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Opioids and Weed

Medically reviewed by Alexander Tabibi, MD

March 10, 2021

Table of Contents

Why Opioids and Weed?
In Summary

However today with over 130 people a day dying from overdoses related to opiates things are changing. When discussing opioids and cannabis in the same sentence it is often in the context of how medical and recreational marijuana may be contributing to factors that may improve the disaster we are seeing across the US in opioid overdoses and deaths. (Made worse by the addition of fentanyl which is potent and cheap – and very dangerous).

Why Opioids and Weed?

Causes of the opioid epidemic

First we must look to a degree at what has fueled the opioid crisis in the United States and other parts of the world. While some can rightly blame geopolitical issues such as the wars in Afghanistan that started an increase in heroin production – there were homegrown issues that lead to a huge swelling of demand for opiates.

The poster child of the abusive practices of the pharmaceutical businesses which started peddling newer opioids has been Purdue Pharma who made tens of billions of dollars selling in Oxycontin with a falsehood narrative built around it that the risk of addiction was very low. They did this knowing full well that this was not true. In fact they knew that even a relatively short period of usage of opioids actually lead to a rate of addiction that when multiplied by the tens and tens of millions of people using it – meant that millions would be hooked.

Purdue went all in convincing physicians in huge numbers. In fact between just 1996 to 2001, Purdue held over 40 national pain-management and speaker-training conferences which were all-expenses-paid for over 5000 pharmacists and physician at high-end resorts in Florida, Arizona, and California. Additionally Purdue “aggressively” promoted the use of opioids, which had previously targeted cancer physicians and patients – for use in the “non-malignant pain market” – as in non-cancer patients who may be having a procedure or be suffering from an accident or injury.

Nothing better demonstrates the success Purdue had with its deceptive practices, including giving gifts to physicians as well as significant and ethically dubious incentives for writing more prescriptions. From 1996 with $44 million in sales of Oxycontin, these practices to a combined sales of almost $3 billion in 2001 and 2002.

As people started to receive these opioids – especially extended release versions, more and more people became addicted to opioids which they could get from their doctors (who were often incentivized to write scripts – and who were lead to believe there was little risk of addiction), or illegally creating a huge black market for opioid prescriptions.

The prescription market also provided access to drugs which allowed people thus increasing the illicit use of prescription opioid drugs thereby also creating another source of future addicts. The science backs this with two studies in particular, with one showing that 86% of young heroin users had started with the recreational use of prescribed opioid pain relievers prior to using heroin. Another study showed that 75 percent of opioid addicts began by abusing prescription drugs.

Why weed?

Cannabis has been used for thousands of years for the relief of pain and prior to its prohibition was in the American Pharmacopoeia of medicines. Today cannabis and cannabinoids (e.g CBD, CBN, CBG, Delta 8) are becoming increasingly available as legalization spreads across the US states and the world. Hemp derived products containing less than 0.3% THC were made federally legal in the 2018 Farm Bill.

In addition to its potential in anxiety, sleep and PTSD, perhaps one of the sought after effects of marijuana is the ability to reduce the perception of pain. For example in those with headaches or migraines cannabis was show to reduce pain by about 50% at specific dosages. Additionally cannabis is used in treating the symptoms of cancer.

It is believed that many of those who are abusing opiates are doing so for pain relief and that cannabis may – by relieving the pain reduce the dependency on the opiates. Opiates work on the body by interacting with opioid receptors which modulate pain perception and though less well studied the ECS (endocannabinoid system) works with cannabinoids that effect the CB1 and CB2 receptors. It is believed that the modulation of pain by cannabis and cannabinoids occurs both by direct affects on the ECS and indirectly by the interactions of the ECS with the opioid related perception of pain.

Evidence that cannabis reduces opioid abuse and overdoses

There is an ever growing body of evidence supporting the concept that increasing access to cannabis can reduce overdoses. The states that legalize the use of cannabis serve as an experiment against those states where cannabis remains illegal. One can also look at the change in patterns of opioid use, abuse and overdose in places where legalization has occurred.

States that legalized marijuana

Montana – 1.7% less people tested positive for opioids when legalization occurred with evidence for the decline pointing at the substitution of marijuana in patients experiencing pain rather than prescribed opioid pain relievers.

JAMA – the Journal of the American Medical Association found that opioid overdose deaths declined by 25% in states where medical marijuana had been legalized. They concluded that ‘Medical cannabis laws are associated with significantly lower state-level opioid overdose mortality rates. Further investigation is required to determine how medical cannabis laws may interact with policies aimed at preventing opioid analgesic overdose.’

A study in the BMJ published in January 2021 showed an interesting connection showing a lower level of opioid-related deaths and the presence of dispensaries. The correlation showed that U.S. counties with more marijuana dispensaries also have lower death rates with a 17% lower death rate in those counties where the number of dispensaries increased from one to two.

Scientific evidence

According to the Journal of Pain and Symptom Management “Cannabinoids block pain responses in virtually every laboratory pain model tested. In models of acute or physiological pain, cannabinoids are highly effective against thermal, mechanical, and chemical pain, and are comparable to opioids in potency and efficacy.”

Additionally cannabinoids have both anti-inflammatory effects (including never inflammation) and also lessen neuropathic pain and it is believed that the ECS may interact with the same brainstem circuitry involved in opioid analgesia and that THC can enhance the analgesic effects of opioids but can also reduce pain without the opioids present. This can lead to those using cannabis together with opioids potentially requiring less opioids.

In Summary

The opioid epidemic in the US has been in large part driven by the huge increase in the availability and prescriptions for drugs like Oxycontin and the death rate was further fueled by additives such as fentanyl. In addition to having stricter controls on access to opioid prescriptions and treat those who are addicted to heroin and other opioids – cannabis may serve as a potent force reducing the need for opioids in those abusing the drugs, or in those experiencing pain.

There is good data supporting both the scientific viability of cannabis in providing pain relief and reducing the opioid requirements of the individual as well as epidemiological data supporting the fact that increased access to legal cannabis reduces opioid usage, overdoses and deaths.