Medical Marijuana as an Opiate Treatment? Pros & Cons of This Eyebrow-Raising Method

Getting out from under the oppressive, debilitating and often quick downward spiral of opiate addiction is never easy. It’s understandable that a great deal of medical research and attention centers on the development and testing of effective, safe treatment to help addicts overcome all forms of addiction, particularly addiction to opiates, which has reached epidemic proportions in recent years.

One such method, albeit quite eyebrow-raising, is the use of medical marijuana as a means of treating opiate addiction.

WHAT IS MEDICAL MARIJUANA?

According to the National Institute on Drug Abuse (NIDA), medical marijuana is a term that refers to using the unprocessed whole marijuana plant or its basic extracts in order to treat a condition or a disease. The Food and Drug Administration (FDA), however, has neither recognized nor approved the marijuana plant as medicine that can be legally (according to federal law) prescribed in the United States.

There are currently only two FDA-approved drugs derived from marijuana chemicals, called cannabinoids, that contain cannabinoids in pill form. These medications are known as dronabinol and nabilone, used for treating nausea and increasing appetite. As scientific research into the medicinal properties of cannabinoids continues, more medications of medical marijuana may be approved.

The main mind-altering ingredient in marijuana is delta-9-tetrahydrocannabinol (THC). Cannabinoids are chemicals related to THC. Another marijuana chemical is cannabidiol (CBD), used in the treatment of epilepsy. Research funded by the National Institutes of Health (NIH) and other entities continue to explore medicinal uses for THC, CBD and other cannabinoids.

To this end, preclinical and clinical trials are currently being conducted using marijuana and marijuana extracts to treat such diseases and conditions as substance abuse, mental disorders, seizures, pain, Alzheimer’s disease, HIV/AIDS, multiple sclerosis, and inflammation.

PROS OF USING MEDICAL MARIJUANA AS AN OPIATE TREATMENT

While people have used marijuana for a number of health conditions and purposes for around 3,000 years, it’s only within the past dozen or so years that medical marijuana research has gained traction, states have legalized medical marijuana, and public opinion has shifted more in favor of the use of marijuana for medical purposes. In fact, however, this perception that medical marijuana has benefits for certain users is separate from the sentiment that marijuana should be legalized for recreational purposes.

Advocates for medical marijuana to be used as an opiate treatment cite several potential benefits:

• Several studies point to the urgent need for development of cannabidiol (CBD) for treatment of opiate disorders as a way to help curb the exploding opiate addiction crisis (painkillers and heroin) in the United States.
• Medical marijuana is considered a safer alternative to prescription opiates, such as OxyContin, Vicodin and Percocet for alleviating chronic pain.
• Medical marijuana use has shown some potential to treat substance use disorders and PTSD.
• The switch from prescription opiates to medical marijuana results in reduced drug side effects and better symptom management. A 2012 pre-clinical study found that cannabidiol interfered with brain reward mechanisms facilitating the acute reinforcing properties of opiates, thus suggesting that cannabidiol “may be clinically useful in attenuating the rewarding effects of opioids.”
• Findings in a preliminary pilot human study support other preclinical evidence and clinical studies that evaluated anxiety. The data suggest that CBD has a potential therapeutic efficacy in reducing negative states in opiate-addicted individuals. This, in turn, may lead to reduced craving and reduced likelihood of relapse.
• Using medical cannabis may help some opiate addicts kick their habits. According to the University of British Columbia research, some medical marijuana users may be taking it as an exit drug from potentially more harmful substances, such as opiate medication.
• Some doctors say that the use of combination drugs – using medical marijuana and opioid pain medications — reduces the overall opiate dose and decreases opiate overdose.

CONS OF USING MEDICAL MARIJUANA AS AN OPIATE TREATMENT

The persuasive arguments of medical marijuana proponents aside, there are legitimate concerns over the use of marijuana as an opiate treatment.

• Marijuana is classified as a Schedule 1 drug, putting it in the same class as heroin. Even though a number of states have legalized marijuana and regulated the substance for both medicinal and recreational purposes, it is still against federal law.
• Marijuana is a major gateway drug, often experimented with during adolescence and leading to recreational use of illicit drugs as well as prescription drugs used for nonmedical purposes.
• A study examining the results of three national surveys on alcohol, tobacco and drug use (two in Canada, one in the United States) found that early use of marijuana affects people’s physical and mental health, causing cognitive impairment, memory loss, higher rates of respiratory diseases and some cancers.
• Medical marijuana use among adolescents in substance abuse treatment is common. One study showed 74 percent of adolescents used someone else’s medical marijuana. Furthermore, adolescents using medical marijuana developed regular marijuana use at an earlier age, had more cannabis use and dependence symptoms, and more symptoms of conduct disorder than adolescents who did not use medical marijuana.
• Using medical marijuana to treat addiction, particularly opiate addiction, may not really address the underlying causes of addiction. Only a comprehensive treatment program to overcome addiction, including psychotherapy and other therapeutic modalities can provide a solid foundation for recovery. Furthermore, a 2017 study from the University of Southern California of participants in treatment for a variety of addictions, including addiction to opiates, found that longer treatment (exceeding the standard 30 days) is more effective for long-term recovery.
• Screening procedures for cannabis use problems may not be able to accurately assess such problems in “medically motivated” marijuana users. Studies suggest a more careful consideration of whether or not cannabis use is medically motivated when screening for problematic marijuana use.
• Some doctors say that cannabis substitution therapy for opiate addiction requires extensive follow-up. While some patients may use medical marijuana as an exit drug from opiates, others may gravitate toward opiates, or do both, without careful monitoring by doctors and treatment facilities.
• Updating drug policies is a desirable and necessary goal. However, without required input from scientific, medical, or policy research communities, policy changes rushed through increase the potential for unintended adverse consequences. These include short- and long-term harmful effects, as well as far-ranging health and social costs.
• Acute cannabis intoxication and recent use of cannabis for therapeutic purposes may cause reversible deficits that can influence short-term memory loss, among other cognitive difficulties. In general, while the adverse effects of marijuana use are not yet well studied, experts maintain that there is enough information that is available that provides solid basis for concern.
• People with compromised immune systems, older individuals, and those suffering from cancer or AIDS, for example, may be more affected by the harmful effects of medical marijuana. At present, there isn’t enough scientific research into this area to know the extent of vulnerability in those populations.

Given the reality of the current opiate epidemic and the need to develop and approve safe and effective treatment for such addiction, the widespread public acceptance of medical marijuana, and legislative efforts to push through bills approving medical marijuana, there’s no doubt that medical marijuana as a treatment for opiate addiction will continue to stir interest and spur research. However, much work still needs to be done before medical marijuana will become an approved treatment for opiate addiction.

Sources:

Associated Press, “Could marijuana help treat painkiller and heroin addiction?” Retrieved March 10, 2017

Journal of the American Academy of Child & Adolescent Psychiatry, “Medical Marijuana Use Among Adolescents in Substance Abuse Treatment.” Retrieved March 9, 2017

International Journal of Drug Policy, “Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients.” Retrieved March 9, 2017

Medscape, “Role for Cannabis in Treatment for Opioid Addiction?” Retrieved March 10, 2017

National Center for Biotechnology Information, U.S. National Library of Medicine, “Early Phase in the Development of Cannabidiol as a Treatment for Addiction: Opioid Relapse Takes Initial Center Stage.” Retrieved March 10, 2017

National Institute on Drug Abuse (NIDA), “Is Marijuana Medicine?” Drug Facts: “What is medical marijuana?” Retrieved March 11, 2017

Partnership for Drug-Free Kids, “Opioid Addiction Being Treated With Medical Marijuana in Massachusetts.” Retrieved March 10, 2017

PsychCentral, “The Unexplored Potential of Cannabis to Treat Opioid Addiction.” Retrieved March 11, 2017

The JAMA Network, JAMA Internal Medicine, “Legalization of Medical Marijuana and Incidence of Opioid Mortality.” Retrieved March 10, 2017