Cannabis can save lives, particularly those in the grip of a deadly opioid addiction.
This is not an opinion, it’s science. We’ve known this since 2014, when a multi-institutional study conducted by researchers at the Perelman School of Medicine at the University of Pennsylvania examined the rate of deaths caused by opioid overdoses between 1999 and 2010. Their results were published in JAMA Internal Medicine.
There were only 13 states that allowed the use of Medical Cannabis at that time, and on average these 13 states had an approximately 25 percent lower annual opioid overdose mortality rate after laws were enacted than states without them. Since 2014, the number of American States that allow Medical Cannabis has more than doubled to 29.
Unfortunately the opioid crisis has also exploded across our country, and the 49th State has not been spared from its clutches. According to the Alaska Opioid Policy Task Force, there’s no other “single cause of death that’s quadrupled over a period of one decade.” Much of this has to do with the increased potency of newer opioids, which can be 50 to 100 times greater than what the user may be accustomed to off the street.
Comparison of heroin with newer opioids, how much required for an overdose
According to Kate Burkhart, Executive Director of the Advisory Board on Alcoholism and Drug Abuse, there are only twelve state-funded rehabilitation beds in Anchorage. This limitation can create a situation where a person must wait after going through detox before going into rehab, which makes it far less likely they’ll even stay clean.
Alaska also has a limited number of providers who can provide medically assisted treatment. While any qualified practitioner can prescribe opioids, only a very small subset of them have the DEA certification to prescribe buprenorphine, which is used to treat opioid dependance and overdoses. Nationally, there’s almost a million providers that have the DEA permit to prescribe opioids, but only 5,000 of them have the DEA approval to prescribe buprenorphine. These are long odds for an addict in crisis.
But it’s not just street users that are dying. Almost half of all deaths resulting from opioid analgesic (pill/capsule) overdoses occur in patients who have legitimate prescriptions. In states allowing the use of Medical Cannabis, which may be prescribed as an alternative to opioid painkillers, the risk of overdose is significantly lower.
While clinical evidence for the pain-relieving properties of Cannabis is limited, some studies have suggested that ”it may provide relief for some individuals”, according to the lead author of the Perelman-UPA study cited above, Marcus A. Bachhuber, MD. "In addition, people already taking opioids for pain may supplement with Medical Cannabis and be able to lower their painkiller dose, thus lowering their risk of overdose.”
The study also showed that the relationship between lower opioid overdose deaths and rising Medical Cannabis laws strengthened over time; deaths were about 20 percent lower in the first year after a state's law was implemented, and more than 33 percent lower another four years later. A logical conclusion is that the empowerment of Medical Cannabis laws are changing the way people misuse or abuse opioid painkillers.
While Alaska’s task force tries to concentrate on harm reduction, prevention and rehabilitation, nationally our country’s executive branch seems determined to focus on enforcement. Our current Attorney General, Jeff Sessions, can’t even seem to discuss opioids without repeating his assertion that many heroin addicts start with Cannabis. This is the highly-derided “gateway theory”, which has it exactly backwards.
In 2010 alone, Medical Cannabis laws resulted in an estimated 1,729 fewer deaths than were expected, statistically. More recently, a study published in 2016 examined opiate-related deaths in Colorado between 2000 and 2015. These researchers compared mortality rates in two nearby states: Nevada, which legalized only Medical Cannabis, and Utah, where all Cannabis use is illegal. They found a significant drop in the number of opiate-related deaths after recreational Cannabis became legal in Colorado.
Our military veterans are twice as likely as the general population to die from an opioid overdose. In 2013 the Department of Veteran’s Affairs (VA) enacted the Opioid Safety Initiative, which reduced the number of veterans on opioids by over 30 percent. In a 2014 study, they found that 15 percent of 2,500 recently deployed soldiers were regular opioid users. Alternative treatments have been significantly safer and more effective than the typical top-down, authoritarian “my way or the highway” approach.
This is causing a sea-change in the way the VA is responding to the opioid crisis. They have recently implemented treatments like yoga, meditation and acupuncture as alternatives to opioids. But activists like Nick Etten, founder of Veterans for Medical Cannabis Access, believe that Medical Cannabis can help as well. “We see Cannabis not as a gateway drug,” he said, “we see it as an exit path off opiates.”
We can’t forget about the elderly! New research from Israel shows that Cannabis can be a safer way to medicate for chronic pain, and it's been published in the February 2018 European Journal of Internal Medicine. These researchers administered Cannabis treatment to 2,736 patients, with a median age of 74.5. After six months of treatment, almost 95 percent of the respondents reported an improvement in their condition, and over 18 percent stopped using opioid analgesics or reduced their dose.
While Cannabis does offer some mild pain relief, it doesn’t disconnect the user’s brain from their central nervous system by activating opioid receptors like opioids do. Cannabis does cause the release of dopamine in the brain’s reward pathway. That signal conveys a powerful sense of pleasure and craving, which may pre-empt some of the rewarding effects of opiates, decreasing the general desire to use them.
There is even promising preliminary evidence that Cannabinol (CBD), one of the active ingredients (cannabinoids) in Cannabis, can blunt craving in opioid addicts following a period of abstinence, helping to prevent relapses. When researchers examined the link between Medical Cannabis and opiate use in a group of patients with chronic pain in New Mexico, they reported that subjects who had access to Cannabis were 17 times more likely to stop using opiates for pain compared with those who didn’t.
All this mounting epidemiologic evidence is consistent, and hard to ignore.
Cannabis isn’t a gateway drug, it’s a partial solution to a full-blown epidemic. If Mr. Sessions follows through on his promise to crack down on Cannabis, one obvious result will be the worsening of the opioid crisis, which has already been declared a National Emergency. Since so many opioid deaths involve prescriptions, having another legal option for pain relief goes quite a way in reducing consumption of opioids.
Irie for Life, Herb
