Can cannabis help with the opioid crisis?
The opioid crisis has been a public health emergency in the United States for years. With nearly 90% of the 80,000 opioid overdose deaths in 2022 resulting from highly potent synthetic forms, new strategies are needed to solve the problem. One strategy that has been proposed is the use of cannabis as a substitute for opioids. However, the question remains: can cannabis replace opioids?
Early population reports found that states that legalized medical cannabis saw a reduction in opioid overdose deaths. However, those findings no longer hold when the timeline of analysis is extended to the present day. States that legalized recreational cannabis saw an initial reduction in opioid-related emergency room visits by 7.6% compared to states that did not legalize cannabis, but this difference was gone within 6 months. It remains possible that cannabis may serve as a substitute for common prescription opioids like oxycodone, codeine, or hydrocodone, but can’t overcome the severity of dependence to more potent illicit opioids like fentanyl or heroin that are being abused at escalating rates.
Some studies point to notable reductions in prescription opioid use among patients who also use cannabis, but this benefit disappears in rigorously controlled clinical trials. These clinical trials fail to find consistent results on cannabis co-use with prescription opioids, despite most patients saying that they prefer cannabis over opioids.
However, there are currently 15 ongoing clinical trials investigating the ability of cannabis to reduce opioid need. These clinical trials are driven by hard-to-ignore evidence from animal studies that look at the pain-relieving interactions between the endocannabinoid system, which is stimulated by cannabinoids like THC, and the opioid system. Pain experiments in rodents have consistently found that THC reduces the need for opioids. Across seven different studies, THC reduced the effective dose of morphine by 3.5 times.
Many cannabinoids, such as THC, stimulate CB1 receptors in the endocannabinoid system, which are found in the same pain-processing brain areas as opioid receptors and may also contribute to pain reduction. CB1 receptors in the body interact with opioid receptors to boost their pain-relieving effect in rodent studies. CB2 receptors, another cannabinoid target, can stimulate the release of the body’s own opioids which activate pain-relieving opioid receptors.
Despite the potential benefits, there are also risks associated with co-using cannabis and opioids. In some cases, the combination of cannabis with opioids was associated with worsened mental health, and this combination may be worse for those over 65 years old. Yet other safety issues, like opioid’s suppression of breathing, were not made worse with co-use of cannabis, at least alleviating some concern.
In addition, CBD is emerging as a potential strategy to help those trying to overcome opioid use disorder. A study published in the American Journal of Psychiatry found that CBD reduced cravings and anxiety in people with opioid addiction. However, more research is needed to fully understand the potential of CBD as a treatment for opioid addiction.
In conclusion, while there is some evidence to suggest that cannabis may be a potential substitute for prescription opioids, it is not a guaranteed solution to the opioid crisis. More research is needed to fully understand the benefits and risks of using cannabis as a substitute for opioids or as a complement to opioid therapy.