Can Medical Marijuana Help End the Opioid Epidemic?

For eight decades, the U.S. has attempted and failed disastrously in its fight against illicit drugs. While this battle has been raging for decades, it was made a focus by the Reagan administration with its, “War on Drugs.” During this time, hundreds of thousands of lives have been ruined and trillions of taxpayer dollars have been spent and wasted in the futile conflict to curb drug use and what do we have to show for it? Rising drug use, drug overdoses, and mass incarceration. Many viewed and continue to view this as an unwinnable war with no clear objectives and no clear enemy, especially since the perpetrators and victims are American citizens. The lines separating criminals and citizens blur even further when polls show that approximately one in five Americans will use an illegal substance at least once per month. Much to the bemusement of many Americans, one of the prime suspects in the war on drugs and a major target of law enforcement were efforts to curb marijuana use.

After being outlawed in 1937 with the Marijuana Tax Act, marijuana was scheduled as a class 1 drug by the DEA, which means:

1.     The drug or other substance has a high potential for abuse.
2.     The drug or other substance has no currently accepted medical treatment use in the U.S.
3.     There is a lack of accepted safety for use of the drug or substance under medical supervision.

Because of this, the DEA and law enforcement have viewed marijuana use, possession and cultivation in the same light as they have heroin, crystal meth and ecstasy, amongst others. In the last decade, heroin has killed more than 500,000 Americans because of overdose. In the last two millennia, marijuana has killed exactly zero people.

These types of inconsistencies have shaken many citizens’ faith in the integrity of the DEA. Albert Einstein once correctly spoke regarding this topic saying: “The prestige of government has undoubtedly been lowered considerably by the prohibition law. For nothing is more destructive of respect for the government and the law of the land than passing laws which cannot be enforced. It is an open secret that the dangerous increase of crime in this country is closely connected with this.” As he mentions, when Americans see an inconsistency in action and words, their trust in the almighty government decreases.

So, despite this schedule 1 classification and the attempt to criminalize the drug, the tide of public opinion is overwhelmingly against the DEA’s attempt to continue treating Marijuana as a dangerous substance. This is evidenced in polling numbers on public opinion: In the 70’s, roughly 1 out 3 Americans viewed the drug favorably or used it. Today, more than 66% of Americans would prefer for it to be legalized. It is estimated that more than 25 million Americans use Marijuana either recreationally or medicinally every single month; barring some new scientific revelations, this number will likely continue to increase.   

As all of this goes on, the country finds itself mired in the middle of an actual epidemic, the opioid crisis. Thanks to legislation pushed by Big Pharma lobbyists over the past two decades, painkillers remain legal and have been given out almost willy-nilly to the public at large by “Pill Mill” clinics. According to NIDA, the National Institute on Drug Abuse, “Taken as prescribed, opioids can be used to manage pain safely and effectively. However, when abused, even a single large dose can cause severe respiratory depression and death. Other consequences can also occur from the act of abusing opioids, such as addiction, harm to a person’s physical and mental health, and severe withdrawal symptoms. Because these drugs are habit-forming, their potential for abuse is considerably high, and many people do abuse them whether they mean to or not.”

NIDA estimates that over 30,000,000 people across the world abuse and are addicted to opiates such as Vicodin, Percocet, Oxycodone and heroin. Within the United States, in 2015, 33,000 citizens died of overdosing on opioids. That number rose to 50,000 in 2016. To put that number into perspective, according to Vox, “More than 58,000 American soldiers died in the entire Vietnam War, nearly 55,000 Americans died of car crashes at the peak of such deaths in 1972, more than 43,000 died due to HIV/AIDS during that epidemic’s peak in 1995, and nearly 40,000 died of guns during the peak of those deaths in 1993.” Over the past decade alone, prescription drug overdoses have increased 200%.

Opioids are now the main killer of American citizens below thirty years of age and now take more lives annually than auto accidents. This number does not take into account Heroin, the next logical step on the opiate path, which is responsible for an additional 13,000 American deaths annually. Further, it is estimated that opioid accrues more than $72 billion in medical costs alone each year in the U.S. These sobering numbers are only expected to grow unless we take dramatic steps to fight this growing epidemic.

Substitute Goods

Within the field of basic microeconomics, there is a concept known as Consumer Choice. Consumer Choice refers to the decisions that consumers make in regards to products and services, whereby said consumers make their choices based on cost, supply, and readily available substitutes. The Law of Demand states: “The rate consumption falls as the price of the good rises, even when the consumer is monetarily compensated for the effect of the higher price.” In layman’s terms, when prices go up, people are less likely to buy a product. On the opposite side, if there is a limited supply of a good and high demand, people are willing to pay more for that good.

Now, while price is one way to decrease demand for a good, a better option is to provide similar product known as a substitute good. These goods are products that a consumer sees as similar or comparable, where having more of one product makes them desire less of the alternative product. For example, if you have two kinds of apples, say a Granny Smith and a Golden Delicious, these are considered to be almost perfect substitutes. So, let’s pretend Golden Delicious cost $2 at the supermarket and then Granny Smith apples, costing 50¢, are added to the inventory, what happens? Well, logically, consumers are more likely to buy Granny Smith apples since they see it as nearly a one for one substitute and it costs them 200% less money. As fewer and fewer people purchased Golden Delicious, the supermarket would likely be forced to drop the price of the Golden Delicious in order to incentivize customers to buy more of those. And, as more and more people purchased Granny Smith, the super market would likely raise the price of the Granny Smith as supply dwindled.

Is Marijuana a Viable Substitute?

As mentioned earlier, when employing economics, one of the optimal means by which you can reduce price or market share of a good is to offer a substitute product. When consumers have increased choices, they likely chose the good that works while simultaneously costs them less or that comes with fewer negative side effects than its competitor. So, in the case of fighting pain, the question seems to be, does marijuana serve as a viable substitute for pain pills? According to the DEA, that answer is, no. However, recently, House Minority Leader Rep. Nate Gentry said, “Medical cannabis has great potential as an opioid replacement drug and we want to move people away from being prescribed highly addictive opiates.”

Opiates

First, it is important to delineate what opiates actually do to the body. From a physiological perspective, opiates modify the brain’s chemistry in two ways: First, they affect how the brain reacts to pain stimuli by numbing or dampening pain receptors sensitivity to pain or discomfort. Second, this pain is further forgotten as opiates flood the brain with feelings of a “high”, upsetting and confusing the pleasure and reward centers within the brain, creating a sensation of extreme pleasure, euphoria, sedation and numbing – far beyond normal pleasures such as exercise, food, or sex. Opiates work directly on the central nervous system, including the brain, respiratory systems and cardiovascular systems, by lowering heart rate, respiration and blood pressure while pumping out increase feelings of happiness. Opiates are an extremely effective means of pain relief, however, repeated use or abuse of them can alter brain chemistry, which results in physical and psychological dependence. This dependence can morph into addiction, which logically leads to harder drugs and a higher likelihood of overdose.

Marijuana

There are two active chemicals in Cannabis that many believe to have medicinal applications, Cannabidiol (CBD) and Tetrahydrocannabino (THC). CBD affects a person’s brain without the psychotropic feelings associated with a high. THC contains the more dominant pain relieving properties as well as the psychotropic effect. When you use cannabis, the brains cannabinoid receptors are both excited and activated, but do not communicate as per usual. The concentrations of cannabinoid receptors are in the parts of the brain related to memory, motivation, drive and reward. So, when you use cannabis, your motivation and reward centers are activated and you receive a sense of euphoria on top of the fact that any sense of pain is dampened or hindered by the neural blockers.

As a result, marijuana has been shown as an effective pain reliever for medical issues such as AIDS, Arthritis, Chrons Disease, MS, and cancer. So, when asking whether or not cannabis is a proper substitute for opiates, the answer would seem to be a resounding yes. Marijuana is often highly effective at treating the same types of chronic pain that patients are often prescribed opiates for. In fact, they may even be a better option as we have seen with many patients, who, given the choice between marijuana and opiates, appear to be opting for the natural remedy. Given the choice between the two, many patients chose cannabis since it does not have the same negative connotations or drawbacks, nor does it come with the potential of serious physical dependence.

Applying This in The Real World

In a recent study of more than 400 patients, Anita Briscoe, a psychiatric nurse, noted that more than 25% of her patients reported being able to get off their opioid dependence with the aid of cannabis. She stated, “If they are in pain, cannabis is helping relieve their pain, often to the point that they don’t need opiates anymore.” Another study published in the JAMA International Medicine discovered that states with medical marijuana laws had 25% lower opiate overdoses a year when compared to states without medical marijuana.

In Colorado, opiate deaths have decreased annually by over 10% since recreational marijuana was introduced. In Maine, a movement was created to add opiate addiction to the list of ailments that medical marijuana would be capable of treating. While the health department shot it down, advocates such as Dr. Dustin Sulak strongly believe it to be a possible solution to the opiate epidemic. He states that approximately 70% of the people use medical marijuana for chronic pain. Of the 500 people he treated and later interviewed, the vast majority stated that they had used marijuana in combination with opiates in order to treat pain, and with the help of marijuana, they either stopped opiates completely or reduced their dosage of opiates over time.

While not conclusive, much of the evidence thus far points to the fact that many patients view marijuana as a substitute, if not a superior one. Even if legalization of marijuana only reduced those numbers by 10%, that is still 5,000 more Americans who do not die from overdose; 5,000 Americans who will not potentially turn to heroin, crime or other illicit means in order to feed their addiction. As of now, we are losing the battle against opiate addiction. Marijuana is a viable substitute that absolutely can make a marked impact on this national tragedy.

Sources:

Cadena, Aaron. “Could CBD Legalization Help End America’s Opioid Crisis?” CBD Origen. 7 Jan. 2019. 15 Mar. 2019. https://medium.com/cbd-origin/could-cbd-legalization-help-end-americas-opioid-crisis-a85a87f9255f

Piomelli, Danielle. “Cannabis and the Opioid Crisis.” NCBI. 2018. 15 Mar. 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5931647/

Gholipour, Bahar. “How Medical Marijuana Could Help Curb the Opioid Epidemic.” Live Science. 2 April 2018. 15 Mar. 2019. https://www.livescience.com/62193-legalizing-marijuana-surprising-benefit.html