Can cannabis play a role in helping people kick opioid dependency? Several recent studies says ‘yes.’
Researchers at New York’s Columbia University assessed the use of cannabinoids versus placebo in opioid-dependent subjects undergoing in-patient detoxification and outpatient treatment with naltrexone, an opiate receptor antagonist. Investigators reported that the administration of oral THC (dronabinol) during the detoxification process lowered the severity of subjects’ withdrawal symptoms compared to placebo, but that these effects did not persist long-term. By contrast, patients who consumed herbal cannabis during the outpatient treatment phase were more readily able to sleep, reported experiencing less anxiety, and were more likely to complete their treatment as compared to those subjects who did not.
“One of the interesting study findings was the observed beneficial effect of marijuana smoking on treatment retention,” authors concluded. “Participants who smoked marijuana had less difficulty with sleep and anxiety and were more likely to remain in treatment as compared to those who were not using marijuana, regardless of whether they were taking dronabinol or placebo.”
The team’s findings appear online ahead of print in the journal Drug and Alcohol Dependence.
The study’s findings are not unique. In a 2001 study published in The American Journal of Drug and Alcohol Abuse, researchers at the New York State Psychiatric Institute assessed treatment retention rates among 47 opiate-dependent subjects participating in a six-month outpatient program. Authors reported that participants who consumed marijuana intermittently were significantly less likely to reinitiate their opiate use during the program as compared to those who either used it habitually or abstained from using it altogether. Those who used cannabis during the program were also more likely to adhere to naltrexone treatment. The authors concluded that occasional marijuana use is associated with better overall outcomes, which “may support a harm reduction approach to naltrexone maintenance.”
In 2009, investigators at the New York State Psychiatric Institute again assessed the relationship between cannabis use and opioid-treatment therapy in a cohort of 63 outpatient subjects. The researchers’ results replicated those of the 2001 study, finding that intermittent cannabis consumers were more likely to adhere to their treatment regiment and complete the outpatient program than were those who never used the substance.
Recent observational data from medical marijuana states further substantiates the theory that legal cannabis access may be a significant harm reducer for patients at risk of opioid dependency or mortality. According to data published in 2014 in The Journal of the American Medical Association, states with medical marijuana laws experience far fewer opiate-related deaths than do states that prohibit the plant. Investigators from the University of Pennsylvania, the Albert Einstein College of Medicine in New York City, and the Johns Hopkins Bloomberg School of Public Health in Baltimore conducted a time-series analysis of medical cannabis laws and state-level death certificate data in the United States from 1999 to 2010 — a period during which 13 states instituted laws allowing for cannabis therapy. They reported, “States with medical cannabis laws had a 24.8 percent lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws.”
Investigators from the RAND Corporation and the University of California, Irvine reported similar findings earlier this year in a policy paper for the non-partisan think-tank, the National Bureau of Economic Research. “[S]tates permitting medical marijuana dispensaries experience a relative decrease in both opioid addictions and opioid overdose deaths compared to states that do not,” they concluded.
Some scientists believe that cannabis may act synergistically with opiates. Clinical data published in 2011 in the journal Clinical Pharmacology & Therapeutics reports that the administration of vaporized cannabis “safely augments the analgesic effect of opioids.” Authors speculated that this “synergistic interaction” between cannabinoids and opiods “may allow for opioid treatment at lower doses with fewer [patient] side effects.” Consequently, some pain physicians are now recommending that patients use cannabis adjunctively or, in some cases, prior to using opiates as a “harm reduction strategy [to] reduce the morbidity and mortality rates associated with prescription pain medications.”
Paul Armentano is the deputy director of NORML (National Organization for the Reform of Marijuana Laws) and serves as a senior policy advisor for Freedom Leaf, Inc. He is the co-author of the book, Marijuana Is Safer: So Why Are We Driving People to Drink? (Chelsea Green, 2013) and the book, The Citizen’s Guide to State-By-State Marijuana Laws (Whitman, 2015).