The ongoing global opioid epidemic continues to wreak havoc with victims, and their families across the world. According to official date from the United Nations, opioids now account for two thirds of all drug related deaths. That includes deaths from accidental legal opioid drug overdose as well as accidental illegal use of opioids. The overlapping margin between an effective pain killing dose of opioids and a fatal dose means that many of the opioid deaths happened to law abiding citizens taking prescription medications in line with doctors dosage recommendations.
Opioid medications simply carry an inherent and unavoidable risk that they will kill a proportion of those that use them. Because more people are being prescribed opioids than ever before more people are dying than ever. But cannabis has some unique properties and synergies with opioid medications which means it can help reduce the opioid crisis. Read on to find out how.
Opioids include heroin as well as morphine-based medicines. In addition there are some new, synthetic opioids such as Fentanyl which can be 50-100 times more potent than morphine. The World Health Organization has released a report indicating that 450,000 people die from drug related deaths in 2015. Anything that can be done to reduce the growing number of overdose deaths will save hundreds of thousands of lives. Evidence is growing that one effective way is to use cannabis as an exit drug. It’s ironic that cannabis prohibitionists originally claimed cannabis was a gateway drug to hard drugs. Now it’s quite clear from several studies that in areas with legal cannabis, doctors write fewer prescriptions for opioids.
The main use for opioid medications is pain relief. Cannabis is also widely used for pain relief (analgesia). The problem is that opioids are highly addictive, and once hooked on them you need to steadily increase dosage to get the same effect. Eventually the effective analgesic (pain-killing) opiate dose becomes very close to the lethal dose. By substituting a non-lethal painkiller (cannabis) for a lethal pain killer (opioids) there is a clear benefit in risk reduction. But there are some important medical reasons why cannabis can reduce the amount of opioids required to produce pain relief.
Cannabis uptake into the body is regulated by the endo cannabinoid system (‘ECS’). The opioidergic system deals with the uptake of opiates into the body. Recent studies show that these two systems interact in many different ways. Distribution of receptors in the endo cannabinoid system are in close proximity to those from the opioidergic system in the brain. The receptors also show cross-sensitization of their behavioral pharmacology. CB1 (cannabinoid) receptors are used by the endo cannabinoid system and mu opioid receptors (MORs) are used by the opioidergic system. They are found in many of the same areas in the brain. The close physical locations of these two system in the brain together with the neighbourly relationships and similarities of the CB1 and MOR receptors explains the interactions seen between the opioid and cannabinoid systems in reward and withdrawal. In simple terms, this means that the human body shows certain similarities in the pathways used by the body to derive pleasure and pain relief from cannabis and morphine.
A sub-analgesic dose of medicine means a dose that will be ineffective for pain relief for a person a given size, weight and drug tolerance. One fascinating study has shown that sub-analgesic doses of opioids actually become effective at pain relief when combined with sub-analgesic doses of cannabis. The synergy between the THC and opiates explains why so many pain sufferers find that opioids in combination with cannabis seem far more effective even at lower opiate doses. This explains lower opioid prescriptions and deaths in states with legal cannabis. Those that combine their opioid prescription with cannabis will find that they need less opioids to get their pain relief. Some will find they can avoid opioids completely and just use cannabis.
This is extremely important as society aims to reduce opioid deaths. If opioids could be prescribed less, and in smaller doses alongside cannabis, then accidental overdoses would be reduced. What’s more, the science supports the facts. But that doesn’t mean that the politicians will support either.
Cannabis prohibitionists are keen to ensure that cannabis legalization is not done to help reduce the opioid crisis. In the USA, rising political star and new Hampshire Governor Chris Sununu is determined to oppose the use of cannabis as an exit drug for opioid users.
“When we are dealing with opioids as the single biggest health crisis this state has ever had, you are going to tell me legalizing more drugs is the answer?” Sununu said in late 2018. “Absolutely not”
Prohibitionists still carry an influential voice even when science says the opposite. In 2016, official data showed that 66.4% of the 63,632 drug overdose deaths in the USA involved an opioid. That is a staggering increase of 21.4% from 2015. From 2016 to 2017, synthetic opioid-involved overdose death rates increased 45.2%. This report has some fascinating insights into the genuinely explosive rise of opioid deaths in the USA. In 2014 drug overdoses overtook car accidents for the number of deaths in the USA. Around 100 people are dying in the USA each day from opioid overdoses. Around half of these are patients using prescribed medications in line with doctors recommendations. Even when used under medical supervision, opioid medicines kill. That’s the biggest concern over their use, opioids are inherently dangerous and addictive killers.
The fact that cannabis can amplify a sub-analgesic (non pain-killing) dose of opioid and allow it to become an effective pain killer is a crucial finding. It explains why less opiates are used/prescribed in areas with legal access to cannabis. In the future it is quite possible, and even likely, that opioid-based pain killers for the seriously ill will include THC and cannabinoids. This would allow lower, safer, opioid doses to be used. This would reduce addiction and long term dependance, as well as reducing overdose deaths. Pharmaceutical companies are certainly already experimenting with the co-use of opioids and cannabinoids for future medicines.
Meanwhile, more people than ever grow their own cannabis from feminized cannabis seeds or autoflower seeds. Some of these are medical cannabis users who complement their prescribed opioid medicines with natural cannabis. No doubt many of them are able to maintain effective pain relief and minimise use of opioids by using cannabis. Few people outside of the cannabis industry consider cannabis a genuine life saver. But just in the area of avoidable, accidental opioid overdoses, cannabis has the potential to save tens (or even hundreds) of thousands of lives each year.
August 16th 2019