December 13, 2017

Cannabis And The Opioid Epidemic: Part 1

There is increasing talk in the news about the opioid epidemic and cannabis, but what is the connection between them? While opioids may be necessary in certain cases, they are not always the best choice for pain. Can cannabis take the place of many opioids? Before we explore cannabis as replacement, it is important to understand what an opioid is, and how bad the epidemic really is.


What is an opioid?

Opioids are an umbrella term that also includes opiates - so what is the difference between the two? Opioids are synthetic or semi-synthetic drugs that work directly on an opioid receptor where opiates are directly derived from opium. Some examples of opioids are: hydrocodone, oxycodone, fentanyl, and heroin. Examples of opiates are morphine and codeine. For this article, I will be using the term opioid as it covers all the above substances. Opioids are typically prescribed for moderate to severe pain but have also been prescribed for coughs, diarrhea, and shortness of breath. 

Opioids, Did You know?

While opioids may do their job in select cases, there are also many downsides to them - some may even argue that the adverse effects outweigh any of the benefits. It is important to remember that the opioid umbrella covers prescription opioids as well as illegal opioids, such as heroin. Just because a medication is prescribed does not  guarantee that the medication is not being abused. The Centers of Disease Control and Prevention (CDC) has data that statesthat providers wrote nearly a quarter of a billion opioid prescriptions in 2013, which is enough for each American adult to have their own bottle of pills! Another astonishing fact is that the number of opioid prescriptions sold to medical facilities have quadrupled from 1999-2010 even though there has no been any increase in amount of pain reported by Americans in the same time period. Lastly, deaths from prescription opioids have more than quadrupled since 1999. There truly is an opioid epidemic occurring in the United States. The three most common issues that are discussed in regards to opioids are tolerance, physical dependence, and addiction.

Tolerance
When taking opioids, your body develops a tolerance to the medication meaning you would need to take more of the medication to get the same effect as you did when you began. The problem with this is that as you increase the dose, you run the risk of overdose. According to data from the CDC,91 Americans die from an opioid overdose (including prescription opioids and heroin) everyday.

Physical Dependence
Physical dependence means that you experience withdrawal symptoms when lowering a dose or stopping the substance. It doesn't matter if the use is legal or illegal, physical dependence can occur with all opioids. Withdrawal symptoms from opioids can be very uncomfortable and include but are not limited to: muscle aches, anxiety, high blood pressure, nausea and vomiting, rapid heartbeat, abdominal cramping, and diarrhea. Physical dependence can lead to addiction and in fact, plays a large part.

Addiction
Addiction shows a change in behavior due to the biochemical changes in the brain after continuous use of a substance. When someone is addicted to a drug, that drug usually becomes a priority in their life aside from the damage they are doing to themselves or others. The 2012 National Survey on Drug Use and Health found there were about 2.1 million people in the United States experiencing substance use disorders with prescription opioid pain relievers and around 467,000 individuals addicted to heroin. 

What does cannabis have to do with opioids?

Could cannabis be the answer in fighting the opioid epidemic in America? In 2014, the Journal of The American Medical Association (JAMA) published a very telling article stating that painkiller deaths dropped by 25% in the states that legalized cannabis. Previously, there had been considerable debate as to whether cannabis could be used to treat chronic pain, but recent research has uncovered some important facts. JAMA found that patients are able to supplement their chronic pain and take fewer or no pills which makes the patients less likely to experience an overdose. This finding was further supported by the National Academies of Science, Medicine and Engineering as they released a reports stating that cannabis indeeddoes treat chronic pain.

Beyond cannabis being a possible replacement for opioid medications, cannabis has also shown potential to decrease the desire and need for opioids in users. Jeff Chen, the Director of UCLA's Cannabis Research Initiative said, "If there is a chronic pain component, the cannabis can address the chronic pain component. We also find opioid addicts have a lot of neurological inflammation, which we believe is driving the addictive cycle. We see in preliminary studies that cannabinoids can reduce neurological inflammation, so cannabis could be directly addressing the inflammation in the brain that's leading to opioid dependency". This statement made by Jeff Chen was further supported by a2015 studyin the journal, Neurotherapeutics. The Neurotherapeutics study found that Cannabidiol (CBD) showed to be effective in lessening an addict's desire for heroin. 

So far, we have seen very promising studies in having cannabis be a main player in fighting the opioid epidemic. Stay tuned for the next blog post: Opioid Epidemic Part 2