A natural drug once seen as taboo by mainstream America may now be poised to help battle the country’s opioid crisis.
From 1999-2018, 450,000 people in the United States have died from overdoses involving opioids — from illicitly manufactured ones such as heroin to those prescribed every day by doctors around the country, according to the Centers for Disease Control and Prevention. In an effort to curb what has been dubbed an epidemic, doctors in many states are now turning to cannabis as a substitute for pain management and sleep solutions.
Washington, D.C., and 33 states across the country allow medical marijuana use, with more than 20 enacting cannabis-for-opioids legislation that allows for qualifying individuals who have or could receive prescriptions for opioids access to medical cannabis as an alternative.
Dr. Michele Ross, the founder of Infused Health, understands the difference such programs could make. She got a doctorate in neuroscience and studied drug addiction. She herself is a fibromyalgia and neuropathy patient who switched to cannabis from the morphine and oxycodone she took for roughly a year and a half.
“Although my dosage was increasing, my pain relief wasn't, and in fact it seemed like my pain was getting worse,” she says of the opioids. “I was so depressed. After getting off opioids and transitioning to cannabis, not only was cannabis better for pain management but even if I forgot to use cannabis for a day or two, my pain levels were significantly lower. I chalk this up to cannabis treating the root problems, including inflammation and stress, that were causing the pain. Opioids reduce perception of pain but do little to treat the problem and can cause brain changes that mimic depression. Once I used cannabis, I no longer needed the opioids and haven't used them since.”
She now works to educate doctors and patients on how to use cannabis in place of opioids, which were not designed for long-term use. Along with addiction concerns, people tend to build a tolerance to opioids, which reduces their effects over time, doctors say.
“Most of my patients are able to replace their opioids with cannabis products,” she says, noting that a variety of products now on the market helps to widen the application. “Depending on the type of product used, such as cannabis lotion, patients won't even feel a high but will get pain relief.”
Ross says most cannabis products enter the bloodstream, where cannabinoids such as THC bind to receptors in almost every cell in the brain and body. But a key difference makes using the products safer than opioids.
“There are almost no cannabinoid receptors in the brainstem, the part of the brain that regulates breathing, which is why cannabis can't cause respiratory depression, overdose and death,” Ross says. “Opioid receptors are found in the brainstem and responsible for the high overdose and death rate. This makes cannabis a much safer option, especially when coupled with the fact that cannabis is much less addictive than opioids, as well.”
Ross says she personally uses THC gummies to go to sleep and finds them to be more effective than prescription or over-the-counter solutions. She also uses a combination of THC tinctures and topicals to manage pain, and it allows her to continue working.
“While I was on opioids, I was bedridden, forgetful and unable to work,” Ross says.
Cannabis can help “almost every patient” reduce or eliminate opioid use, Ross says, but the type and amount matter. For instance, people with severe back pain might respond best to a cannabis suppository that delivers THC straight to spinal nerves and inflamed muscles, Ross explains. But someone with severe gut pain might do better with a high-dose THC edible.
When it comes to sleep, in particular, Ross says THC has a U-shaped dose curve. Too little might not help someone to sleep; too much can get them there but lead to poor sleep quality and a “hangover” feeling in the morning. Dosage can vary based on pain issues, weight and more, she says.
“I actually prefer patients use a combination of THC and CBD when possible,” Ross says. “CBD helps balance any unwanted side effects of THC, like increased appetite or drowsiness, while offering ways to reduce inflammation and anxiety using receptors THC doesn't target. Getting healthy, not high, is the goal with pain relief with THC.”
Tom Stacey, owner of Kannaboom, has found sleep success with the help of cannabis. It all started after he was prescribed Trazodone for sleep issues he said are not uncommon for those ages 55 and older. He just turned 60.
“It didn’t really work for me,” he says of the drug. “I got to sleep, but I got up at 2 or 3 in the morning.”
He turned to THC gummies, often splitting a 10mg dose of an indica strain with his wife at bedtime.
“I don’t get really high; I just get sleep,” he said. “I’d rather use an organic substance than a pharmaceutical.”
The website and podcast about cannabis he started were in direct response to growing up in an era when marijuana was vilified, he says. He lost a brother in the early 1990s who died after experiencing seizures. Stacey says he is left to wonder whether today’s treatments might have helped.
“He could be alive if we didn’t have these backward attitudes toward cannabis,” Stacey said. “I saw the need to just help educate people. There’s a lot of legit medical applications.”
His educational efforts focus on but are not limited to CBD. He noted that research is important when it comes to use of CBD products, as that industry has been largely unregulated.
Laura Geftman — a licensed clinical social worker and founder of The Calm, Cool & Collected — works as an addiction therapist and cannabis coach. She cautions that all chemical compounds, including THC and CBD, are psychoactive.
Terpenes, she says, are the biggest indicator of the effects different cannabis strains will have. Strains with high levels of Terpinolene, Myrcene and Caryophyllene, for example, can contribute to better sleep, as they have a tranquilizing effect. Strains rich in Borneol, Myrcene and Beta-Caryophyllene are helpful with chronic pain, according to Geftman.
“The effects of cannabis greatly vary from one person to another and largely depend on the body’s needs and the cannabis strain,” Geftman says. “There are many bodily receptors and cannabis chemical compounds that contribute to different desired effects.”
Cannabis is a safer alternative to opioids because while it can be “habit-forming,” it is not as addictive in the same way pharmaceuticals they replace can be, Geftman says. And there is no record of a fatal overdose from cannabis alone.
But she still cautions that cases vary by person when it comes to weaning off opioids. And cannabis abuse can be a problem for anyone treating chronic pain or sleep disorders.
“It's recommended to work closely with a healthcare professional to monitor your treatment plan,” she says.