You’ve probably heard this argument before. The opioid epidemic in America has spiraled out of control. Deaths from overdoses have skyrocketed, naloxone is now standard issue for many first responders, and prescription painkillers are to blame. Cannabis has demonstrated some analgesic effects, and in states where cannabis is legal, opioid-related deaths are much lower.

Case closed, right?

Well, let’s not jump to conclusions. In today’s article, we’re going to take a deep dive into the research and the literature, and draw a fact-based conclusion, rather than a correlational assumption.

Opioids are primarily prescribed for pain management. They have a long-documented history of reducing pain by inhibiting the release of certain neurotransmitters, thereby causing a significant reduction in acute pain. Since they are some of the most effective drugs at reducing acute pain, some doctors have prescribed them to treat chronic pain as well.

But acute pain and chronic pain are two different beasts. Acute pain is typically short-lived and in direct response to an environmental stimulus. Chronic pain is often long-lasting and has few or no obvious causes.

Enter cannabis, whose mechanism of action differs greatly from opioids. Where opioids inhibit neurotransmitters, cannabinoids alter the body’s endocannabinoid system, artificially shifting the balance of endocannabinoids. In theory, cannabis can treat entirely different kinds of pain than opioids can because its mechanism of action is so radically different.

But like any good crisis, the opioid epidemic may not have a single cause. It would be easy to blame overprescription of opioids for the epidemic, but this ignores the crucial human factor. The transition to an addicted state is often subtle and varies from person to person. Additionally, overdoses are generally rare when prescriptions are followed carefully; overdoses are often the side effect of a person going well beyond their prescribed dose.

This has led some scientists to believe that the increase in opioid overdoses are actually deaths of despair. Some studies have suggested that Americans in particular have pretty low “social capital” and high rates of stress and depression due to our culture and economic woes. Suicide rates and alcohol deaths are also up, right next to opioids.

Can cannabis help us with this? Well, to some extent, it can. Cannabis users feel a “euphoria” (this is the research term for “high”) while under the effects of the drug, and the cannabis industry has created over 165,000 jobs in the USA, according to some estimates. This relieves some of the pressure.

However, the euphoria produced by cannabis is only temporary, and does not resolve any underlying issues that may push a person to overdose. Luckily, it’s pretty much unheard of for adults to overdose on cannabis, and most people agree that children shouldn’t be using cannabis except in specific cases.

Some of our readers have probably already heard that states which have medical cannabis laws have lower rates of opioid overdoses. Indeed, a few studies have noticed a correlation:

1. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010 -- Marcus A. Bachhuber, MD; Brendan Saloner, PhD; Chinazo O. Cunningham, MD, MS; et al
2. Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population -- Ashley C. Bradford, BA; W. David Bradford, PhD; Amanda Abraham, PhD; et al
3. Association of Medical and Adult-Use Marijuana Laws With Opioid Prescribing for Medicaid Enrollees -- Hefei Wen, PhD; Jason M. Hockenberry, PhD
4. The use of cannabis in response to the opioid crisis: A review of the literature -- Marianne Beare Vyas, RN, MSN, ANP-BC, Virginia T. LeBaron, PhD, APRN, FAANP, Aaron M. Gilson, PhD, MSSW

Please note that these studies are correlational, not causational. However, they all show the same trend: states with medicinal cannabis laws (MCLs) on the books show a statistically significant lower overall rate in opioid overdose and addiction when compared to states without MCLs. The % decrease varied depending on the type of opioid and the state laws.

And here’s where it gets really fascinating. States that allowed active dispensaries saw a 17.4% decline in opioid doses filled, and states that only allowed home cultivation saw a 9.4% decline in opioid doses filled. In other words, easier access to cannabis displayed a direct, statistically-significant correlation to declining opioid use.

While these studies may be correlational, they offer strong evidence to suggest a benefit to legalizing cannabis in the opioid crisis.

So where does this evidence point us? Well, based on what I read, I came to the following conclusions:

1. Cannabis has a different method of action than opioids in pain relief, allowing it to be used in the treatment of different kinds of pain. More research needs to be conducted to determine all of cannabis’ use cases, but federal rules have made the research process difficult.
2. Opioids are still the most potent tools for a doctor to use in treating acute pain. However, opioids and cannabis may not be mutually exclusive in the ongoing effort to treat pain, as cannabis shows potential for treating chronic pain.
3. Cannabis cannot resolve the social and economic woes underlying “deaths of despair.” That said, cannabis has a very low toxicity for adults, and it is extremely unlikely for users to overdose when using it.
4. In states where cannabis is legal, prescription opioids have seen decreased usage. While we cannot assume what patients were thinking, it seems that they found another way to treat their pain.

At Growers Network, we try to be comprehensive in our research. Was there anything I missed or didn’t address? Please let us know in the survey or comments below!

Resources:

1. Want to learn more about subjects similar to those touched upon in this article? Check out our articles on subjects such as:
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   2. Latin America: Leading the Way on Cannabis Reform
   3. Chronic Pain and MMJ
   4. Dravet Syndrome and Medical Marijuana
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