Legalized marijuana and the opioid epidemic

by Amalie Kropp, GCSOM, MBS 2019
Mentor: Dr. Brian Piper, PhD

We all would be hard pressed to find someone not affected by the opioid epidemic. This epidemic has been plaguing the United States over the last fifteen years. The opioid epidemic stems from the early 1990s when the medical community started to recognize pain as a fifth vital sign.(1) Here are some quick statistic on how devasting the opioid epidemic has been:

· The Drug Enforcement Administration (DEA) found a marked increase in the total number of opioids prescribed every year since the mid-1990s (2), leading up to the national peak in opioid distribution in 2012

· Opioid prescribing increased from 148 million prescriptions in 2005 to over 206 million by the end of 2011(3)

· 90 Americans die each day due to overdoses (4)

· An increase of 320% between 2000 and 2015 in opioid-related mortality

· 3x higher than in 1999 (5)

This has had long-lasting and devasting effects that have rippled throughout the entire country as more people became dependent and overdosed on opioids. It breaks my heart to know so many people seek treatment for pain and end up dying. While there have been downward trends in prescribing of opioids after 2012, patients are still dying. We need to do better for them. Physicians and other healthcare providers have the responsibility to treat their patient’s non-cancer pain, while also considering nonopioid alternatives such as marijuana. Marijuana has been a national “hot topic” but, I truly believe there is evidence that it can help so many people in many different ways.

Marijuana or cannabis was been used with the medical community as early as in 5th to 2nd centuries.(6) It is an ingenious plant to Central Asia that has psychoactive properties that interacts with the physiological endocannabinoid system in the human body. The main components include tetrahydrocannabinol (THC), and many other cannabinoids (CBD) that bind to the CB1 and CB2 receptors located throughout the body and central nervous system. In the more recent years, marijuana was become another hot topic as states all across the United States begin to decriminalize and legalized medical and adult-use marijuana.

Since California first legalized medical marijuana in 1996, 33 states and the District of Columbia have passed laws broadly legalizing marijuana, either medically or recreationally, as of November 2018. Washington D.C. and ten other states have expanded to recreational marijuana use.(8) With the endorsement of the states, more objective, clinical evidence is surfacing that marijuana can be used to manage chronic pain (9), reduce overdose mortality rates (10,11), treat opioid withdrawal (12), and decrease opioid prescribing rates.(5,13,14) I was born and raised in Colorado, and have seen, first-hand, that positive that marijuana has brought to the state. Many states seem to be seeing the trend and following suit.

Marijuana has a many positive benefits:

· Manage chronic pain (9)
· Reduce overdose mortality rates (10,11)
· Treat opioid withdrawal (12)
· Decrease opioid prescribing rates (5,13,14)
· Much lower risk of addiction and virtually no overdose danger (15,16,17,18)
· Conclusive evidence that cannabis can be used safely and effectively to treat chronic pain (19)

Many polls are showing that marijuana has increasing popularity. According to a Pew research center poll conducted in 2018, 62% of Americans are supportive of legalized marijuana for medical purposes, which has doubled in over a decade from 31% in 2000.(20) The popularity of marijuana is quickly rising in the 50 and older age group. (21) This age group may be most likely to experience chronic pain related conditions and are open to the analgesic effects of marijuana.9 Overall, marijuana is gaining strong support politically. This rise in acceptance also helps dispels myth of cannabis being a gateway drug, decreasing the stigma of this alternative treatment.

The opioid epidemic is far from over, as people continue to be diagnosed with opioid use disorder and overdose all across the country. Physicians and other healthcare providers have the responsibility to treat their patient’s pain, while also considering nonopioid alternatives. I believe that marijuana may be that safer opinion as found in many of the studies.

*References from “The Effects of Legalized Marijuana and the Opioid Epidemic", Amalie Kropp, Readings in Basic Sciences.