Drug overdoses and opioid-related deaths have reached epidemic proportions throughout the United States (1). Over the past 25 years or so, the number of opioid-related deaths (from prescription opioids including oxycodone, hydrocodone and methadone and heroin) quadrupled to more than 200,000 (2). In 2015 alone, opioid overdoses resulted in 33,901deaths (1, 2) and in 2016 nearly half of all opioid-related deaths involved prescription opioids (CDC). Today, opioid-related deaths in the US surpass combined deaths caused by both car accidents and guns annually (2, 3).
Cause of the Epidemic
While the exact causes of the current opioid academic are uncertain, a variety of factors including job loss, chronic unemployment, financial hardship and over-marketing/over-prescribing of opioids have been suggested. It is important to note, however that between 1981 and 2011 the number of opioid prescriptions in the US tripled from 76 million to 219 million per year (4). According to a recent survey, over 97 million people took prescription opioids in 2015 and of these, roughly 12 million used opioids without being directed by a doctor (5). Interestingly, because of recent state legislative initiatives that restrict the opioid prescribing habits of physicians, the number prescription opioids deaths appeared to level off in 2011(6). However, since 2011 the number of heroin overdose deaths and those related to illegal “black market” synthetic opioids like fentanyl has skyrocketed (CDC) in many hard hit states like West Virginia, Pennsylvania and New Hampshire. This is because heroin and fentanyl are now much cheaper and more available than prescription opioids (6).
The current opioid epidemic is forcing many physicians to reevaluate their use of prescription opioids for pain control and to consider alternative pain management strategies. There is an emerging body of evidence that suggests that medical cannabis (smoked, vaporized or ingested) can effectively manage and control chronic non-cancer pain (6-9), reduce opioid consumption (10-15) and help to lower opioid overdose deaths (14, 15).
Medical Cannabis and Pain Management
There are numerous reports that show that smoked or vaporized medical marijuana (and cannabis extracts), used alone or in combination with opioids, can effectively treat chronic neuropathic pain, muscle pain associated with spasticity from Multiple Sclerosis and certain types of cancer pain (8,9). More important, these studies found that smoked/vaporized cannabis or its extracts induce few adverse side effects and are safe for use; even in chronic pain patients who take prescription opioids for pain management (7).
Cannabis Reduces Opioid Consumption and Lowers Overdose Deaths
Although cannabis is not approved as a treatment for pain in the US, there is new evidence from states where medical cannabis is legal that cannabis reduces opioid consumption in chronic pain patients. Several studies in the US and around the world showed that opioid use dropped by as much as 50% among chronic pain patients when they were given access to cannabis. (10, 11). Further, other studies with chronic pain patients showed that cannabis use—along with its opioid-sparring effect—enhanced patient executive cognitive performance (12). The observed improved cognitive functioning likely resulted from a 42% reduction in opioid use by these patients (12).
A study that researched the association between the existence of state medical marijuana laws and opioid overdose deaths from 1999 to 2010 found that opioid overdose deaths declined by as much as 25% in states that had medical cannabis laws in effect (14). Other research showed that reductions in opioid overdose deaths tend to improve in states where medical cannabis laws have been in effect the longest (15). For example, in California, where medical cannabis laws have been in effect since 1996, there has been a 33% drop in the number of opioid overdose deaths (14). Similar reductions were also observed in other legacy medical cannabis states such as Oregon, Colorado and the State of Washington (14,15).
Several biotechnology and pharmaceutical companies are attempting to develop cannabis –derived drugs and mimetics that treat pain by binding to certain types of cannabis receptors found throughout the body (16). Removing cannabis’ psychotropic effects and preserving its pain-relieving benefits is the major objective for this new class of drugs (16). Although these drugs are still in early stages of development, using them rather than addictive opioids to manage chronic pain would be an important step in curbing opioid overuse and abuse.
A Path Forward
Physicians play a critical role in prescription drug misuse and abuse prevention. To that point, continuing medical education programs that help raise awareness and educate physicians about the benefits of cannabis for pain management represents and important first step to curb over-prescription of opioids. Further, ongoing political and financial support for recent federal initiatives (17) such as enhancing access to prescription drug monitoring using health information technology, formalized collaborative efforts between insurers, health care providers, and employers to combat opioid misuse and abuse and community-based programs like the national take-back initiative—which provides a safe, secure, environmentally-responsible plan for disposing of prescription opioids and educates the public about the potential for abusing and trafficking prescription medications—will also be critical. Finally, new federal and state legislation that offers counseling and medical solutions to treat opioid abusers rather than punish them will be vital to control America’s epidemic opioid crisis.
- Rudd RA, Seth P, David F, Scholl L. Increases in Drug and opioid-involved overdose deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep. ePub: 16 December 2016. DOI: http://dx.doi.org/10.15585/mmwr.mm6550e1 Accessed October 23, 2017
- CDC. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016. Available at http://wonder.cdc.gov Accessed October 23, 2017.
- Drug overdoes now kill more Americans than guns. CBS News 2016 https://www.cbsnews.com/news/drug-overdose-deaths-heroin-opioid-prescription-painkillers-more-than-guns/ Accessed October 23, 2017
- America’s opioid epidemic is worsening. The Economist (UK) 2017 https://www.economist.com/blogs/graphicdetail/2017/03/daily-chart-3 Accessed October 23, 2017.
- Hughes A, William MR, Lipari RN, Bose J. Prescription drug use and misuse in the United States: results from the 2015 national survey on drug use and health. Substance Abuse and Mental Health Services Administration (SAMHSA) 2016 https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR2-2015/NSDUH-FFR2-2015.htm Accessed October 23, 2017.
- Katz J. Short answers to hard questions about the opioid crisis. The New York Times 20 https://www.nytimes.com/interactive/2017/08/03/upshot/opioid-drug-overdose-epidemic.html Accessed October 23, 2017.
- Jensen B, Chen J, Furnish T, Wallace M. Medical marijuana and chronic pain: a review of basic science and clinical evidence. Curr Pain Headache Rep. 2015; 19:50 doi: 10.1007/s11916-015-0524-x.
- Wilsey B, Marcotte, Deutsch R, Gouaux B, Sakai S, Donaghe H. Low-dose vaporized cannabis significantly improves neuropathic pain. J. Pain. 2013; 14:136-148.
- Andreae MH, Carter GM, Shaparin N, Suslov K, et al. Inhaled cannabis for chronic neuropathic pain: a meta-analysis of individual patient data J. Pain 2015; 16:1221-1232.
- 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; 17:739-744.
- Haroutounian S, Ratz Y, Ginosar Y, Furmanov K, Saifi F, Meidan R, Davidson E. The effect of medicinal cannabis on pain and quality-of-life outcomes in chronic pain: A prospective open-label study. Clin J Pain. 2016; 32:1036-1043
- Gruber SA, Sagar KA, Dahlgren MK, Racine MT, Smith RT, Lukas SE. Splendor in the Grass? A pilot study assessing the impact of medical marijuana on executive function. Front Pharmacol. 2016; 7: 355 eCollection 2016.
- Bradford AC, Bradford WD. Medical marijuana laws reduce prescription medication use in Medicare Part D. Health Aff (Millwood). 2016; 35:1230-1236.
- Bachhuber MA, Saloner B, Cunningham CO, Barry CL. Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010. JAMA. Intern Med. 2014; 174:1668-1673.
- Kim JH, Santaella-Tenorio J, Mauro C, Wrobel J, Cerda M, Keyes KM, Hasin D, Martins SS, Li G. State medical marijuana laws and the prevalence of opioids detected among fatally injured drivers. Am J Public Health. 2016; 106: 2032-2037.
- Mintz CS, Fabrizio AJ, Nison E. Cannabis-Derived Pharmaceuticals. J. Comm. Biotechnol. 2015; 21:16-30.
- SAMHSA’s effort to fight prescription drug misuse and abuse. https://www.samhsa.gov/prescription-drug-misuse-abuse/samhsas-effort Accessed October 23, 2017.