Legal weed: An accidental solution to the opioid crisis?

published on August 21, 2017 by Stephanie Lake and M-J Milloy in Macleans

Legalized marijuana offers chance to investigate substitution effects for people who use opioids

It’s hard to go a day in Canada without hearing about at least one of two types of drugs – but for vastly different reasons. One class of drug — opioids — kills four people a day in British Columbia. The other — cannabis — will be legal for adult purchase and consumption by this time next year.

The opioid overdose epidemic is Canada’s gravest public health crisis since the emergence of HIV in the 1980s. With its roots in the over-prescription of high-potency painkillers, sparked by the contamination of the illicit drug supply with fentanyl and related drugs, the crisis has reached across demographic divides. Experts agree on the need for creative responses based in scientific evidence.

Could cannabis legalization be a part of this solution? Increasingly, this is what the latest scientific research indicates.

Fatal overdoses

The opioid crisis is a product of the medical system’s over-reliance on opioids for pain relief. Almost one in five Canadians live with some form of chronic pain. Twenty years ago, pharmaceutical companies began to develop slow-release formulations of opioids (e.g. OxyContin) and marketed them as safe and effective medications for the treatment of chronic non-cancer pain.

We know now that these drugs carry an extremely high risk of dependence and fatal overdose. Despite this, more than 20 million opioid prescriptions are filled each year in Canada. Drug overdoses are now the leading cause of death among Americans under the age of 50. And prescription opioids are involved in nearly half of these deaths. It is also becoming apparent that opioids might be less effective than initially thought in treating certain types of chronic non-cancer pain (e.g. neuropathic pain).

Cannabis, derived from the Cannabis sativa plant, contains several compounds. These include tetrahydrocannabinol (THC, the primary psychoactive component of cannabis) and cannabidiol (CBD). Beyond the well-known psychoactive effects of cannabinoids, new research has shown that they also interact with systems in the body involved in the regulation of pain.

This discovery has led researchers to investigate the potential for cannabis to treat various pain conditions for which opioids are currently first- or second-line therapies. High-quality clinical research involving cannabis has been stunted by its prohibited legal status. But a recent review of clinical studies involving cannabis-based medicines (including smoked or vapourized cannabis) found strong evidence for relief of chronic non-cancer pain.

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