Marijuana – The Safe Solution to the Opioid Epidemic
On January 4, 2018, the U.S. Attorney General, Jeff Sessions, rescinded federal guidelines previously implemented under the Obama Administration. Prior to this, Marijuana was still considered an illegal drug under federal law, but guidelines limited federal prosecution in states where legislatures had legally allowed the sale and use of Marijuana.1 Advising Sessions on how to manage Marijuana is Dr. Robert DuPont, who popularized the term “Gateway Drug” in reference to Marijuana in the 1980’s, and is now recommending that all individuals be tested for any and all drug substances during a primary care visit to a physician.2 Unfortunately, neither Dr. DuPont nor Attorney General Sessions have taken into account two major factors affecting the health and livelihood of Americans, not basing their decisions on scientific findings:
- Marijuana has been found to be no more a gateway drug than alcohol or tobacco, and environmental factors play a far greater role in those who eventually abuse other drugs than does Marijuana3
- Marijuana has been shown in published clinical studies to reduce both the problems with Opioid addiction as well as the mortality rate from Opioid overdoses4
Opioids are substances that affect the Opioid receptors, the body’s response mechanism that allows for the alleviation of pain, and are legally prescribed to alleviate moderate to severe pain.5 The four major categories of Opioids consist of:6
- Natural and Semi-Synthetic Opioids (e.g. Oxycodone, Hydrocodone, Morphine, Codeine)
- Synthetic Opioids (e.g. Fentanyl, Tramadol)
- Methadone
- Heroin
According to the Centers for Disease Control, the leading cause of death due to injury in the United States is drug overdose, with over 63,000 deaths in 2016.7 Unfortunately, 41% of these overdose deaths are due to Opioids, with a majority of these deaths originating from legitimate prescriptions by a single medical provider.8,9 Considering that 259 million prescriptions of Opioids were dispensed by doctors in 2012, it is surprising that that the overdose rate isn’t even higher.10 Regardless, the growth of Opioid prescribing has not only quadrupled the death rate due to overdoses, it has also increased the treatment admission rate for substance abuse 600%.11
State Findings
As stated previously, under the Obama Administration, prosecution of Marijuana use and selling at the federal level was effectively eliminated, allowing the states to dictate through their own legislation on how to proceed with legalization and enforcement. As a result, 29 states have now legalized Marijuana with select guidelines, with 8 of these states approving Marijuana for recreational use.12 A study published in the Journal of the American Medical Association (JAMA) developed an analysis to review 13 states that had legalized Marijuana prior to 2010, and compared Opioid overdose mortality rates with the remaining 37 states who had not legalized Marijuana usage through the same period. From the initial year that Marijuana was legalized within each state through year 6, the below figures show how much lower Opioid mortality rate is in those states compared to those states without legalized Marijuana. Notice that the greater the time of Marijuana legalization, the trend towards lower Opioid overdose mortality rates:
% Lower Rate of Opioid Overdose in States where Marijuana is Legalized
Year 1: 19.9% lower rate
Year 2: 25.2% lower rate
Year 3: 23.6% lower rate
Year 4: 20.2% lower rate
Year 5: 33.7% lower rate
Year 6: 33.3% lower rate
Because of the differences in Marijuana laws from state to state, as well as the requirement of rigorous, active participation within scientifically controlled groups of patients with similar pain management issues, these findings alone are speculative, at best. However, the strength and consistency of the apparent relationship between usage of Marijuana and lowered Opioid overdose rates at the population level does further warrant the active study of how and why such mortality rates are lowered and is being investigated.13
Analgesic Benefits of Marijuana over Opioids
Chronic pain is considered more severe for the livelihood to most individuals than comparable chronic conditions such as heart disease, lung disease, or kidney disease. As people live longer, more chronic conditions manifest, including pain issues. As a result, physicians have increased Opioid prescribing.14 Individuals with chronic pain are twice as likely to commit suicide compared to those individuals who are not in chronic pain, hence the hesitation of a medical professional to not prescribe an Opioid for someone living with such aa chronic pain condition.15 However, Marijuana has been found to clinically reduce pain for:
- Fibromyalgia and Rheumatoid Arthritis16
- Neuropathic pain associated with HIV+ patients (which has been difficult to treat with Opioids)17
- Anti-Inflammatory issues18
Patients who have used Marijuana after initially being prescribed various medications for pain have shown a great reduction in usage of these previously prescribed medications, especially among the Opioid class:19
Drug Class-Pain % Patients on Drug Prior to Marijuana % Patients on Drug using Marijuana
Opioids 65% 18%
Anti-Depressants 39% 14%
NSAIDs 62% 21%
SSRIs 34% 8%
The volume of these prescribed drugs, with the subsequent use of Marijuana as an addition or alternative for other prescribed pain medications, would greatly reduce the direct and indirect costs associated with chronic pain, estimated at $635 billion annually.20
Patient Preferences
Recent clinical findings have been published supporting the patient preference of Marijuana over Opioid prescription, where the opportunity is legally allowed. A survey from nearly 3,000 prescription Marijuana patients who had been prescribed an Opioid for pain reduction for at least 6 months prior found:21
Question to Patient using Pain Medication using Marijuana % of Patients Who Agree
Able to decrease Opioid Dose 97%
Experienced Side Effects from Opioids Alone 88%
Marijuana Side Effects More Tolerable than Opioids 92%
Marijuana more effective than Opioids for pain 80%
Marijuana just as effective as Opioids for pain 71%
Prefer Marijuana to Opioids 93%
Would use more Cannabis as a substitute if available 93%
Similar studies have shown that individuals who substitute Marijuana for prescription drugs do so for the following reasons:22
Less adverse side effects: 65%
Better symptom management: 57%
Less withdrawal potential 34%
The Future of Marijuana for Pain Management
Politics has played a major role in the legalization of Marijuana, as well as the hesitation of Congress and the Federal government, as it is still classified at a Schedule 1 drug, with “no accepted medical use and high potential for abuse,” in the same category as LSD, Heroin, and Peyote.23 People have realized the benefits of Marijuana in reducing pain, as well as the virtually non-existent danger in using it; there has never been an overdose or death of Marijuana recorded.24 This is evident of how the media has addressed Marijuana usage of the last half-century, it’s softening position reflecting the changing views of public of its general acceptance:
1967: TV’s “Dragnet,” with main star, police Sergeant Joe Friday (played by Jack Webb), discussing the dangers of Marijuana: ““Marijuana is the flame, heroin is the fuse, LSD is the bomb.”25
1992: Bill Clinton, as a candidate for President of the United States, asked if he ever smoked Marijuana: “When I was in England,” he said, “I experimented with marijuana a time or two, and didn’t like it. I didn’t inhale, and I didn’t try it again.”26
2008: Barack Obama, as a candidate for the President of the United States, asked if he ever inhaled Marijuana: “The point was to inhale. That was the point.”27
Notably, both presidential candidates were subsequently elected for 2 terms; using Marijuana was not a make or break deal in getting elected in the last quarter century. When one considers that:
- 54 million individuals in the U.S. suffer from Rheumatoid Arthritis, a chief chronic condition that Opioids are prescribed for28
- Most individuals in the U.S. are prescribed Opioids for pain are over 4029
- Individuals over 40 make up 40% of the entire population, and 54% of the voting population30
While Attorney General Sessions edict may elicit an initial fear of setting back the health and wellness that Marijuana offers, this mandate may backfire, as 61% of Americans support legalization of Marijuana.31 Both Democrat and Republican members of Congress, concerned about being re-elected and not upsetting their constituents with such an obviously simple and safe solution for the Opioid epidemic, will be forced to address this before the next election.32
-David Bond
3 “Is Marijuana a Gateway Drug?” National Institute of Drug Abuse, December 2017.
4 Armentano P, “Can marijuana help mitigate America’s opioid crisis? The Hill, June 16, 2017.
5 “Opioids,” Psychology Today, December 7, 2017.
6 “Opioid Overdose Deaths by Type of Opioid,” Kaiser Family Foundation, 2015.
9 “Legalizing Marijuana Decreases Fatal Opiate Overdoses, Study Shows,” Drugabuse.com.
12 “State Marijuana Laws in 2017 Map,” Governing the States and Localities, September 14, 2017.
14 Lynch M, “The need for a Canadian pain strategy,” Pain Research and Management, 2011;16:77–80
23 “Drug Schedules,” Drug Enforcement Agency, 2018.
24 “Annual Causes of Death in the United States – 2015,” Drug War Facts.
26 “Clinton Tried Marijuana as a Student, He Says,” The New York Times, March 30, 1992.
28 “Chronic Disease Prevention and Health Promotion,” Centers for Disease Control, June 28, 2017.
29 “Prescribing Data – Opioid Overdose,” Centers for Disease Control, August 30, 2017.
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