their main objective was to find out how the opioid crisis is affecting the workforce. They discovered:
"Opioid abusers cost employers nearly twice as much in healthcare expenses on average than non-abusers... Opioid abuse costs employers approximately $10 billion from absenteeism and presenteeism alone."
Let's compare the side-effects of opiate-based drugs versus cannabis. These opiate-related side-effects are the reasons the user suffers, the workforce suffers, and families suffer - thus leading to the investigation of using cannabis as an alternative analgesic.
Cannabis Side-Effects are Safer than Opiates'
Not only are the side-effects of cannabis fewer, but they're far less traumatizing to an individual and their families which is the strongest reason men and women are turning to cannabis. Both opiate-based drugs and cannabis have been declared analgesic medications (though cannabis lacking official government and FDA-approval resulting in less clinical outcome studies), yet the one that has never caused an overdose death is the one being labeled and associated with the worst stigmas.
Keep in mind, opiates come in many forms: codeine, fentanyl, heroin, hydrocodone, hydromorphone, meperidine, morphine, opium, oxycodone, pentazocine, propoxyphene, and time-release oxycodone - each one of them possibly leading to addiction and fatal overdose.
There's never been a reported death attributed to cannabis in any form, be it flower or concentrate, and those that do intake too much for their system either experience anxiety/a panic-attack that can be quelled or heavy fatigue.
Possible Side-Effects of Opiate-Based Drugs
- Depressed Heart Rate
- Respiratory Depression
- Slurred Speech
- "Heroin nods" (when a user falls asleep while sitting/standing with head hung)
- Physical Dependence
- Psychological Dependence
- Hyperalgesia (abnormal heightening of sensitivity to pain)
- Hormonal Dysfunction
- Muscle Rigidity
- Allergic reaction (including rash, hives, wheezing, swelling of lips, face, tongue, throat - as well as closing of throat)
Possible Side-Effects of Cannabis
- Red Eyes
- Paranoia / Anxiety
- Increased Appetite
- Increased Heart Rate
- Short-Term Memory Impairment
- Sleepiness or Lethargy
- Psychosis in individuals with pre-existing psychotic diseases
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The side-effects not listed here take a more philosophical turn. Anyone suffering from opiate addiction is not only hurting themselves, but their friends and family as well. Children suffer the worst, lacking proper bonding with their parents who prioritize drug-use over them and possibly being taken to foster homes when a parent overdoses.
Studies Using Cannabis for Opiate Withdrawals
We tend to presume the opiate crisis in the U.S. is fairly recent, since the number of addicts has surged in the past 18 years. However, opioid addiction isn't new, and neither is using cannabis to curtail its negative side-effects.
The Lancet, a weekly peer-reviewed general medical journal founded in 1823 by an English surgeon named Thomas Wakley, was once a renowned world-leading medical journal and still continues to publish today. In 1889, an article was published entitled, "Opium Poisoning," that included a study by Dr. E. A. Birch outlining the application of cannabis for the treatment of chloral hydrate and opium sickness (withdrawals). Not only did he find that cannabis reduces the cravings of opium addicts, it acted as an anti-emetic (meaning it helped prevent vomiting and nausea).
If only we had taken this information and ran with it, medical cannabis would be in a better spotlight today and perhaps opiate addiction wouldn't be such a profound issue.
In more recent discoveries, 14 studies were conducted on both rats and humans involving the use of "CBD as an Intervention for Addictive Behaviors: A Systematic Review of the Evidence". When examining opioid-related addictive behaviors:
"CBD was found to have an impact on the intoxication and relapse phase of opioid addiction. Data on its effect during the withdrawal phase remain conflicting and vary based on co-administration of other cannabinoids such as THC."
It was found that CBD reduced the reward-facilitating effects that morphine induces, without influencing motor function. This, and THC may act synergistically with CBD, producing better outcomes regarding the reduction of opiate addiction than if CBD were used by itself as a treatment.
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Another study entitled, "Early Phase in the Development of Cannabidiol as a Treatment for Addiction: Opioid Relapse Takes Initial Center State," made the conclusion that:
"To date, the evidence appears to at least support a potential beneficial treatment for opioid abuse... CBD might be beneficial for treating opioid-dependent individuals... CBD could thus offer a novel line of research medication that indirectly regulates neural systems modulating opioid-related behavior, thus helping to reduce side effects normally associated with current opioid substitution treatment strategies."
And finally, the University of Michigan published "Medical marijuana reduces use of opioid pain meds, decreases risk for some with chronic pain," in March of 2016. A 64% reduction in prescription opioid use was found when patients used medical cannabis in their pain management regimes. Of the 185 participants taken from a dispensary in Ann Arbor, 45% of them also stated they noticed improvement in the quality of their life. They also noted fewer side-effects from their original medications.
"We're in the midst of an opioid epidemic and we need to figure out what to do about it. I'm hoping our research continues a conversation of cannabis as a potential alternative for opioids... We would caution against rushing to change current clinical practice towards cannabis, but note that this study suggests that cannabis is an effective pain medication and agent to prevent opioid overuse." - Kevin Boehnke, lead author of the study & doctoral student in School of Public Health's Department of Environmental Science.
The Largest Self-Report Study Supporting Cannabis as an Analgesic Opiate-Replacement
Just last year, in June of 2017, The University of California Berkeley teamed up with Kent State and Hello MD (a telemedicine company that provides online access to doctors and assistance in obtaining a medical cannabis card in legalized states) to gather information pertaining to cannabis and opioid use: Cannabis as a Substitute for Opioid-Based Pain Medication: Patient Self-Report. Their goal was to collect self-report substitution data on a large sample. To do this, they administered a survey online to Hello MD patients from California that have medical cannabis cards. The participants were entered into a raffle to win a free vaporizer as initiative.
"Of the 2,897 patients recruited for the survey, 63% were using marijuana for pain-related conditions, such as fibromyalgia, back pain, and arthritis. About 30%, or 841 patients, also reported using an opioid currently or in the past six months. Of those 841, 92% agreed or strongly agreed with the statement that they preferred cannabis over opioids for their condition. And 93% agreed or strongly agreed that they were more likely to pick cannabis over opioids if both were readily available." - Beth Mole, Ars Technica
Here is the info and results they collected from their survey:
- Number of participants: 2,897 men and women entered
- 55% male, 11 respondents were trans males & 1 respondent trans female
- 53% between the ages of 20-39
- 29% over age of 50
- 15% over age of 60
- Mean age= 40
- 64% identified as white, 14% latino, 7% African American
- 71% had some college education or completed college
- 14% completed postgraduate work
- 16% report pain as primary condition - though when accounting for all pain related conditions that they used pharmaceuticals or cannabis for (menstrual cramps, fibromyalgia, back pain, arthritis, etc), it rose to 63%.
- Common mental health conditions for which respondents used cannabis included
- Anxiety (13%)
- Insomnia (9%)
- Depression (5%)
- 50% smoke cannabis, being most common method of ingestion
- 31% vaporize cannabis
- 10% use edibles
- There's a very low rate of topical use
- 30% (N=841) reported using an opiate based pain med currently or in past 6 months
- Of these, 61% report using them with cannabis
- 97% report decreasing the amount of opiates consumed when also using cannabis
- 89% report that taking opiates produces unwanted side-effects like constipation & nausea
- 92% report cannabis has more tolerable side-effects than opiate-based meds they've taken.
- 81% report taking cannabis by itself was more effective at treating their condition than taking cannabis with opiates
- 71% say cannabis produces same amount of pain relief as their opiate meds
- 92% prefer cannabis to opiates for the treatment of their condition
- 93% are more likely to choose cannabis to treat a condition if more readily available
- 64% report taking a non-opiate based pain med for their condition currently or in the past six months (such as Tylenol or Ibuprofen)
- 76% report taking non-opiate based pain med along w cannabis currently/ in past 6 months
- 96% do not need to take as much of non-opiate pain meds when using cannabis
- 92% say cannabis works better for their condition than a non-opiate based pain med
- 95% prefer cannabis over non-opiate based pain meds
These findings brought about the following conclusions:
- Cannabis substitution for opiate and non-opiate based pain meds is common among pain patients.
- Pain patients report cannabis works well as a substitute and complement for both opiate and non-opiate based pain meds.
- Stigma of cannabis is still an issue, especially for people of color.
- It is obvious humanity needs more clinical outcome studies.
- Despite lack of clinical outcome studies, it's apparent that cannabis is indeed helping patients not only control their opioid use, but helping to prevent addiction, overdose, and abuse, acting as the opposite as a gateway drug as it reduces a patient's need for increasing doses of what's essentially heroin.
A comprehensive list of studies pertaining to cannabis use for pain can be found here: CannabisReports.com. You'll note there are mostly surveys due to the old barriers drug prohibition creates, making it hard for universities and health facilities to conduct and publish cannabis-based research legally. However, there are a few studies conducted on rats as well as a rare few done on humans.
What we should note is that there is indeed evidence that patients ARE using cannabis either with their opioids to reduce the amount they need, or as a substitute to cut out opioids completely despite the government's continued classification of cannabis as a schedule one substance. The more people that become aware that cannabis can offer alternative healing methods, the more these patients will turn to the voting poles vigilant for legalization.
"If it wasn't a political issue, if it was strictly a scientific issue, this would have been out there decades ago." - Reiman, manager of Marijuana Law and Policy at the Drug Policy Alliance.