There has been a lot of talk about cannabis being used as an alternative to opioid-based painkillers. States that have made medical marijuana accessible to patients in need have seen a reduction in opioid overdoses. In a recent survey of 4,276 patients, 51% of patients use cannabis to reduce or replace the need for painkillers. 74% of patients use less than 1 gram of cannabis on the days they use it. 61% of patients surveyed use cannabis daily. 36% of patients use cannabis for pain.
So, how and why does cannabis reduce the need for opioids? Is it really just a case of “Legalize cannabis, and you reduce the influence of the black market and people being introduced to other, more harmful drugs?” Maybe to some extent, but there seems to be something a bit more fundamental at play here. Many opioid overdoses are the result of prescription opioids, not necessarily black market ones. In 2016, 42,000 people in the US died from an opioid overdose, and 40% of all opioid overdose deaths involved a prescription opioid.
Is addiction to opioids started off by people being introduced to it via cannabis (the gateway theory)? Or does addiction to opioids start off by treating postoperative and chronic pain with opioid-based pharmaceuticals, and could cannabis in actual fact be an alternative or even be an “exit” from opioids? Although it may seem radical, but there is perhaps more evidence to support the latter theory. The “gateway theory” of cannabis leading onto other substances should probably be turned upside down and shaken all around. Sure, there may be some curious people who take their experimentation with mind-altering substances too far, but this seems to be more the exception rather than the rule.
So, if the gateway theory is (mostly) wrong-headed, then why does legalizing cannabis for medical purposes lead to lower opioid overdoses? There may actually be a scientific, biological reason. Given the choice, many people would opt for cannabis over opioids for long-term pain. It would seem that, rather than being unable to eat properly, waking up in cold sweats in the middle of the night, being essentially “zombified” during the day, having cravings for more just in order to function properly and beat the pain, and all the other side-effects of opioid use and addiction, people would prefer to choose cannabis.
And why not? Swap all the problems that come with opioids for being able to sleep properly, eat a full meal and remain functional whilst awake, on top of the reduced pain, and it becomes a no-brainer for many patients. Being able to sleep and eat is perhaps one of the best ways of reducing pain in the long-term, and cannabis seems to provide this at least to some extent. We can’t conclude anything for definite from our study (which is difficult even in the best of circumstances due to cannabis being federally illegal), but there is so much sound reasoning that cannabis could be used for chronic pain that it seems almost ridiculous that opioid prescriptions are so widespread.
Due to such short sightedness, we are unable to say anything regarding cannabis’s medical potential for definite. We have in vitro, in vivo and experiments on rodents of various kinds (mostly rats and mice), as well as several human trials and case studies, but not enough to state anything conclusive. There is some evidence in experiments on rats that tetrahydrocannabinol (THC) may affect the mu- and kappa- opioid receptors, leading credence to cannabis being used as a painkiller and potentially help people get off of opioids. Cannabidiol (CBD) may well be a potent anti-inflammatory. Cannabis also contains many terpenoids that have anxiolytic, painkilling and addiction-beating properties. Indeed, this range of effects makes cannabis superior to opioids for beating pain in many respects, except in perhaps the most extreme or dire of circumstances. Now, all we need is the ability to test these theories out and have a grasp on cannabis and what it can be used for medically once and for all.
To learn more about some of the potential medical applications of cannabis, check out our study.