Prescription drug overdoses are the leading cause of accidental death in the United States. Alternatives to opioids for the treatment of pain are necessary to address this issue. Cannabis can be an effective treatment for pain, greatly reduces the chance of dependence, and eliminates the risk of fatal overdose compared to opioid-based medications. Medical cannabis patients report that cannabis is just as effective, if not more, than opioid-based medications for pain.  

Thirty percent of the sample (N=841) reported using an opioid-based pain medication currently or in the past 6 months. Of those who have used opioids, 61% reported using them with cannabis. Ninety-seven percent of the sample “strongly agreed/agreed” that they are able to decrease the amount of opioids they consume when they also use cannabis. In addition, 89% “strongly agreed/agreed” that taking opioids produces unwanted side effects such as constipation and nausea. Ninety-two percent of the sample “strongly agreed/agreed” that cannabis has more tolerable side effects than the opioid-based medications they have taken. Eighty-one percent “strongly agreed/agreed” that taking cannabis by itself was more effective at treating their condition than taking cannabis with opioids. When asked if cannabis produces the same amount of pain relief as their opioid-based medications, 71% “strongly agreed/agreed” with that fact. Ninety-two percent of the sample “strongly agreed/agreed” that they prefer cannabis to opioids for the treatment of their condition and 93% “strongly agreed/agreed” that they would be more likely to choose cannabis to treat their condition if it were more readily available.   This paper presents an evidence-based rationale for cannabis-based interventions in the opioid overdose crisis informed by research on substitution effect, proposing three important windows of opportunity for cannabis for therapeutic purposes (CTP) to play a role in reducing opioid use and interrupting the cycle towards opioid use disorder: 1) prior to opioid introduction in the treatment of chronic pain; 2) as an opioid reduction strategy for those patients already using opioids; and 3) as an adjunct therapy to methadone or suboxone treatment in order to increase treatment success rates. The commentary explores potential obstacles and limitations to these proposed interventions, and as well as strategies to monitor their impact on public health and safety.

Conclusion:  Cannabis alone will not end opioid use disorder and associated morbidities and mortality. However, the introduction of ever more powerful opioids like fentanyl and carfentanyl into the illicit drug market and the resulting day-to-day increase in opioid overdoses highlights the immediate need for innovative short and long term intervention strategies to add to current efforts like ORT, heroin maintenance programs, supervised consumption sites, the depenalization of substance use, and increased education and outreach on the potential harms associated with both prescription and illicit opioid use. The growing body of research supporting the medical use of cannabis as an adjunct or substitute for opioids creates an evidence-based rationale for governments, health care providers, and academic researchers to seek the immediate implementation of cannabis-based interventions in the opioid crisis at the regional and national level, and to subsequently assess their potential impacts on public health and safety.

Cannabis -vs- Opiod Addiction