Overdosing America: If Opioids Are The Problem, Is Cannabis The Cure?

Lance Pilgrim was a typical American kid. Hailing from small-town Texas, after high school and attending some college, he enlisted in the Army. Initially, Lance loved military life, reports The Statesman. Writing home to his mom: “It was so serene last night, mamma, I don’t think I can even put it into words.” But, things would soon change. 

March 2003: The U.S. invades Iraq. Part of the 3rd Infantry, Lance was one of the first soldiers deployed. Combat took its toll on Lance. After returning just four months later, his mom, Judy recounts: “He had a different look in his eyes — a really deep sadness.” 

A few months later, Lance suffered a minor injury. A broken finger. Thanks to an aggressive (and misleading) marketing strategy aimed at rebranding prescription opioids as relatively harmless (and effective for short and long-term use), the VA (and most American doctors) were handing out prescription narcotics like they were candy. An Army doc prescribed Lance OxyContin. 

Lance may have only suffered a minor physical injury. But, after being exposed to combat trauma, he suffered emotional injuries (which were far more severe than a broken finger). 

It didn’t take long for Lance to start abusing “Oxy’s” (as they’re known colloquially). Lance’s mom recalls, “He found out very quickly he could deal with his mental health problems with the drugs.” 

The two years for Lance were hell. He went AWOL four times. The Army discharged him. His stints at rehab were futile. One month into residential treatment program for PTSD in Waco, TX, Lance got kicked out. Shockingly, despite his documented struggles with drug abuse, they sent him home with an Rx for Vicodin, another narcotic painkiller. 

Six days shy of his 27th birthday, on August 18, Lance’s lifeless body was found in a room at the (ironically named) Relax Inn. The single story stucco motel was located within a stone’s throw from the high school football stadium Lance grew up playing in. The toxicology report found a lethal combination of methadone and hydrocodone. 

How Bad Is The Epidemic?

We haven’t seen an epidemic like the opioid epidemic since the AIDS crisis of the 1980s and early 1990s. Total deaths in 2014, per the CDC:

  • Opioids: 18,893
  • Heroin: 10,574
  • Benzodiazepines: 7,945
  • Cocaine: 5,415
  • Cannabis: 0

Could Cannabis Have Prevented the Death of Lance (And Thousands of Others)?

According to Brian Perron, Ph.D., associate professor at the University of Michigan’s School of Social Work, who studies substance-abuse issues: “In states where medical marijuana is legal, physicians should be aware that medical marijuana is a potentially safer and more effective treatment approach than opioids.”

What does the research say? A 2014 study published in JAMA Internal Medicine and led by researchers at the Perelman School of Medicine at the University of Pennsylvania, found that states that legalized clinical cannabis for chronic pain experienced (on average), a 25 percent drop in opioid-related deaths.

States that legalized clinical cannabis for chronic pain experienced (on average), a 25 percent drop in opioid-related deaths.

When faced with what many consider the worst drug epidemic in history, don’t we have a moral duty to explore to potential solutions that can save lives? And, if so, specifically, how can cannabis play a role in comprehensive strategy to fight the drug epidemic?

  1. Cannabis works as a substitute. Research has shown many drug and alcohol abusers can use cannabis as an effective, less harmful substitute for more harmful prescription opiates or other illegal drugs—in the process, dramatically reducing or eliminating dependence on these other substances. (Studies show that alcohol, nicotine, cocaine and heroin carry far higher levels of risk than cannabis, and in fact, cannabis is approximately 114 times less deadly than even alcohol.)
  1. Cannabis may be effective as a method of “stepping off” hard-drug use. Dutch studies have found that using cannabis has been effective at encouraging young people to get off harder drugs and that when cannabis was used in a controlled coffeehouse environment versus “drug houses”—or, other polydrug-using environments—many subjects learned to use cannabis moderately while not combining with other substances. 
  1. Cannabis can save lives. Ending prohibition can reduce the death rate from drug overdoses. Recent studies have shown that states with legal MMJ experienced a significant decrease in heroin and prescription pill overdose death rates, and significant drops in the suicide rate. 

The narcotic-fueled drug problem is complex and there is no easy fix. Cannabis is not a cure-all and all potential remedies to the drug crisis should be explored. But, if we’re committed to seriously tackling the drug epidemic, it’s high time (pun intended), that we looked hard at incorporating cannabis into prescription remedies. 

Allow doctors to prescribe cannabis as a first-line treatment in place of opioids or benzodiazepines

We know that not only are prescription narcotics and benzodiazepines responsible for thousands of drug overdoses each year, but prescription narcotic medication is a gateway drug to heroin. Eighty percent of heroin abusers started on prescription drugs. Contrary to decades-old propaganda, cannabis is not a gateway drug and has not been responsible for a single overdose death.  

Further, cannabis can be used to treat chronic pain instead of narcotics. It can be used in place of benzodiazepines to treat PTSD and anxiety—without the disastrous consequences and potential for lethal overdose.

Allow doctors to prescribe cannabis for substitution therapy 

Many doctors—and much research—prove that cannabis can also be used as substitution therapy as an exit drug from narcotics and benzodiazepines.

If the goal is to decrease the deaths, harm reduction must be part of the solution, and clearly cannabis can play an important role. Substitution therapy is not without risks, and patients should be monitored to ensure they don’t continue to both narcotics and cannabis. 

Said Dr. Mike Hart, a Canadian doctor who has helped several hundred patients—many of whom are veterans—get off narcotics or benzodiazepines: “There’s no doubt, substitution therapy can save lives. However, we have to keep in mind that we are essentially substituting a safer chemical, but the keyword here is ‘safer,’ which doesn’t mean without risk. Ongoing followup and monitoring is important to ensure the patient doesn’t simply replace one substance for another. Of course, if our goal is to decrease overdose deaths, getting people on a safer drug is common sense.“ 

Allow doctors to prescribe cannabis as narcotic reduction therapy

Ideally, all patients could get off of narcotic medication altogether, however, depending on a patient’s pain, that may not always be possible. However, even in severe cases many doctors report they are able to at least significantly reduce a patient’s use of opioids by 50 percent or more. Chronic pain sufferers who use narcotic pain medication may be able to reduce their narcotic intake by complementing their therapy with medicinal cannabis. Doing so can increase the effect of opioid analgesics. 

Said Dr. Donald Abrams, professor of Clinical Medicine at the University of California San Francisco and Chief of Hematology & Oncology at San Francisco General Hospital: “Cannabinoids and opioids interact synergistically on separate but parallel pain receptors, meaning people who have pain who are on opioids may be able to take lower dosages or the same dosage for a longer period of time with decreased side effects.”

Contrary to common perception, most patients who use both prescription opioids and cannabis are not necessarily at higher risk for abuse. In fact, according to a May 2015 study published by the Journal of Studies on Alcohol and Drugs, a peer-review scientific journal focusing on substance-related issues, subjects did not report higher rates of alcohol or other drug use than subjects who used medical marijuana only.