Marijuana Legalization and the Opioid Epidemic

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

In the United States, millions of people “have been diagnosed with an opioid use disorder,” and “more than 80 [Americans] die each day from opioid overdose.” Where is this coming from? Well, most new heroin users start out on prescription drugs; prescription opioid painkillers. This is important, because more than “200 million opioid painkiller prescriptions are still written every year.” Did you catch that number? 200 million prescriptions every year in the United States—”a number closely approximating the entire adult population.” That’s incredible.

“When you see something like the opioid addiction crisis blossoming in so many states around this country,” said White House Spokesperson Sean Spicer, “the last thing we should be doing is encouraging people” to smoke cannabis. But if opioid addiction starts with people taking prescription pain pills, maybe cannabis would reduce the problem by offering a substitute painkiller. Or you could see it go the other way, where cannabis acts like as a “gateway” drug, or “stepping stone,” to harder drugs, and could make the opioid epidemic worse.

Well, first, does cannabis work? “Is it a truly effective drug for pain that [has been] arbitrarily stigmatized and criminalized by the federal government? Or is it without any medical [benefit at all, and] its advocates hiding behind a [smoke]screen”—pun intended—”of misplaced (or deliberately misleading) compassion for the ill?” The official position of the American Medical Association is that marijuana “has no scientifically proven, currently accepted medical use for preventing or treating any disease.” But, what does the science say?

Well, “despite the widespread use of opioids,” the majority of “advanced cancer patients [may] die with unmet pain-relief needs.” And so, adding cannabis may help, as double-blind, placebo-controlled clinical trials have found that cannabis compounds do produce pain relief, “equivalent to moderate doses of codeine,” an opioid used to treat mild-to-moderate pain. But wait; if you’re dying from cancer, don’t you want the good stuff? Why not just crank up the morphine?

Look, if you want, you can put someone in a coma, erase all their pain. But the problem with these high doses of opiates is that here you are, at the end of life, surrounded by loved ones, and you’re so gorked out you can’t even say goodbye. So, that’s where cannabis may help, allowing someone to drop the opiate dose down a bit without compromising pain control.

That’s what many report, anyway. If you look at New England, which is like ground zero for the opioid epidemic, “[t]here were enough opioids dispensed from Maine pharmacies in [one year] to supply every person in the state with a 16-day supply.” What are they doing up there?

But among New Englanders surveyed who were on opioids, most claim that “they reduced their [opioid] use since they started [medical cannabis].” Some also reduced their use of antidepressants, alcohol, anti-anxiety medications, migraine meds, and sleeping pills. 40% said they were able to reduce their opioid use “a lot.”

It may even reduce the use of crack! It may seem strange to give drugs to drug addicts, but if people even partially switch from more to less harmful drugs, overall harm may be reduced. So, what happened after medical marijuana laws were passed? Did opioid overdoses go up, stay the same, or go down?

They went down. “Medical cannabis laws are associated with significantly lower…opioid overdose mortality rates”—about a 25% lower rate of overdose deaths, the striking implication of which is that medical marijuana laws “may represent a promising approach for stemming” the opioid overdose epidemic. “If true, this finding upsets [not only] the applecart of conventional wisdom regarding the public health implications of marijuana legalization [but also of its] medicinal usefulness.” Here, the AMA is saying it doesn’t do anything helpful m­­edically, but if people are getting enough benefit to cut down on their prescriptions, then obviously something’s going on.

What about other prescription drugs? Once medical marijuana laws were passed, fewer people were filling prescriptions, for not just painkillers, but anti-anxiety drugs, antidepressants, anti-nausea drugs, antipsychotics, anti-seizure drugs, and sleeping pills. If all states did that, then that could save around a half-billion dollars a year. But the half-billion taxpayers save is the half-billion drug companies lose. So, no wonder the drug companies are freaking out.

Why do you think “pharmaceutical corporations were major sponsors of the marijuana prohibition lobby,” trying to stop legalization—the makers of OxyContin, Vicodin. “Other major [funders] of the opposition included the beer industry…, and the private prison industry.”

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• Hurd YL. Cannabidiol: swinging the marijuana pendulum from 'weed' to medication to treat the opioid epidemic. Trends Neurosci. 2017;40(3):124-127.
• Furlow B. Recreational cannabis legalisation in the USA outpaces research into health effects. Lancet Respir Med. 2017;5(5):385-386.
• Bachhuber MA, Saloner B, Cunningham CO, Barry CL. Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010. JAMA Intern Med. 2014;174(10):1668-1673.
• Cohen PJ. Medical marijuana: the conflict between scientific evidence and political ideology. Part one of two. J Pain Palliat Care Pharmacother. 2009;23(1):4-25.
• American Medical Association House of Delegates. AMA Resolution: 907(1-16).
• Maida V, Daeninck PJ. A user's guide to cannabinoid therapies in oncology. Curr Oncol. 2016;23(6):398-406.
• Hall W. U.S. policy responses to calls for the medical use of cannabis. Yale J Biol Med. 2015;88(3):257-264.
• Abrams DI. Integrating cannabis into clinical cancer care. Curr Oncol. 2016;23(2):S8-S14.
• Piper BJ, Dekeuster RM, Beals ML, et al. Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep. J Psychopharmacol (Oxford). 2017;31(5):569-575.
• Socías ME, Kerr T, Wood E, et al. Intentional cannabis use to reduce crack cocaine use in a Canadian setting: A longitudinal analysis. Addict Behav. 2017;72:138-143.
• Bachhuber MA, Saloner B, Cunningham CO, Barry CL. Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010. JAMA Intern Med. 2014;174(10):1668-1673.
• Hayes MJ, Brown MS. Legalization of medical marijuana and incidence of opioid mortality. JAMA Intern Med. 2014;174(10):1673-1674.
• Bradford AC, Bradford WD. Medical Marijuana Laws Reduce Prescription Medication Use In Medicare Part D. Health Aff (Millwood). 2016;35(7):1230-1236.
• Dyer O. US states that allow medical marijuana see drop in prescriptions for other drugs, study finds. BMJ. 2016;354:i3942.

Motion graphics by Avocado Video.

• addiction
• alcohol
• antidepressants
• anxiety
• cancer
• cannabis
• depression
• headaches
• industry influence
• marijuana
• mental health
• migraine headaches
• pain
• smoking