In 2017, the U.S. Department of Health and Human Services declared a public health emergency, and it announced a five-point strategy to battle the opioid epidemic. Since then, the fight has been nonstop, with mainstream approaches like medicine and counseling, legislation like the 2018 Opioid Crisis Response Act, and even more holistic ways like using medical marijuana.
Can using medicinal cannabis really aid in the opioid crisis? Experts are on the fence as to whether replacing one drug with another is a sound solution and whether it comes with its own set of dangers, such as addiction, dependency and other health concerns.
The good and the bad
For people who have chronic pain, opioids are often overprescribed, says Michael Cammarata, CEO of Neptune Wellness Solutions, a Canada-based cannabis company with a location in Conover, North Carolina.
“Medicinal marijuana is a much safer alternative for chronic pain that’s less severe and should be more widely considered in treatment plans before turning to opioid prescriptions,” he says, adding that it can “absolutely” be used as a substitute for opioids. “Of course, it’s very situational and different for everyone; generally speaking, however, cannabis is still effective in treating chronic pain and preventing opioid abuse.”
Cammarata adds that the major positive of using medicinal cannabis as opposed to opioids is that the addiction risks are much smaller — for using it both long and short term.
“It’s definitely true that cannabis cannot treat pain the same way that opioids can, which is why patients often request prescriptions,” he says. “I still believe that marijuana should be used first and opioids left as a plan B.”
Chronic pain is a difficult diagnosis to treat because it has both a psychological and physiological component, says Dr. Glenn Babus, a pain management specialist based in New York City.
“Retrospectively, it does seem to help a larger percentage of my patients with chronic pain who failed other treatments,” Babus says. “What works for one patient doesn’t necessarily work the same way for another — same with medical marijuana.”
Pot and pain
Some research has shown that people with an established heart disease under stress may develop chest pain more quickly if they have been smoking marijuana than they would’ve otherwise. The National Institute on Drug Abuse also has said there’s no research showing that it’s safe for some pregnant women who use marijuana for nausea. There’s more research indicating that chronic users of medical marjiuana may have impaired memory and learning.
“Opioids have a long-standing history, backed by an enormous amount of evidence, that it is highly addictive and detrimental to one’s health, especially when used over long periods of time,” says Hillary Peckham, co-founder of Etain, a cannabis company in Westchester County, New York. “Marijuana research does not indicate the same risks. For example, there has not been a reported overdose or death from consumption of marijuana.”
As it stands, marijuana is still federally illegal in roughly half the states in the country.
“What is most interesting about medical cannabis is there are not yet any good evidence-based articles on its use,” Babus says. “There is no such thing as a medical cannabis residency or fellowship. The big risk though is high use in adolescents before their brains are fully developed because it can cause permanent cognitive loss measured in decrease in IQ.”
Cammarata thinks a lot of the debate boils down to the fact that one is legal and one isn’t.
“At the end of the day, one is a prescription medicine, and one is an illegal drug,” he says. “Subconsciously, there’s still a bias against cannabis — even legal, medical cannabis.”