Cannabis, the anti-opioid prescription
Philadelphia is plagued by opioid abuse, addiction, and senseless opioid-related deaths. According to the Centers for Disease Control and Prevention, Philadelphia is home to the nation’s second-highest rate of drug overdose deaths: 46 per 100,000 residents. In its most recent report on the subject, the Philadelphia Medical Examiner’s Office found that in 2016, 907 deaths resulted from drug overdoses in the city. Opioids were involved in more than 80 percent of them. Deaths involving heroin, fentanyl and other pharmaceutical opioids — even deaths resulting from benzodiazepine overdose, like Xanax and Valium — are on the rise and have been since 2003. Overdose deaths due to fentanyl spiked from less than 50 per year to more than 400 in Philadelphia between 2013 and 2016.
The opioid overdose epidemic is indiscriminate. Coast to coast, across race, gender and socioeconomic status, the entire country is suffering.
And a doctor’s prescription pad is a major contributor to the problem.
There is a direct relationship between prescription opioid use and the prevalence of opioid use disorder (or addiction), a pernicious disease (and yes, addiction is a biological disease) that commonly begins with a legitimate prescription for a painful injury or illness. Simply by following the directions on the prescribed bottle, patients can become physically dependent on the drug, even after their ailment has been resolved. When the prescriptions run out, the consequence of physical dependence is impossible to ignore as the misery of withdrawal (severe nausea, vomiting, stomach cramps, and depression) settles in. Individuals commonly turn to illicit opioids to alleviate these symptoms because they are less costly and easier to obtain than prescription pharmaceuticals.
Prescription opioid sales in the US have almost quadrupled between 1999 and 2014. In 2016, the CDC encouraged doctors across the country to prescribe “nonopioid pharmacologic therapies” for most cases of chronic pain. Despite that, prescription rates remain high. As a result, abuse and overdoses remain increasingly common.
What doctors should be able to prescribe, instead, is cannabis. This relatively benign plant may hold the key to overcoming and even preventing opioid use disorder for countless people. Despite years of stigmatization and false claims that it functions as a gateway to other drug use, cannabis is, in truth, the exit drug from opioid addiction, abuse and related deaths.
Two recent studies published by the American Medical Association’s peer-reviewed journal found that opioid use is lower in states where doctors are allowed to recommend medical cannabis. Other studies have shown that these same states have seen a 25 percent reduction in opioid overdose deaths, and 23 percent fewer non-fatal opioid hospitalizations.
Combating the opioid epidemic requires that we reevaluate our stance as a nation on cannabis. The plant has served as a potent analgesic for millenia. Ancient Chinese, Egyptians, Greeks and Romans used cannabis to combat pain, and so too did Americans throughout the 1800s. Cannabis is far less addictive than opioids and has fewer and more tolerable side effects. It is virtually impossible to overdose on, and is safer to administer over the long term.
Much of this wisdom has made its way into Pennsylvania’s Medical Marijuana Advisory Board, which recently recommended cannabis as a replacement therapy for patients struggling with opioid addiction. The Board also recommended allowing patients access to dry leaf or plant forms of cannabis for administration by vaporization. It’s now up to Pennsylvania's Secretary of Health to accept or reject the recommendations.
The Secretary should accept both, and soon. Currently, cannabis flower and other smokable products are prohibited, but the whole-plant form of medical cannabis provides immediate symptom relief, and is substantially less expensive than processed products like oils. For patients suffering through opioid addiction and withdrawal, there is no time to wait. This is the right prescription for a healthier Pennsylvania.
Adie Wilson-Poe, Ph.D. is on the faculty of the Washington University School of Medicine in Saint Louis, MO; and the scientific advisor to Weedmaps, where she helps lead The Exit Drug campaign.
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