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Can Marijuana Help Addicts Kick Opioids?

Jeffrey A. Singer

Late last month Donald Trump’s administration declared the
rising death rate from opioid overdoses a national public health
emergency. Thirty-three thousand lives were lost to this scourge in
2015, and early reports from the Centers for Disease Control and
Prevention paint an even bleaker picture for 2016.

Policymakers working for the president are doubling down on a
policy aimed at restricting opioids. But this policy isn’t
working. In fact, it might even be contributing to abusers’
switch to more potent drugs such as heroin in
recent years.Yet there is an approach that can truly curb the
rising rate of overdose deaths that is staring them right in the
face: legalizing marijuana.

According to research published earlier this month in the
American Journal of Public Health, Colorado’s
legalization of recreational marijuana in 2014 coincided with a 6.5
percent reduction in opioid overdose deaths. The researchers
studied the opioid overdose rate in the state from 2000 to 2015,
and found that after 14 years of a steady rise in opioid overdose
deaths, the rate decreased by an average of 0.7 deaths per

Research shows this once
maligned ‘gateway’ drug could be an off-ramp.

This is not the first study to find that marijuana is associated
with a drop in the use and abuse of opioids and other dangerous
drugs. A 2014 study examined states where marijuana was
available for medical use between 1999 and 2010 and found, on
average, a 25 percent reduction in annual opioid overdose mortality
compared to states in which marijuana was illegal. Researchers at
the RAND Corporation found similar results in 2015. And in June of
this year, a study of chronic pain patients by the University of
California at Berkeley found that 97 percent of patients decreased
opioid consumption as a result of using medical marijuana, and 81
percent found marijuana alone was more effective than using both
marijuana and opioids.

Clearly some patients require fewer opioids to treat their pain
when they have access to marijuana. But Colorado’s
encouraging data reflects the impact of recreational marijuana
access—not medicinal. These new findings suggest the
possibility that people seeking to get “high” on
mind-altering drugs, when given the opportunity, tend to choose the
safer option—when it’s legal and available from sources
other than black market drug dealers. There might even be a
pharmacological basis to these findings. Research published in 2013 in the journal
Addiction Biology suggests cannabis “interferes with
brain reward mechanisms responsible for the expression of the acute
rewarding properties of opioids…”

And a 2017 article by researchers at Mt. Sinai School of
Medicine points to animal models that suggest cannabidiol, found in
cannabis, might reduce withdrawal symptoms as well as
opioid-seeking behavior. This is an area that needs further
investigation, but one thing is clear: marijuana availability is
associated with a decrease in opioid use, abuse, and overdose.

Opponents of marijuana legalization have claimed for years that
marijuana is a dangerous “gateway drug” that leads users to more
treacherous and addictive drugs, like heroin. These claims are
premised on the fact that most users of heroin, cocaine, and other
dangerous drugs also report that they use marijuana. But they also
report the use of tobacco and alcohol. Critics of the gateway
theory are quick to point out that correlation is not the same as
causation. Now there’s evidence of a negative
correlation between marijuana and harder drugs. More marijuana
correlates with less opioids.

Even proponents of opioid restriction agree that
Medication-Assisted Treatment is a useful tool for dealing with
opioid addiction. This employs medications such as methadone,
suboxone, and naltrexone to wean addicts away from opioids.
Marijuana’s potential for medicinal use has been recognized
by healthcare professionals—and realized by
patients—for many years. Now, it offers the potential for
averting and treating opioid abuse.

Rather than a gateway, marijuana may be an off-ramp to opioid
abuse. Opponents of marijuana legalization should keep that in mind
before they try to close this ramp off.

Jeffrey A.
practices general surgery in Phoenix, is a visiting
fellow at the Goldwater Institute, and a Senior Fellow at the Cato