Can Cannabis Help the Opioid Crisis in Canada

As society sees the crushing devastation caused by prescription opiates come to a head, with almost 2,500 Canadians dying in 2016 as a result of an opioid overdose, the cannabis community is standing up to discuss the role of cannabis in the opioid crisis.

The Problem

According to the Canadian Centre for Substance Abuse, Canada is the second largest per capita consumer of prescription opioids in the world. Morphine consumption in Canada alone is almost double America’s 73 milligrams per capita.

Meanwhile, overdose-related deaths have soared, with Fentanyl abuse becoming increasingly devastating. Fentanyl—a painkiller up to 100 times stronger than morphine is extremely addictive and Canada has seen a 61 percent increase in overdoses year over year.

On October 26, 2017 Donald Trump declared the opioid crises a nationwide public health emergency. This devastating health emergency is taking nearly 100 American lives every day, and as Donald Trump stated, “as Americans we cannot allow this to continue”. While it’s not clear what action he plans to take, it is clear that there is a devastating problem that needs to be addressed.

Here are a few ways that cannabis and the opioid crisis are being linked in modern discourses:

1. Cannabis Helps Reduce Dependence on Prescription Drugs

Cannabis is being praised as of late for its role in helping people depend less on prescription drugs for common conditions like pain, insomnia, or other disorders that doctors have been quick to over-prescribe for. In fact, a growing number of experts say that cannabis should be prescribed before painkillers.

It’s been noted by some of Canada’s top health officials, that Canada has been too “quick to prescribe” when faced with patient complaints of pain especially. As a result, Canadians are the second highest users of prescription opioids in the world per capita, next to Americans, and these numbers are only on the incline. Canada, thus, becomes known as a “nation in pain” as the numbers of prescriptions, and prescription-related deaths climb.

A recent study that was conducted on the HelloMD website, which is a medical marijuana site, sought to understand how cannabis reduces reliance on prescription drugs. Of those surveyed, 43% indicated that they stopped relying on over the counter drugs like Tylenol or prescription drugs like Vicodin to treat pain.

There is some further evidence that cannabis has allowed patients to reduce or eliminate their use of other prescription medications from a peer-reviewed, published research study conducted by DePaul and Rush universities in Illinois. While the sample size of 30 participants is not considerable, the studies provide direct anecdotal evidence of what has been suggested by previous studies, that marijuana may contribute to the reduced use of opioid drugs.

Survey Says…

A 2017 study published in the journal Cannabis and Cannabinoid Research investigated whether patients preferred cannabis or opioids in managing pain. Among its findings, 97% of the sample strongly agreed/agreed that they can decrease their opioid use by using cannabis.

In addition to potential harm reduction, the researchers further concluded that “medical cannabis patients report successfully using cannabis along with or as a substitute for opioid-based pain medication.

Essentially, the overwhelming majority of the 2897 participants would prefer to use medical cannabis than opioids to manage pain.

You can see the results from this part of the study in the graph below.

The research is encouraging in finding feasible solutions to reducing opiate reliance on pain management.

2. Opioid Crisis Sees Relief in Legalized Areas

A 2014 study published in a journal associated with the American Medical Associationstudied the instances of opioid mortality in areas where cannabis was legalized. The study looked at 10 different states that had enacted legalized cannabis laws (medicinal) from the period of 1999 to 2010. It was observed that there was a mean average reduction of 24.8% lower mean annual opioid overdose mortality rate than those where there were no medical marijuana programs.

Another study was reported on by the National Institute on Drug Abuse found that legally protected marijuana dispensaries (referred to as LMDs in this article) were associated with lower rates of dependence on prescription opioids and fewer overdose deaths due to opioids. It was also observed that there are fewer admissions to addiction treatment centers in areas where legalized marijuana dispensaries are available.

The downside that many of these studies point out, however, is the potential for an increase in recreational marijuana use.

Can Marijuana be an Effective Substitute?

As just with any cannabis-related issue, there is an overwhelming lack of research addressing cannabis and its potential to aid in the opioid epidemic that has swept across Canada and the United States.

The discourse is making its way into popular publications. Earlier this year, Rolling Stone reported on those who are taking a stand for cannabis for opioid addiction. An Albuquerque psychiatric nurse practitioner 400 of her patients who tried cannabis to manage symptoms of withdrawal were able to “kick” their opioid habit.

This approach isn’t coming without its critics though, with many who don’t subscribe to the “cannabis is the answer” camp putting forth that you can’t just “cure” a severe chemical addiction with cannabis.

Several studies indicate that cannabis interacts with opioids and alters the associated pain-relieving effects. Opioids and THC are similar in that they both have analgesic effects because they block pain signals in our nervous system. However, they differ since THC binds to the receptors of the endocannabinoid system, while opioids bind to opioid receptors. Effectively, both can be effective in managing pain.

Interestingly, evidence suggests CBD can reduce drug cravings and withdrawal symptoms, which suggests CBD could be an effective treatment for opioid addiction.

There is some school of thought that interacting cannabis and lower dosages of opioids to offer suitable pain relief while reducing the dependence on opioids. This interaction can slowly wean patients off opioid medications altogether as they switch to cannabis-based treatments.

Advocates Carry On

In Canada, cannabis advocates are keeping their voices strong on cannabis’ role in the opioid crisis. Anyone familiar with the marijuana dispensary movement in Canada is undoubtedly familiar with Marc and Jodie Emery, who is being federally prosecuted for their illegal dispensaries. Jodie and Marc are advocates for speaking about the role of cannabis in the opioid crisis, writing advocacy letters to the House of Commons Standing Committee on Health about the opioid crisis and remaining public voices despite their persecution in the cannabis space. They’re never two to back down from speaking about how cannabis can tackle many public problems.

In addition, a Windsor-area doctor, Dr. Christopher Blue is writing cannabis prescriptions rather than prescriptions for opiates, recognizing that Canadians aren’t getting the safe access they deserve to pain management. However, even though cannabis can be a real solution to the opioid epidemic, the overwhelming majority of physicians are still more comfortable prescribing opioids over cannabis for pain. There is a paradigm shift required here starting from the top down in our healthcare system.

While medical cannabis gains ground in Southern Ontario, one resident admits that there is a downfall to medical marijuana when looking to substitute it for painkillers: it’s too expensive and is not covered by the province’s health plan. This Windsor resident sees the price of marijuana as being a barrier to those trying to kick painkillers when they can get their opiates for free, where medical marijuana comes at a price.

One thing is for certain, as marijuana becomes legalized, Canada can begin to notice how legal shifts begin to affect public problems through formalized research that will guide decisions on how cannabis is used in the opiate epidemic.

 

Sources:

Reiman Amanda, Welty Mark, and Solomon Perry. Cannabis and Cannabinoid Research. June 2017, 2(1): 160-166. [PDF]
D I Abrams, et al. (2011). Cannabinoid–Opioid Interaction in Chronic Pain. Clinical Pharmacology &Amp; Therapeutics, vol. 90, no. 6, pp. 844–51. [PDF]
Reiman, A. (2009). Cannabis as a substitute for alcohol and other drugs. Harm Reduction Journal, 6, 35. [PDF]