By Kohl Neal
Over the past three decades, opioid prescriptions and use have increased heavily throughout the country. A greater focus from the medical community on treating pain as an illness led to more common prescription of opioids like Fentanyl and Oxycodone in steadily increasing dosage. Now patients are suffering the impact of that shift, with a rise in opioid-related deaths so high that last year it was declared a state of national medical emergency. With growing access and education around medical applications of cannabis, many states are turning to medical cannabis programs as an answer to the growing problem of opioid abuse. Though modern medical studies show elements of cannabis are effective in pain relief, many are cautious to turn to it as a solution, while others outright reject any medical use of cannabis. Many doctors still question whether cannabis can be as effective as opioids, and some also raise concerns about the risks of dependency and side effects of cannabis. However, for patients and doctors witnessing regular deaths due to opioid overdose, cannabis looks like an obviously safer alternative.
Illinois is just the latest state seeking to introduce measures meant to decrease opioid prescriptions by expanding access to cannabis. The Illinois Senate passed a bill to allow any patient with a prescription to opioids to be eligible for a medicinal marijuana card, and it is now awaiting a vote in the House. If the House does pass the bill, Governor Rauner will be in the awkward position of choosing between either addressing the massive opioid epidemic suffered by major constituencies or continuing his fight to limit the Illinois medical cannabis programs, all in a year where he is seeking reelection. This bill is in part an answer to the Governor’s fight to keep chronic pain off the list of qualifying conditions for cannabis prescriptions under the Illinois Compassionate Use Law. Earlier this year a Cook County court order the Illinois Department of Public Health to add chronic pain to the list of qualifying conditions for cannabis, however, the court order is being held up by an appeal by Rauner’s office. Despite several recommendations from the Medical Cannabis Advisory Board to add chronic pain, autism spectrum disorder, osteoarthritis, and neuropathy to the list of qualifying conditions, Rauner’s Public Health Department has continuously rejected any expansion of the list.
The use and prescription of opioids, on the other hand, have only continued to grow. Illinois has taken a heavy hit from the opioid epidemic seen across the country. Both rural and urban cities have seen spiking rates of overdose in the past few years. From 2014 to 2016 hospitalization for opioid-related overdoses went up 45 percent 1 as reported from the Illinois Department of Public Health. Deaths due to opioid overdose have increased tenfold from 2013 to 2016, with drugs like Fentanyl and Oxycodone claiming almost two thousand lives in Illinois alone in 2016. By county, the most drastic increase in overdoses have come from rural and suburban counties, but Chicago has also seen a significant rise in emergency room visits due to opioid overdose. Experts hope that overdose deaths will show a decrease for 2017 and 2018 due to greater use of drugs like Naproxen, which can counteract opioids and save somebody’s life during an overdose. But emergency responses are not enough if addiction and use continue to increase at such high rates.
What about cannabis therapy?
The pain relieving properties of cannabis have been reported and touted for decades, though for much of that time reliable scientific studies were hard to come by due to the heavy restrictions on medical cannabis. Now that more states have legal recreational or medical cannabis markets, there is a wealth of information and evidence about the medical properties of cannabis. A recent Harvard Review of multiple studies found reliable evidence that cannabinoids, the active elements in cannabis, are efficacious in treating chronic pain, neuropathic pain and multiple sclerosis. Cannabinoids like THC and CBD have been shown to be incredibly effective for debilitating muscle and arthritic pain. They are particularly effective in providing immediate relief with concentrated into tinctures and salves. Many of these medical products are designed for patients to maximize pain relief without the psychoactive side effects.
While there is mounting evidence that cannabis can be used to treat pain, many doctors are skeptical that it is as effective as opioids, and they worry about the risks. As with any pain medication, when patients rely on cannabis for pain relief they may become dependent and unable to perform everyday tasks without it. But of course the same can be said for opioids and other pain medication, but to much higher degrees. There is a risk of addiction to cannabis, with dependency occurring in 9 percent of regular users, though those numbers are hard to determine as many people arrested for cannabis go through addiction counseling by court order. That can be compared to the much higher rate of 23 percent of people prescribed opioids becoming dependent according to the American Society of Addiction Medicine. That higher rate of addiction also comes with a much greater risk. Regular cannabis use can cause psychological dependence, though no physical dependence, meaning there is no danger of withdrawal. Regular opioid use can cause opioid receptors in the brain to stop producing natural opioids, meaning the body becomes dependent on the drug for regulating pain. That makes the tolerance to opioids go up dramatically, so patients require constantly increased dosage. When those receptors don’t receive high enough doses, it can cause pain, muscle spasms, diarrhea, and anxiety. And if they receive too much, it can slow breathing and even stop a patient’s heart. There has never been a recorded incident of cannabis overdose and most doctors agree it is impossible to overdose on cannabinoids. Meanwhile, on average, 115 Americans die from opioid overdoses every day. That means every 15 minutes, someone is likely overdosing on opioids. And the problem is on the rise, with early numbers showing a 30 percent increase in overdoses just in 2017.
Quarterly rate of suspected opioid overdose, by US region
Source: Centers for Disease Control and Prevention
Some politicians and even doctors who oppose medical cannabis still cling to the notion that it is a gateway drug. They claim that while the side effects of cannabis itself are minimal, cannabis itself is a gateway drug, in that using it recreationally can lead to abuse of other, more dangerous drugs. While there is little evidence to support this claim, there is mounting evidence that patients who abuse prescription opioids have a much higher chance of using and abusing heroin. According to the CDC about 80 percent of heroin users first misused prescription opioids, and overdoses in heroin have risen concurrently with opioid overdoses in recent years. Because heroin is an opiate it has the same pain killing, suppressant effect as prescription opioids, but it is cheaper and easier to get, particularly for patients without health insurance. Those are also the patients with the fewer treatment or intervention options, for whom it is difficult and dangerous to kick their addiction even if they want to. For opioid patients who lose their insurance, finding heroin may be the only way to avoid going into shock, not to mention avoid debilitating pain. These low income, under-insured patients are the ones who suffer the most from opioid addiction, and could be most helped by available, affordable pain treatment in cannabis.
Many doctors with access to medical cannabis have already started advising patients with opioid prescriptions to try cannabis. This has led to some surprising and very hopeful findings that cannabis can not only treat pain, but opioid addiction itself. According to a survey published in the Journal of Pain, patients currently taking opioids for chronic pain who start using cannabis do not need to increase their opioid prescriptions to account for tolerance. In fact, they found a 64 percent decrease in opioid use among those patients. Cannabis was also found to be a remedy for many of the debilitating side effects of opioid medication and symptoms of withdrawal such as nausea, drowsiness and muscle spasms. This evidence suggests that cannabis is not just an alternative to opioids, but a key remedy to those struggling with opioid addiction.
Cannabis to treat pain or other physical and mental ailments is not without risk. Most doctors now agree that treating the causes of pain is preferable to treating pain itself, and of course, cannabis cannot be the only solution to address opioid addiction in this country. Addiction treatment, counseling and education among patients is a necessity. But a huge portion of Americans suffer from chronic pain and receive treatment for it. Of those treatments, cannabis is not only the safest, but highly effective. While our country goes through an epidemic of opioid addiction and overdose, the increased use of medical cannabis can be one of many solutions needed to create safer treatment and save lives. The only question remaining is if the Illinois government can embrace this solution to address the opioid crisis facing their state, or if they will reject it and continue to ignore the problem of opioids to maintain a strict partisan agenda.
Kohl Neal is a member of Chicago NORML, sits on the Education Committee and is spearheading a guest blogger series initiative. For more information on contributing to the series, please contact Kohl directly.