The Opioid Crisis is one of the most heartbreaking aspects of modern society. A pharmaceutical intended to improve quality of life by diminishing pain has resulted in the tragic loss of thousands of lives across our country and the world at large. In 2018, 2 out of every 3 drug overdose deaths were caused by opiates.
Prescription Treatment for Opioid Use Disorder
While the opioid crisis is still present in our society, health organizations have reported a decrease in the percentage of opioid-related deaths over the course of the past few years. With the decrease in overdoses, though, comes an increase in medication-assisted treatment for opioid use.
Before jumping into how medical marijuana can help those struggling with opioid use, it’s important to understand the “traditional” methods of treating opioid/opiate addiction.
Two substances often prescribed to patients battling Opioid Use Disorder (OUD) are Methadone and Buprenorphine (one of the main substances found in Suboxone, a popular medication for those with OUD). Developed to help those suffering an addiction or dependence to opioids and opiates, these pharmaceuticals have helped many, but they do come with their own set of issues.
Methadone History and Benefits
Developed decades ago and used as a treatment for opioid use since 1947, methadone is a synthetic opioid agonist, which is defined as a substance that sets off a physiological reaction when combined with receptors in the brain. Essentially, methadone acts as a stand-in opioid, working to relieve cravings by triggering the same receptors in the brain. While it reacts with the receptors the same way opioids do, it occurs at a much slower pace and therefore does not cause feelings of euphoria.
The Dangers of Methadone
Methadone has played an essential role in many peoples’ recovery. The use and administration of the substance is only offered in specialized treatment plans and is closely monitored by medical professionals. Methadone is so heavily supervised given its potential to further incite addiction given the fact that it produces similar effects to opioids.
What’s more, in recent years, to offset the high cost of prescription painkillers, doctors have started to prescribe methadone as a cheaper, and potentially less addictive, solution to chronic pain. The increased prescription of methadone has increased exposure to the substance. As an unfortunate and ironic result, a substance developed to help treat opioid use disorder is now part of the problem.
Besides the potential of addiction, methadone (like every medication) isn’t without side effects. The biggest, and most dangerous side effect is overdose. In fact, methadone is easier to overdose on than other opioids, and can result in a coma or even death. Signs of a methadone overdose include:
- Clammy or blue-tinged skin
- Bluish lips and fingertips
- Respiratory depression (slow and shallow breathing)
- Extreme fatigue and/or the inability to stay awake
In addition to overdose, methadone can cause symptoms like:
- Impaired balance and coordination
- Sleepiness and drowsiness
- Lightheadedness or dizziness
- Nausea or vomiting
Additionally, the use of methadone alongside other prescription or illegal drugs can result in serious and long-lasting heart conditions, ranging from arrhythmia to heart attack.
Buprenorphine History and Benefits
Approved by the U.S. Food and Drug Administration (FDA) in 2002, buprenorphine became the first medication eligible for distribution by certified physicians outside of specialized treatment clinics.
The FDA’s approval marked a monumental day in the opioid crisis, as it opened the door for easier access to treatment for those in need. Furthermore, in 2016, under the Comprehensive Addiction and Recovery Act (CARA), eligibility to prescribe the medication was extended to qualifying nurse practitioners and physician assistants.
Unlike methadone, buprenorphine is a partial opioid agonist, so while it binds to the same receptors in the brain, the reaction it causes is much weaker. However, it still has the ability to reduce cravings and ease symptoms of withdrawal, without producing a euphoric feeling. When initially released in 2002, buprenorphine came in the form of tablets. Now, the substance is available to patients who have stabilized use of buprenorphine in sublingual films, a subdermal implant lasting 6 months, and a once-monthly injection.
Buprenorphine, along with naloxone, is also one of the main active ingredients in the popular OUD medication, Suboxone. When combined, these two substances help ease opioid cravings and symptoms of withdrawal while simultaneously blocking the effects of opioid medication, including pain relief and well-being, that often lead to abuse.
The Dangers of Buprenorphine
Much like methadone, the fact that buprenorphine is an agonist, even a partial one, means that it poses the risk of addiction and dependence. However, that risk is significantly lower than that posed by methadone and other opioids.
While the threat of addiction or dependence is low, buprenorphine—and medications that contain the substance like Soboxone—still come with their fair share of side effects. Because most suffering from OUD are buprenorphine in the form of Suboxone, the list below will discuss side effects for both buprenorphine and naloxone, respectively.
- Nausea and vomiting
- Muscle aches and cramps
- Stomach pain
- Nervousness and irritability
- Body aches
- Fever and chills
- Sneezing and/or runny nose
It is also important to note that an abrupt cessation of buprenorphine, and medications like Soboxone that contain the substance, can lead to symptoms of withdrawal. Those prescribed buprenorphine must slowly be weaned off the substance to prevent withdrawal and, as a result, relapse.
Final Thoughts on Prescription Aids for OUD
As extensively discussed above, methadone and buprenorphine possess the ability to help drastically improve someone’s chance of recovery, but not without side effects and risks—especially when it comes to methadone. Thousands of people have successfully treated their OUD with these medications but, on the unfortunate, other hand, many have had negative experiences with the medications.
We can’t speak for everyone, but it is our belief that when given the option, one would most likely choose the path towards recovery with less side effects and less potential for further dependency or addiction.
That’s where medical marijuana comes in.
Medical Marijuana for Opioid Use Disorder
While medical marijuana (MMJ) has been called the gateway drug for decades, modern research combined with anecdotal evidence has worked hard to prove otherwise. In fact, cannabis is actually an up-and-coming treatment option for people struggling with opioid use disorder.
In an article published by the Recovery Research Institute, a leading nonprofit research institute working towards the advancement of addiction treatment and recovery, the recent uptick in medical marijuana laws correlates with a decrease in opioid overdose deaths and hospitalizations.
Research surrounding medical marijuana for opioid use, as well as for any condition, can be hard to come by given the substance’s federal status as a Schedule I drug.
However, researchers hypothesize that cannabis has the potential to help facilitate recovery in a plethora of ways.
Chronic Pain and Medical Marijuana
Chronic pain is one of the leading qualifying conditions for medical marijuana certification among most states with an MMJ program. As such, researchers believe that for those with a pain-related dependence to opioids medical marijuana poses a promising alternative. In short, cannabis as a pain reliever is tied to our bodies’ endocannabinoid system and the role it plays in how the body manages and regulates pain. You can learn more about MMJ and chronic pain here.
For many people with OUD, their addiction and dependence stemmed from an innocent attempt to cope with pain. Opioids are often prescribed after both serious and routine surgeries, but for those with a predisposition to addiction the innocent initial use can turn sinister quickly.
For this reason, researchers studying medical marijuana for OUD believe that cannabis poses a promising solution to those with a dependence on opioids as a response to chronic pain.
Stress, Anxiety, PTSD and Medical Marijuana
In our home state of Pennsylvania, anxiety is the most often cited condition for certification—and it’s often hand-in-hand with PTSD. With the onset of the COVID-19 pandemic, the number of people facing anxiety has risen, as has the number of people battling OUD. Those using opioids to battle stress and anxiety often chase the euphoria the substances create—medical marijuana produces similar feelings without the high risk of addiction and with zero risk of overdose.
As with any addiction, working towards the root cause of stress, anxiety, and PTSD poses the best chance of recovery. However, while working towards mental stability, people with OUD may find the use of MMJ beneficial to their overall wellbeing.
Final Thoughts on MMJ for OUD
We want to be clear that medical marijuana, like the use of methadone or buprenorphine, will not “cure” opioid addiction or opioid use disorder. Unfortunately, addiction, and any other mental health disorder, does not have a cure. There are medications prescribed to help lesson symptoms of the condition (i.e. SSRIs and other antidepressants, anti-anxiety medications, etc.), but they do not provide a magic, “all better” fix.
With that said, medical marijuana can help to drastically improve chances of recovery for those battling opioid use disorder by easing pain, whether or not related to symptoms of withdrawal, and mimicking feelings of euphoria. Despite what generations of the past have claimed, there have been no reports of cannabis-related overdoses and the substance itself is not addictive.