BuzzFeed: Could Pot Help Solve The Opioid Crisis?

November 19, 2018

Published on BuzzFeed on November 15, 2018 by Dan Vergano

Scott Jordan never thought weed would help him kick the painkillers he took for a bad back. “I smoked pot in high school,” he told BuzzFeed News. “I didn’t really believe medical marijuana was going to help me.”

But the 58-year-old New Yorker, a longtime HIV activist and artist, wanted off opioids. They made him frequently drowsy and constipated, interfering with his busy life.

So he tried weed as a treatment — sometimes in liquid form, and sometimes vaped. “I was completely amazed,” he said. “It worked almost from the start.” That was three years ago. “I have been without OxyContin or any other opiate since May of 2015.”

Jordan is part of a small but growing group of opioid users across the country who have found relief in medical marijuana. The Manhattan dispensary where he receives a prescription of marijuana extracts has been running a pilot study of customers who also use opioids. That preliminary data, finding that weed helped the majority of opioid users, was encouraging enough to spur a much larger project — the first federally funded study of medical marijuana to combat heroin and painkiller addiction.

The $238,000 study funded by the National Institute on Drug Abuse (NIDA) will follow more than 10,000 medical marijuana patients in New York over the next two years to see if their opioid use drops.

“It is a kind of natural experiment,” said the study’s lead investigator, Arthur Williams, a clinical psychiatrist at Columbia University. “The patients are there, they are taking opioids already, and we can see what happens in a controlled way.”

A few years ago, the idea that the government would fund a study that uses one illicit drug to treat addiction to another would have been crazy. NIDA’s past research on cannabis had been criticized for shoddiness, moldy product, and hostility to studying pot’s potential benefits. But that’s changing, thanks to a rising tolerance of weed and a dramatic spike in opioid deaths nationwide. More than 72,000 people died of drug overdoses in the US last year, the majority from opioids found in painkillers, heroin, and fentanyl, triggering a nationwide public health emergency.

Addiction researchers who have studied the effects of cannabis in animals and people are praising the new effort.

“This represents a major shift in federal thinking on the medical benefits of cannabis,” Adrianne Wilson-Poe, a neurophysiologist at the Washington University School of Medicine, who is not part of the study, told BuzzFeed News.

“I think this is still an area that needs much more study so I’m glad NIDA is funding this,” Daniel Clauw of the University of Michigan School of Medicine told BuzzFeed News by email. He and his colleagues have found 64% lower opioid use in pain patients who reported using medical marijuana in an online survey.

The new NIDA project springs from the pilot study at Jordan’s dispensary, Columbia Care LLC (not affiliated with the university), the country’s largest medical marijuana provider. That study of 76 people found that 62% reduced or stopped taking opioids after using medical marijuana.

Participants in the study won’t be smoking marijuana but will instead take regular, precisely measured extracts high in THC, which causes the high from marijuana, and cannabidiol (CBD), the hipster health extract now found in oils, creams, and gummies. The study will look at people taking extracts that are high-THC or high-CBD, and paired ratios of those two.

All of the existing evidence about marijuana reducing opioids’ harmful effects relies on patients’ own reports that they use cannabis, Wilson-Poe noted. But with the NIDA study, for the first time, she said, “we will be able to know which kinds of cannabis products are best suited for preventing drug overdose.”

New York legalized medical marijuana in 2014, and the state made opioid use a qualifying condition for its prescription in July of this year.

Long before that, pharmacists at the Columbia Care dispensary, which needed to ask patients if they were taking other drugs to avoid unwanted interactions, began noticing that clients taking marijuana for pain were reporting lowered opioid use, chief science officer Rosemary Mazanet told BuzzFeed News.

“That’s why we started the study. We had the data already in hand,” she said. “It just seemed fortuitous.”

For much of the past decade, many pain researchers and patients nationwide have anecdotally reported success in lowering opioid dependence with marijuana. Some mouse studies also suggest that cannabinoids lessen symptoms of opioid withdrawal, such as tremors, diarrhea, and weight loss, though the jury is still out on whether this happens in people.

Emerging evidence suggests there is a biochemical interaction in the brain between cannabinoids and a neural pathway that triggers cravings for opioids. This neural chess match seems to have a synergistic effect in reducing pain, making lower doses of both cannabis and opioids effective. The interaction also seems to lower addiction rates in animals.

One outcome of the study might be that different patients need different forms of medical marijuana. Arthritis patients with inflammation in their joints might do well on the CBD extract, whereas people dependent on painkillers might need some THC to trigger the synergies with opioids that lead to reduced cravings.

“What works for your grandmother won’t work for my grandmother,” Wilson-Poe said. “Everyone’s endocannabinoid system is different.”

She expects that “whole plant” medical marijuana would provide more benefits for patients than extracts with just THC or CBD alone, given the dozens of compounds — cannabinoids, terpenes, flavonoids, and others — found in cannabis. “One of the shortfalls of not enough research is that we don’t know what all these compounds do, and how they interact in people.”

On the other hand, Williams said that efforts to study patients at dispensaries in the past have failed because smoked marijuana or extracts of the whole plant vary widely in strength and components day to day, making it unhelpful to researchers looking for standardized, reproducible doses.

“We really are unsure there is a protective effect, which is why we have to do the study,” Williams said. He is also investigating whether medical marijuana limits patients taking anti-anxiety drugs such as Xanax and Valium, which increase the risk of an opioid overdose.

In the long run, medical marijuana might turn into another form of medication-assisted treatment (known as MAT), like methadone and Suboxone, which use milder opioids to help people get off more dangerous ones. Today, MAT is in short supply, with fewer than one-third of the people who want such treatment getting it. Cannabis, in contrast, is now legal in 32 states. So the expansion of medical marijuana dispensaries nationwide might offer one avenue for offering the treatment to a wider audience.

But Williams, the leader of the new study, is cautious about claiming that cannabis could become a new MAT. “These are early studies,” he said. “Better information could inform specific interventions, but it is early.”

There’s also the question of whether marijuana use could itself become a dangerous habit. “Cannabis use disorder is a real problem and it hurts people’s lives,” Wilson-Poe said. Marijuana is by far the most popular illicit drug in the US, with 22.2 million people using it in the past month, around 90% of them for recreation. “Still, the risks of a fatal overdose just aren’t there compared to opioids.”

Having tried Suboxone, Jordan said the switch to medical marijuana as a kind of MAT was much easier overall.

Jordan started on painkillers four years ago, prescribed after an infected hip replacement led to multiple surgeries and bone-on-bone back pain. HIV-positive and in recovery from alcohol abuse for decades, he said his experience had made him reluctant to take opioid painkillers in the first place.

Then, after another surgery to replace a thumb joint, he started on Suboxone “to rid myself of opiates that I was dependent on.”

The surgeries were a side effect of HIV medication that lowered the blood supply to his bones. “That’s really why I am talking about this,” he said. “There are so many people out there with HIV who must be going through what I did. I want them to know about this.”

When his doctor recommended trying medical marijuana, he was dubious at first. But since he started in 2015, it quickly cut his need for strong painkillers, leaving him using only a small daily dose of Suboxone, a much less dangerous drug. Insurance doesn’t cover the cost for now, but Jordan says the $85 it costs him each week is less than what he used to spend on opioids and their side effects. Sometimes he pays less in weeks with less pain, he added, and the dose can be lowered easily without suffering from withdrawal.

Despite his success with cannabis, he thinks the researchers should proceed cautiously. “It needs to be carefully monitored,” he said, suggesting that counseling should accompany the drug.

“I don’t think it is a magic tool, but another tool that for many people will just make sense.”