Opioids, Overdoses, and Cannabis: Is Marijuana An Effective Therapeutic Response to the Opioid Abuse Epidemic?

Abstract

Over the last decade, America has witnessed an increase in drug overdoses deaths in numbers partaking of Biblical proportions. As one physician put it, “The proliferation of opioid use in the United States is called an epidemic, but it more resembles metastatic cancer.”

Some have argued that the crude form of smokable marijuana can provide an escape hatch from today’s opioid overdose epidemic by serving as a substitute for opioids, or as an opioid-sparing adjunctive medication. That argument is mistaken. The FDA will never approve that delivery system as a medical device, nor will it approve the marijuana plant as a drug. One or more individual cannabinoids, however, might someday prove valuable in the alleviation of pain. In fact, the FDA has already demonstrated its willingness to approve cannabinoids for therapeutic uses, by approving cannabidiol for the treatment of rare, childhood forms of epilepsy and THC for chemotherapy-induced nausea and wasting. Studies conducted to date do not establish that cannabinoids can usefully resolve the affliction suffered by those with chronic pain in a manner that avoids harmful side effects. Until we reach the point at which science can confidently say that cannabinoids are a proper analgesic substitute for opioids, physicians will need to rely on an array of analgesics (opioid and non-opioid) and other types of alternatives to medications for pain relief. Pain patients are also being encouraged to assume that perfection in pain relief is not always possible and coping with certain forms of pain are feasible.

Additional research might help us reach the point where a range of alternative non-opioid, or biased opioid agonists or cannabinoids, other targeted non-addictive substances, or alternatives to medications can alleviate suffering. Congress should eliminate any unreasonable roadblocks that keep science from reaching that goal and should even go further by actively encouraging research to learn of new possible targets. Some bills pending in Congress would do that and therefore deserve serious consideration on an urgent basis. If isolated cannabinoids can help control the opioid overdose epidemic, we should be in a hurry to learn about it.

But we are not there yet. Accordingly, we cannot justify basing today’s public policy decisions regarding the proper classification of the marijuana plant as a controlled substance on its usefulness as an analgesic substitute for opioids.

Keywords: Marijuana, Cannabinoids, Opioids, Opioid Overdoses