Is cannabis alone powerful enough to solve the opioid crisis?

Published Mar 4, 2023 10:57 a.m. ET
Unsplash / Towfiqu barbhuiya

All human beings experience some kind of pain in life, be it due to age, injury, or a medical condition, but it wasn’t until the 1990s that we began attempting to truly measure its severity. With more than 20% of adults experiencing chronic pain, it’s no surprise that opioid prescriptions have nearly doubled since then, and the United States is the worst in terms of use of these highly addictive substances with 80% of the global supply ending up in the hands of Americans.

In 2017 President Trump recognized the extent of the opioid crisis, calling it a public health emergency and promising to make changes in hopes of reducing the nation's opioid death total, which at that time had surpassed 50,000, and the problem has only gotten worse since then. Last year alone more than 80,000 Americans died from overdoses involving opioids and 90% of those drugs were synthetic, meaning they were prescribed by doctors, physicians, and specialists.

This problem isn’t going away anytime soon, and some experts are suggesting legalization could be a key factor in reducing the ever-climbing death toll.

Would legalizing cannabis reduce the demand for opioids?

The jury is still out on this great debate, though it does seem like a reasonable strategy to adopt according to scientific research. Many reports have revealed a distinct reduction in the abuse of opioids following legalization. However, the extent of these benefits is still unclear.

U.S. states that legalized cannabis did note a reduction in opioid-related visits to emergency departments by as much as 7.6% but the difference seems to wane over a period of six months. So while cannabis may be a reasonable substitute for many prescription painkillers in some situations, making it more accessible is not enough on its own to eliminate users' dependence on highly abused opioids such as hydrocodone, oxycodone, codeine, and fentanyl.

Some clinical trials note reductions in reliance on opioids among medical patients who use cannabis in conjunction with prescription painkillers, but this benefit appears to be inconsistent and difficult to measure, even though the majority of patients claim to prefer cannabis over prescribed opioids.

Current studies on how cannabis may replace or reduce opioid use

Right now there are approximately 15 ongoing trials to see how effective cannabis may be at reducing the need for opioids, many of which are driven by past studies on animals that investigated the pain-relieving power of the endocannabinoid system (ECS). The ECS is stimulated by several cannabinoids and that effect may be enhanced by opioids. Results from tests conducted on rates always seem to suggest that THC could be a useful tool by reducing the dose of opioids required to achieve relief, in some cases by as much as 3.5 times, and key findings point to three pieces of evidence as proof.

1. Several cannabinoids including THC stimulate receptors in the endocannabinoid system, which are located in many of the same regions of the brain and body as opioid receptors.

2. CB1 receptors are able to interact with opioid receptors to improve pain relief potential in rodents.

3. CB2 receptors which may also be stimulated by cannabinoids have the power to trigger the release of naturally produced chemicals within the body that activate opioid receptors.

Patient perspective may make a big difference

Some experts point to the power of the placebo effect as an amplifier of the pain-relieving qualities of cannabis, as those who choose to use it report more significant reductions in discomfort compared to those who may not believe in its potential. This could be why some people have great success with managing pain with cannabis, while others may not experience the same level of relief.

So, can cannabis replace opioids?

We still aren’t sure whether or not prescribing cannabis in conjunction with or instead of opioids is an effective method of pain management, as the sheer number of potential differentials like product choice, cannabinoid content, and terpene profiles make it an incredibly difficult question to answer through limited scientific studies. However, as we learn more, we will eventually have a clearer picture of the possibilities.

Legalizing cannabis reduces demand for painkillers like codeine


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