Marijuana Replacing Opioid Use? Ohio Is Thinking About It

Could Ohio use cannabis to finally help it's opioid overdose problem?

Posted Dec 31, 2018

I recently gave a talk at the Jewish Federation in Cincinnati, Ohio focused on reducing stigma in addiction. After the talk, I was lucky enough to stay behind and speak to dozens of the attendees about their questions, struggles, and experiences. One mother, whose story touched me in a particularly strong way, had lost two children to heroin overdoses and was hanging onto another son who was using Suboxone to help ease his cravings. She had people tell her that he was just substituting one opiate for another. She was worried. But in Cincinnati, they need all the help they can get. But what if there was a completely different solution?

The use of medical marijuana remains highly controversial across the globe. Many people believe it’s a gateway drug to riskier drug use, and there is little doubt that marijuana use can be problematic on its own. But when it comes to medical marijuana as a treatment for substance addictions, the debate becomes even more heated. Isn’t it just substituting one drug for another? That’s what some people think!

Like with any medical condition, whether it’s a physical health issue, an addiction, or mental illness, when it comes to treatment we have to weigh the risks vs. the benefits. When the benefits of a treatment approach can outweigh the risks, then it’s definitely worth consideration. As mentioned earlier, Ohio is in desperate need of a new approach to addiction. It has the highest overdose death rates per capita in the United States and opioids are the largest contributor with almost 5000 fatal overdoses in 2017.

Opioid addiction is already a legitimate reason for medical marijuana prescription in New York, Pennsylvania, and New Jersey, which are leading the way in this approach. While some states, like Maine, Vermont, New Mexico, and New Hampshire have had less success in allowing opioid addiction as a qualifying condition under the medical marijuana scheme, they’re working on it, too.

Should Ohio offer medical marijuana as a treatment for opioid addiction? Could it save lives? Would it create more “addicts?” The experts are divided on this debate. Let’s have a closer look at who is an advocate for medical marijuana and who is against its use in treating opioid addiction.

Who Is on Team Medical Marijuana?

There are numerous leading experts in the field who are proponents for medical marijuana in addiction treatment.

Medical professor and physician, F. Stuart Leeds, is advocating for medical marijuana to be used in Ohio to treat opioid addiction. He is in the process of submitting his application to the State Medical Board of Ohio and hopes they will consider expanding their list of approved conditions that are treated by medical marijuana.

While Jessica Gelay of the Drug Policy Alliance’s New Mexico has been fighting for Opioid Use Disorder to be added as a treatable condition with medical marijuana since 2016. Even with the limited research in this field, she believes in the huge potential of treating opioid addictions with medical marijuana.

A rehabilitation program in Los Angeles called “High Sobriety” provides medical marijuana treatment for opioid addiction recovery. Clinical social worker Joe Schrank believes in an individualized approach to addiction that may not necessarily mean abstinence from opioids, rather harm reduction. Medical marijuana can offer patients a better quality of life. But it's certainly NOT free of controversy and problems.

"[Cannabis forms] a great therapeutic alliance from the get-go. Like, we’re here with compassion, we’re not here to punish you, we want to make this as comfortable as we possibly can, and the doctor says you can have this [marijuana]. I think it’s better than the message of 'you're a drug addict and you’re a piece of s**t and you’re going to puke.'" —Joe Schrank.

Let’s look at why experts believe medical marijuana is a viable option for opioid addiction:

  • It can alleviate detox withdrawal symptoms. When people with an addiction to opiates like heroin or painkillers present for treatment, they are often offered buprenorphine to aid recovery and help fight off cravings for their drug of choice. However, when the dose of buprenorphine is reduced, the individual experiences awful withdrawal symptoms which medical marijuana could alleviate by reducing anxiety, cravings, and nausea, while improving appetite and mood. When an individual feels more in control and less awful during the recovery phase then they are more likely to continue the process and have a successful recovery.
  • In the big scheme of things, marijuana isn’t all that bad. Compared to opiates, marijuana overdoses are almost unheard of. Even though the research doesn’t advise the person with an opioid addiction to then use marijuana for the rest of their life, if they did, then the risks associated with opioid addiction are severely reduced. This means less chance of fatal overdose, transmission of HIV or hepatitis C, and a range of other medical and psychosocial problems. What’s more,
  • It can save lives. A study published in the Journal of American Medical Association in 20141 compared the opioid overdose rates in states where medical marijuana programs were established to the states without. They found that the states with medical marijuana programs had a quarter fewer deaths than the states that did not.
  • It helps people use fewer opiates. Multiple research studies have now supported the finding that (self-reported) opiate use goes down substantially when individuals who struggle with chronic pain use marijuana instead or in addition to opiate medications. The average reduction might shock you – 64 percent and more!2-5 If that doesn’t support the notion that marijuana use could reduce overdose deaths and ameliorate some of the physical dependence on opiates, I don’t know what would…

Who Is in Opposition to Medical Marijuana?

Health experts also oppose the use of medical marijuana as a treatment for opioid addiction. For instance, Dr. Mark Hurst, the director of the Ohio Department of Mental Health and Addiction Services does not believe medical marijuana is a viable treatment for opioid addiction because of the lack of scientific evidence. Clinical psychologist Brad Lander from the Department of Addiction Medicine in Ohio State University Wexner Medical Center, who argues that while medical marijuana may be viable as a short-term treatment for managing withdrawal symptoms while a patient is on buprenorphine, the long-term effects may outweigh any benefits experienced by the patient.

Let’s look at why these experts believe medical marijuana is not a viable option for opioid addiction:

  • Insufficient scientific evidence. Even though the proponents of medical marijuana claim anecdotal evidence that it is effective in treating opioid addiction, there’s limited scientific evidence to back up these claims.
  • Marijuana use comes with its own set of risks. Long-term marijuana use tends to impair memory, judgment, reactivity and motor control. It has also been linked to low motivation, known as amotivational syndrome, where an individual becomes apathetic and disinterested in activities they would usually enjoy. These symptoms may interfere with the individual’s ability to stay engaged in traditional opioid addiction programs and therapies that address the underlying reasons for the addiction. There is also at least one study that suggests that early marijuana use can bring about more future opiate use even among current opiate users.6

Where do I stand on this issue?

On one side we have experts saying there’s huge potential for medical marijuana use, there’s early evidence that for chronic patients it helps reduce opiate use, and anecdotally providers are getting feedback from patients that it is a helpful treatment approach.  On the other side of the fence, health experts say there’s just not enough research. It’s clear this argument could be solved by investing more money for research into the field and with more states legalizing medical marijuana for the treatment of medical conditions, it will come as no surprise that health professionals, and patients, from many other states will be advocating for mental health and addictions to be added to the list in the future.

Let’s not forget that clinical practice in the field is usually 15-20 years behind the research. I believe that the use of marijuana to treat pain can reduce the need for opiates to begin with, and reduce opiate use among current users, which should greatly help with overdose risks. That’s a BIG win by itself.

Additionally, a number of participants in the IGNTD Recovery programs report using marijuana to combat withdrawal from opiates or anxiety from alcohol and opiate cessation. Again, this is anecdotal evidence from the people who are actively accessing this kind of approach. We have to listen to what works for people on an individual basis. After all, abstinence is not the only measure of recovery. So, what is my stand on the issue? Do whatever works for you and keeps you moving forward – the point is to continue on your quest of improving your overall quality of life and reduce your dependence on chemicals or behaviors that are interfering with it.

References

1.            Bachhuber MA, Salone B, Cunningham CO, CL. B. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States. JAMA Intern Medicine. 2014;19104(1-6):1999–2010.

2.            Boehnke KF, Litinas E, Clauw DJ. Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain. J Pain. 2016;17.

3.            Corroon J, Mischley L, Sexton M. Cannabis as a substitute for prescription drugs – a cross-sectional study. J Pain Res. 2017;10.

4.            Lucas P. Rationale for cannabis-based interventions in the opioid overdose crisis. Harm Reduction Journal. 2017;14(1):58.

5.            Reiman A, Welty M, Solomon P. Cannabis as a Substitute for Opioid-Based Pain Medication: Patient Self-Report. Cannabis Cannabinoid Res. 2017;2.

6.            Mark Olfson, Melanie M. Wall, Shang-Min Liu, Carlos Blanco. Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States. American Journal of Psychiatry. 2018;175(1):47-53