An Opioid Epidemic in the United States
The Centers for Disease Control and Prevention recently published an analysis that showed drug overdoses are the leading cause of accidental deaths in the United States – surpassing even that of automobile accidents (“Opioid Addiction”). A majority of these deaths are related to prescription opiates and heroin use. Opiates are drugs commonly prescribed as pain relievers, including oxycodone, codeine, morphine, and fentanyl. The class of drugs also includes the illicit drug, heroin (“Opioid Addiction”). Prescription opioids are currently involved in “more overdose deaths than any other drug” with 20,101 related deaths in 2015 – four times the number in 1999 (“Overdose Death Rates”). Heroin overdoses have also risen fourfold in the past 16 years, with 12,990 deaths in 2015 (“Opioid Addiction”). Many are calling this dramatic increase in opioid-related overdose deaths in the United States an “Opioid Epidemic.”
This epidemic has three main indicators: increases in sales and prescriptions of opiates, high rates of opioid-related mortality, and a surge in admissions to treatment centers for opiate addictions. Driving this epidemic is the surge in the prescription of opiates, which nearly tripled from 76 million prescriptions filled 1991 to 259 million prescriptions filled in 2011 – corresponding to the dramatic increase in opioid-related overdose deaths (Nolan). Many of these painkillers are even being prescribed for conditions they have been proven ineffective for, including chronic pain.
This increase in sales and use for prescription opiates is problematic because opioids are associated with a high risk of overdose death and addiction. Many studies also point to a strong causal relationship between prescription opioids and heroin use. According to the American Society of Addiction Medicine, a survey of new heroin users found that four in five started out abusing prescription opioids (“Opioid Addiction”). Heroin is a much deadlier and addictive drug, with 23% of users developing an opiate addiction (“Opioid Addiction”). The overdose potential for both drugs is high because patients’ tolerance to the toxic effect of opioids builds slower than tolerance to its euphoric effects (“Opiates (Narcotics)”).
Many suggest that marijuana could be a cure for this rise in problematic opiate use because studies show that marijuana is less addictive than opioids and have a near-zero potential for overdosing (Hall and Pacula). This paper will analyze whether marijuana could act as an alternative treatment for conditions usually treated by opioids and how medical marijuana legalization impacts problematic use, influence the supply of opiates driving the problem, and effects heroin and opiate use rates that characterize the opioid epidemic.
Marijuana as Treatment Substitute
In “Cannabinoids for Medical Use: A Systematic Review and Meta-analysis,” the Journal of the American Medical Association (JAMA) reviewed 79 relevant trials that examined the impact of marijuana on a broad range of conditions that marijuana is commonly prescribed for, such as chronic pain, nausea and vomiting due to chemotherapy, spasticity from multiple sclerosis, and sleeping disorders (Whiting et al.). Although they also found that cannabinoids were associated with moderate improvements for most of the conditions analyzed, a majority of the studies had high risks of bias or the improvements were not statistically significant (Whiting et al.). The JAMA analysis did find “moderate-quality evidence” that supports a “30% or greater improvement in pain with a cannabinoid compared with a placebo” (Whiting et al.). However, this beneficial effect was accompanied by the increased risk of short-term adverse effects, including dizziness, nausea, and fatigue from the cannabinoids themselves.
Despite the adverse effects, this potential of cannabinoids to alleviate chronic pain is promising. There is much controversy over opiates’ efficacy in treating non-cancer chronic pain (“Opioids for Chronic Pain”). In some patients, due to a combination of tolerance – the adjustment of the body to dosage over time – and opioid-induced hyperalgesia – an increasing sensitivity to pain, opioids taken over an extended period of time may actually increase the amount of pain experienced (“Opiates for Chronic Pain”). If marijuana can treat chronic pain better than opiates can over an extended period of time, then marijuana can substitute for opiates. Not only could reduce opiate-related side effects, but it could also reduce the prescription dosage needed. Consequently, fewer opioids would need to be prescribed, reducing the supply available for use and misuse. Marijuana as a treatment substitute could lower risk for opiate-related addiction and potentially overdoses.
Abrams and his colleagues studied the effect of marijuana-opiate interaction in patients with chronic pain. They administered vaporized cannabis to 21 patients with various conditions who were receiving either oxycodone or morphine in stable doses (Abrams et al.). After five days of administering the vapor, the researchers evaluated the patients’ pain level and found an average pain reduction of 27.2% when cannabis was added to the opiate. This significant reduction in pain suggests marijuana enhances the pain-relieving effect of opioids.
Since fewer opiates are needed to achieve the same effect, mixing opioids with marijuana could potentially allow for lower opioid doses and an accompanying decrease in opioid-related side effects such as nausea and sedation (Abrams et al.). This suggests another treatment for chronic pain – a combination of both cannabis and opioids to minimize the amount of exposure to each drug. Not only would this lower the risk of opiate dependence, but also minimize the risk of long-term harms associated with marijuana use that may still be unknown.