The medical community is currently split on the debate regarding the merits of medical marijuana as a solution to the opioid epidemic in America. There are many physicians that advocate for the use of medical cannabis in addiction therapy. They have noted individual patient cases where it has helped patients step down from long-term opioid and NSAID medication use. On the other hand, some physicians and addiction therapy providers assert that replacing one addiction for another is not a therapeutic benefit.
What physicians do agree on is that prescription opioids and other pain relief pharmaceuticals have side-effects and risks that, in some cases, can exceed the nominal risks that medical cannabis provides.
We decided to take a closer look at the recent data regarding mortality rates from opioid addiction and health risks. Some of the research supports the use of medical cannabis as an “exit drug.” It also suggests that doctor-supervised medical cannabis patients may provide an alternative way to manage chronic pain and other conditions without the high-risk of long-term opioid use.
It’s time we all paid closer attention to the effects of opioid use in America. National and global health agencies like the National Institute On Drug Abuse (NIH) and the World Health Organization (WHO) state that it is an epidemic and crisis. From 1999 to 2017, over 218,000 Americans died from a prescription opioid overdose. The CDC has estimated that the total economic burden of opioid misuse in the United States is $78.5 billion dollars, per year. This amount includes healthcare costs, addiction treatment, criminal justice costs, and lost workplace productivity.
The statistics become even more alarming. Health agencies report that approximately 1,000 Americans are admitted to a hospital every day from an opioid-induced health emergency. You may ask, how could so many people get their hands on a Schedule I Drug? American physicians wrote 191 million prescriptions for opioids in 2017 alone. That is about 58 pain medication prescriptions per 100 people.
The best place to begin understanding the root cause of the opioid epidemic is to be transparent about how doctors get paid when they prescribe them. The truth is that doctors make more money through pharmaceutical incentive payments. Although alarming, it is true, and a big problem.
Big Pharma spends tens of millions of dollars on marketing pain relief medications to physicians. For example, they provide informative videos with patient interviews. Their goal is to assure physicians of the safety and effectiveness of certain types of opioid medications for pain relief.
What Big Pharma intentionally leaves out, is the impact of long-term opioid use. They do not explain to physicians that prescribed opioids are highly addictive and can, over time, result in an escalation of dosage for the patient. Patients who are taking opioids for a long period of time for chronic health issues can develop increasing resistance to the medication. This frequently requires stronger doses and, in turn, increases the health risks for the patient.
In fact, long term use of opioids can even make patients more sensitive to pain when used long-term. Opioid-Induced Hyperalgesia (OIH) is an increased response to pain from a stimulus that provokes pain in the body. Something as innocuous as having a vaccination or giving a blood sample would be excruciating to an individual with opioid-induced hyperalgesia. It can literally amplify the pain.
Pharmaceutical companies know about the side-effects of OIH but, as you can imagine, they are reluctant to educate practitioners. Again, it is in the “fine print” where drug manufacturers are confident no one will read. But how do opioids actually magnify pain for long-term users? Opioids stimulate specific receptors that help block pain signals from reaching the brain. Your body is still experiencing pain and inflammation, but your brain is not aware of it because those signals are being blocked.
After prolonged opioid use, the human brain begins to act as if the normal pathways for pain signaling are broken. It builds new ones that are even more alert to symptoms of pain; this process is called hypersensitization when OIH occurs. It is a natural process for the brain, which wants to restore neuroplasticity to every neuron that is meant to carry a message of pain, discomfort, or injury to the brain.
For a patient with prolonged opioid use, the reverse of the desired effect occurs. Instead of achieving pain relief from opioids, it starts to feel like pain medications are not working anymore. When they tell their doctor, they are prescribed a higher dose. This higher dose further impairs nervous system messaging and the brain increases the repair of neural pathways.
It then becomes an arms race between the patient’s brain and the prescription opioid, and the patient always loses. First, they are experiencing sub-optimal pain relief. Second, the escalating dose and potency of the opioid increases both side-effects and life-threatening risk factors for the patient.
A 2010 NIDA funded study had physicians discussing the therapeutic benefits of medical marijuana as a solution to the opioid epidemic in America. The study found that opioid mortality rates from 1999-2010 were significantly lower (a drop of 21%) in states that had regulated medical cannabis.
Further analysis provided some conflicting information in 2017. However, 2017 was a year when opioid overdose rates systemically rose in all regions of the United States. Still, the data opened further study that evaluated whether medical cannabis could be an effective pain reliever and way for Americans with chronic pain to transition to a symptom management option with fewer side-effects.
Some clinical studies have revealed that cannabis can alter the brain structure for adolescents during critical development phases. That is why medical cannabis is only recommended for minors when they have a significantly debilitating health issue or terminal illness. In all states, low-THC cannabis products are mandated for minors.
The reason that patients who have moderate to severe chronic pain cannot stop taking opioids, is because they were never presented another alternative. Pain-relieving effects of opioid medications wane with long-term use. However, medical cannabis does not have that same effect. There is no evidence to prove that long-term use of cannabis requires the same escalation in dose over time. It impacts the neurological and pain messaging systems in an entirely different way.
In 2019, the federal government announced that medical research funding could not be used to confirm that medical cannabis is a safer and more effective pain management option for patients in comparison to prescription opioids and NSAIDs. It is not understood why Big Pharma is protecting a cash-cow product which is known to cause severe side-effects and health risks for patients.
Some states have already legalized medical cannabis for addiction therapy. Meanwhile, other states are still investigating the potential of medical marijuana as a solution to the opioid epidemic in America.
This article was originally published by Forbes.