There are a number of ways to become chemically dependent. Believe it or not, it’s possible to develop an addiction without technically abusing or misusing a substance, such as using a prescribed controlled substance for chronic pain. Even when prescription painkillers are used correctly, it’s still possible for a person to become physiologically dependent, especially when they’re prescribed powerful painkillers for an extended period of time. If you’re a physician, what do you do when you don’t want to put a patient suffering from chronic pain at risk of becoming addicted to painkillers?
This is a very challenging situation and is, in fact, why doctors are becoming increasingly reluctant to prescribe addictive substances, even when they’re warranted. However, according to new research, a solution may exist in the form of medical marijuana laws.
A Possible Correlation Between Medical Marijuana and Opioid Use
Although there are numerous substances being abused today, opioid drugs — heroin and prescription painkillers, specifically — are arguably the most damaging. Ever since OxyContin became popular among recreational drug users in the mid-1990s, millions of Americans have become imprisoned by the addictive power of opioid drugs. Meanwhile, the number of annual deaths resulting from opioid use has quadrupled nationwide.1
Researchers at Columbia University’s Mailman School of Public Health designed a study to identify whether rates of opioid use are lower in states where medical marijuana is available.2 The study authors collected data on traffic accidents in which there were fatalities from 18 states over a period of 14 years with most of the victims being between 
the ages of 21 and 40. As well, those 18 states were categorized into one of two groups, states with and states without medical marijuana laws (MMLs). Upon comparing the frequency in which victims of traffic accidents tested positive for opioids between the two groups, a relationship came into focus.
Per the study findings, a person in a state with MMLs is about half as likely to test positive for opioids than someone in a state without MMLs. According to the researchers, this strongly suggests that opioid use among individuals aged 21 to 40 — which encompasses the majority of opioid users — decreases when states pass laws that allow for the use of marijuana for medicinal purposes.
A study published recently in Health Affairs came to this same conclusion by looking at the amount of opioid prescriptions in states that offer marijuana as an alternative medicinal treatment versus states that don’t.3 According to researchers attached to the study, it seems that when medical marijuana is a treatment option, both physicians and patients approach marijuana as if it is a pharmaceutical medication. In fact, many patients who are prescribed marijuana alongside opioids — because the marijuana enhances the efficacy of pain medications — will wean themselves off opioids and continue using only the marijuana.4
What Does This Mean?
There are a couple important takeaways from the results of the studies mentioned above. First, there’s the idea of substitution. Many of today’s long-term heroin addicts started out addicted to prescription painkillers, only switching to heroin when the pharmaceuticals became harder to buy on the streets. The term for this is called substitution, which is when someone addicted to one substance starts to use another substance in its place.5 If there are less people using opioid drugs in states where they have more ready access to marijuana, it’s reasonable to conclude that at least some of them are choosing to use marijuana in lieu of heroin or other opioids.
Things to Consider
In other words, people addicted to heroin can possibly be satisfied or mostly satisfied by marijuana, which is known to be less addictive and less dangerous than opioids. Therefore, the question becomes whether marijuana could potentially be used to complement opioid addiction treatment in a similar manner as methadone or Suboxone.
The use of marijuana as a medicinal treatment is most often associated with cancer, but some researchers have long held that marijuana has value for more uses than it’s presently credited. On the other hand, there are some who don’t just see potential value, but want to actually use marijuana as a form of opioid addiction treatment.
Dr. Donald Abrams, chief of the Hematology-Oncology Division at Zuckerberg San Francisco General Hospital, has been studying the efficacy of marijuana as a pain management treatment for over a decade. In an interview for Time Magazine, Abrams said, “If we could use cannabis, which is less addictive and harmful than opioids, to increase the effectiveness of pain treatment, I think it can make a difference during this epidemic of opioid abuse.”
“If we could use cannabis, which is less addictive and harmful than opioids, to increase the effectiveness of pain treatment, I think it can make a difference during this epidemic of opioid abuse.” -Dr. Donald Abrams
Maine recently became the first state to consider adding opioid addiction treatment to the list of medical conditions that can be treated by medical marijuana.6 The petition was denied,7 but it started a conversation that continues in the state and throughout the country. As it stands, the idea that marijuana could play a key role in addressing the current opioid epidemic is intriguing, but requires more research. The illegal status of the drug has made many professionals and citizens alike reluctant to accept that it may have value as an opioid treatment.
However, while the number of deaths caused by opioid use continues to climb across the U.S., even the Drug Enforcement Administration confirms8 that there is no known instance of marijuana overdose.
Sources
1. http://time.com/4419003/can-medical-marijuana-help-end-the-opioid-epidemic/
2. http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303426?journalCode=ajph
3. http://content.healthaffairs.org/content/35/7/1230
4. http://time.com/4404697/marijuana-opioid-epidemic/
5. https://www.ncbi.nlm.nih.gov/pubmed/18724656
6. http://www.pressherald.com/2016/04/19/advocates-ask-state-regulators-to-consider-medical-marijuana-as-treatment-for-opiate-addiction/
7. http://www.pressherald.com/2016/07/12/state-says-medical-marijuana-cant-be-used-to-treat-drug-addiction/
8. https://www.dea.gov/druginfo/drug_data_sheets/Marijuana.pdf
Written by Dane O’Leary