How cannabis can help replace opioids to relieve pain and aid in addiction recovery
In 2011, the Centers for Disease Control and Prevention declared an “opioid epidemic” in the United States.  This announcement came on the heels of two decades of bad medical over-prescribing practices, leading to opioid misuse and abuse, resulting in soaring rates of overdoses across the country. In other words—too little, too late.
Addiction isn’t a new problem. The human body is inherently vulnerable to addiction through the action of dopamine in the brain. Dopamine, a prominent chemical messenger, is released in response to rewarding and pleasurable events. Its role is to reinforce biologically relevant and necessary behaviors, including eating, sleeping, and sex.  However, humans and other animals are at risk of becoming dependent on the dopamine “rush” and can, therefore, develop an addiction to these behaviors whereby their body becomes dependent on the increased dopamine to function at baseline.
Just like food or sex, substances like alcohol and opioids can lead to dopamine release. Opioids are derived from the poppy plant and are a key component of illicit drugs (like heroin) and pain medications (like oxycodone). While opioid medications have been used for many years to treat pain, a few crucial factors converged in the late 1990s and early 2000s that led to an opioid-addicted nation.
In 1996, healthcare professionals were urged to pay closer attention to the pain reported by their patients – a recommendation bordering on being a requirement, prompting recognition of pain as the “fifth vital sign.”  The Joint Commission on Accreditation of Healthcare Organization heightened the urgency to treat pain in their published guidelines, and Congress declared the first decade of the 21st century to be the “Decade of Pain Control and Research.” [3,4] These events and associated policy changes sent a jolting ripple effect through the medical community that resulted in greatly increased prescriptions for pain medications.
Concurrently, Purdue Pharmaceuticals, the manufacturer of OxyContin®, began aggressively marketing their prescription opioids, spending $200 million on advertising. Their tactics included down-playing the potential risk of addiction and dependency caused by opioid medications. As a result, OxyContin® sales soared from $48 million in 1996 to almost $1.1 billion in 2000.  While Purdue eventually faced criminal and civil charges, by then, the damage to America had already been done.
In 2017, there were 47,600 opioid-related deaths in the US.  While prescription opioids certainly contributed to these statistics, many of these deaths involved heroin, and those who take opioid medications are at significantly higher risk of using heroin, due to its lower cost and easier access.  In fact, the nature of the opioid epidemic has fundamentally shifted the way addiction is viewed in the US.
Government initiatives have invested in strategies to reduce access to prescription opioid medications – but this does nothing to help patients with chronic pain who need treatment, nor those recovering from addiction. Fortunately, there is an overwhelming amount of data supporting medical cannabis as an effective agent for pain relief and in helping people recover from opioid addiction. [8-9]
In Part 2, we’ll take a closer look at these data and review recent policy changes, at the state level, aimed at increasing the availability of medical cannabis to patients with chronic pain and those in addiction recovery.
- Compton,M., et al. “Prescription Opioid Abuse: Problems and Responses.” Prev Med, vol.80, 2015, pp. 5-9 (impact factor: 3.434; cited by: 85)
- Baik, J.H., “Dopamine Signaling in Reward-related Behaviors.” Front Neural Circuits, vol.7, pp. 152 (impact factor: 3.005; cited by: 216)
- Berry, P.H., et al. Pain: Current Understanding of Assessment, Management, and Treatments. National Pharmaceutical Council, 2001 (impact factor: N/A; cited by: N/A)
- Rosenblum, A, et al. “Opioids and the Treatment of Chronic Pain: Controversies, Current Status, and Future Directions.” Exp Clin Psychopharmacol, vol16, no.5, 2008, pp. 405-416 (impact factor: 2.354; cited by: 326)
- Zee, A.V., “The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy.” American Journal of Public Health, vol.99, no.2, 2009, pp. 221-227
(impact factor: 4.138; cited by: 390)
- Scholl, L., et al. “Drug and Opioid-Involved Overdose Deaths – United States, 2013-2017.” Morb Mortal Wkly Rep, epub 21 December 2018 (impact factor: 12.888; cited by: 38)
- Manchikanti,, et al. “Current State of Opioid Therapy and Abuse.” Curr Pain Headache Rep, vol.20, no.34, 2016, pp. 1-9 (impact factor: 2.250; cited by: 32)
- Bachhuber, M.A., et al., “Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010.” JAMA Intern Med, vol.174, no.10, 2014, pp. 1668-1673 (impact factor: 19.989; cited by: 374)
- Boehnke, K.F., et al. “Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain.” J Pain, vol.17, no.6, 2016, pp. 739-744 (impact factor: 4.519; cited by: 110)
- Wiese, B. and Wilson-Poe, A.R. “Emerging Evidence for Cannabis’ Role in Opioid Use Disorder.” Cannabis Cannabinoid Res, vol.3, no.1, 2018, pp. 179-189 (impact factor: N/A; cited by: N/A)