Reducing Opioid Dependence With Cannabis: Here’s What 4 Recent Studies Say
In 2014, a study published in JAMA Internal Medicine detailed the relationship between the rise of medical cannabis and reduced opioid-related overdose deaths. The researchers behind this study determined local medical cannabis legislation led to a 25 percent reduction in overdose deaths, on average.
Around this same time, the opioid crisis was picking up pace. As North America grappled with the epidemic, this study made national headlines. This has left many people asking: could cannabis really solve the opioid overdose epidemic?
In the eight years since its publication, there has been a flurry of academic activity on the subject of cannabis and opioids. Especially over the last year, many studies have attempted to clarify the initial findings. Is there a positive correlation between access to medical cannabis and decreased opioid dependence, overdose, and related deaths? We looked at recent studies to find out.
Medical Cannabis Reduces Opioid Prescriptions for Chronic Pain
Cannabis has unique pain-relieving qualities, well established in the scientific literature. Many studies in the last decade have confirmed that cannabis targets chronic pain just as effectively as opioids.
As per another survey on the subject, from 2017, patients “overwhelmingly” reported cannabis worked just as well, but without the frustrating side effects common with other medications.
Published in Cureus in 2020, researchers from the Society of Cannabis Clinicians reported exciting results from an online convenience sample survey of medical cannabis patients.
Working with 525 people who reported relying on both opioids and medical cannabis to treat chronic pain, the authors set out to determine if cannabis could affect opioid use patterns.
Surprisingly, the vast majority of respondents told researchers that medical cannabis had an immediate impact on their prescription opioid consumption. More than 40 percent of the survey participants ceased all opioid use, while another 45 percent said they experienced a decrease in use.
The survey found that nearly half of all participants experienced a reduction in pain, by a measurement of between 40 to 100 percent.
A Correlation Between Local Dispensaries and a Reduced Opioid Mortality Rate
After the initial results from 2014 on cannabis’s link to reduced opioid overdose deaths, several additional studies have attempted to drill down into this relationship. Does access to medical cannabis really impact opioid-related health crises, especially now that we have more data from more cannabis-friendly markets?
In 2020, authors Greta Hsu and Balázs Kovács compared U.S. mortality data with the number of recreational or medicinal storefronts in over 800 counties in the U.S. They used a panel regression model and looked at all types of opioid-related deaths, including prescription opioids, heroin, and synthetic opioids (but not methadone).
Hsu and Kovacs discovered that a minimal increase from one to two dispensaries at the county level resulted in a 17 percent reduction in all opioid-related deaths, with up to a 21 percent reduction within the synthetic opioid category (which included fentanyl).
While the authors admitted it was too soon to conclude this association as causal, they stated, “higher medical and recreational storefront dispensary counts are associated with reduced opioid related death rates, particularly deaths associated with synthetic opioids such as fentanyl.”
Cannabis as a Tool for Treating Opioid Withdrawal
Beyond the potential of medical cannabis to treat chronic pain, some researchers are exploring whether the plant could also help with opioid addiction. In 2020, a Journal of Substance Abuse Treatment study worked with 200 patients who experienced opioid withdrawal symptoms to find out.
This survey asked participants about the severity of withdrawal symptoms and whether cannabis helped or hindered the experience. A majority of people— 62.5 percent—indicated that they used cannabis specifically to reduce the severity of their withdrawal, although not for all symptoms.
When it came to anxiety, tremors, and trouble sleeping, cannabis seemed to positively impact these symptoms. But, on the flip side, the yawning, teary eyes, and runny nose associated with withdrawal were made worse by cannabis use. Interestingly, women found cannabis to be more helpful than men did — a finding that will need much more attention in the future.
The authors noted that they found “clinically meaningful” indications that cannabis may help patients going through opioid withdrawal. More research is needed to determine exactly which situations would lead to the best results.
Cannabis May Not Benefit Veterans with PTSD and Non-Medical Opioid Use
As many of these recent studies have made clear, there is a pattern among patients using both medical cannabis and opioids as conjunctive therapies. This is especially true for chronic pain conditions, but it’s also common for veterans with post-traumatic stress disorder (PTSD).
A 2020 study published in The American Journal of Drug and Alcohol Abuse was a response to the growing number of places in the U.S. that had approved PTSD as a qualifying condition for a medical cannabis license. There is a precedent for cannabis for PTSD, but does this play out for veterans who also have a substance misuse condition?
The study looked at more than 1,400 veterans admitted to specialized intensive PTSD treatment. More than 30 percent reported both non-prescription opioid use as well as cannabis use.
Unlike the other studies highlighted above, which tended to demonstrate positive findings of cannabis use, this study discovered more troubling findings.
The researchers found that veterans who used cannabis tended to use opioids less frequently. Yet, these same veterans also reported more PTSD symptoms, and they ended up using other substances more regularly. Even during a four-month follow-up, the authors found that substance use and PTSD symptoms did not measurably change.
This study falls in line with other recent explorations of cannabis as a treatment of PTSD, all of which have confusing results when examined collectively. A 2019 systemic review determined, “cannabis and synthetic cannabinoids, both acting on the endocannabinoids system, may have a potential therapeutic use for improving PTSD symptoms,” including anxiety, sleep, and memory. But a 2021 clinical trial found no significant change in symptom severity in the first phase.
When it comes to cannabis, opioids, and PTSD, it’s clear that more research is required.
Cannabis as a Replacement for Opioids? An Uncertain Future
With these latest developments from 2020, there seems to be a growing consensus that access to cannabis does help reduce the problems associated with opioid use and misuse. However, the specifics are still under investigation — especially when it comes to conditions like PTSD.
Even if the results are not quite as cohesive as we might like, at the very least these new studies help guide the conversation about how and when cannabis is an applicable conjunctive or alternative to opioid use.