America’s National Opioid Epidemic

The number of opioid overdose deaths in America since 1999 has surpassed 932,000 people and from December 2020 –
December 2021 there were an estimated 107,000 opioid overdose deaths1. Recently, the CDC estimates that 45 people
die every from prescription opioids. Approximately 75% of the drug overdose deaths in 2020 involved a prescription or
illicit opioid. Of the opioid overdose deaths in 2020 82% were from synthetic opioids2. The number of overdose deaths
involving opioids in 2020 was 8 times higher than in 1999 and its evolution can be outlined in three distinct waves. In the
above graph, 1990s – 2010s marks the rise in prescription opioid overdose death, while 2010 marks the rise in heroin
overdose deaths, and finally 2013 marks the rise in synthetic opioid overdose deaths (ie – fentanyl).
The U.S. is only 5% of the world population, but we manage to utilize 80% of the world opioid supply. 80% of heroin
users report initiating use with prescription opioids and 45% report being currently addicted to prescription opioids.
50% of patients who take opioids for greater than 30 days in the first year will continue to use opioids in excess of 3
years duration. 50% are short acting oral opioids which are more prone to lead to addiction and abuse and 60% of U.S.
patients are taking opioids with other medications known to make overdose more of a risk. Is the root cause arising at
the level of the pharmaceutical company? In the physician’s office? In the chemistry of certain patients’
neurochemistry?

This is tragedy touches every life and every household across our country regardless of race, gender, sex, religion,
socioeconomic status, etc… Our country obviously is experiencing a crisis of exponential proportions and it is destroying
families, lives, souls…

BUT HOW DO WE EVEN BEGIN TO FIX IT?
Opioid overdose deaths typically decrease an average of 24.8% in respective states in the first year after passing medical
cannabis laws. Additionally, each year after the medical cannabis law was passed, the rate of opioid overdose deaths
continued to decrease.

In chronic pain management, Cannabis can be used to replace opioids or to enhance the effects thereof. The addition of
Cannabis to opioids for the treatment of chronic severe intractable pain makes the opioids safer. Cannabis prevents

opioid tolerance and the need for dose escalation. A 2019 study of chronic pancreatitis patients in New Hampshire and
Vermont found a reduction in daily opioid use in medical cannabis users compared to non-cusers, with a subsequent
reduction in emergency room visits for chronic pain3. A 2016 study done on medical cannabis use in Michigan revealed
64% decrease in opioid use, 45% improvement in quality of life, and decreased overall side effects of all medications4.
Similarly, a 2018 study in Canada found that medical cannabis patients had reduced the opioid dose by up to 75% for
their chronic pain5. A 2016 Israeli study showed 44% complete discontinuation of opioids within 7 months of initiation
of cannabis therapy4.

Not only can Cannabis be used to replace opioids for the treatment of chronic pain, but they can also be used together.
Heroin or fentanyl have a very narrow therapeutic index. If you were to take 5 times the dose of the opioid that you use
to relieve pain, it will kill you--because it suppresses the cardiorespiratory centers of the brain (which control your heart
rate and breathing). But there are virtually no cannabinoid receptors present in this area of your brain, which is why
there is no known lethal dose of Cannabis. So not only is Cannabis a safe alternative for pain control, but by adding it to
the opiate regimen, we actually widen the therapeutic index. Although the opioid lethal dose stays the same, its
effectiveness is potentiated and the dose can be lessened into a safer range. Additionally, mouse studies have found
that THC helps to prevent the development of opioid tolerance with chronic morphine utilization.

Cannabis is safer than other harm reduction options for patients that are addicted or dependent on opioids.
Additionally, Cannabis gives a patient empowerment and the ability to partake in their own care. But abstinence from
opioids is not practical for all cases and some patients are better treated with medically assisted therapies (MAT). These
medical therapies include a safer substance, such as Buprenorphine (Suboxone) and Methadone, to replace a more
harmful substance, such as oxycodone or heroin. Medical cannabis can be used adjunctively with MAT. A 2018 study in
Vancouver Canada found a 21% more likely hood of treatment adherence with daily cannabis users6.
Cannabis can treat the symptoms of opioid withdrawal. These include: anxiety, agitation, restlessness, insomnia,
nausea, vomiting, diarrhea, abdominal cramping, muscle spasms, pain, sweating, runny nose. All can be improved with
Cannabis.

Can you have withdrawal from Cannabis? If use is heavy, and ceasing usage is abrupt, then symptoms of dependency
and withdrawal from cannabis can include the following: irritability, nervousness, anxiety, restlessness, anger, change in
appetite or weight, sleep disturbance.
However, Cannabis was documented to be a good replacement for illegal and prescription drugs by a 2015 Canadian
survey of 473 medical cannabis patients7. 80% substituted prescription drugs; 51% substituted for alcohol; 32%
substituted for illicit substances. All of the participants consistently sited the reasons as follows: more effective, less
side effects, less risk of dependence and addiction.

Ohio and other states with medical cannabis have an ethical obligation to add opioid addition and treatment of opioid
withdrawal symptoms to the list of qualifying conditions that can be treated within our state medical marijuana
program. Additionally, states that have not yet realized the medical potential of cannabis should revise and update their
policies and procedures given the extent of the national opioid epidemic. There is irrefutable clinical data highlighting
cannabis as a lifesaving treatment for opiate addiction and dependency.
References

1. Data Overview | CDC’s Response to the Opioid Overdose Epidemic | CDC. Published June 1, 2022. Accessed June 23, 2022.
https://www.cdc.gov/opioids/data/index.html
2. Opioid Data Analysis and Resources | CDC’s Response to the Opioid Overdose Epidemic | CDC. Published June 1, 2022. Accessed June 23, 2022.
https://www.cdc.gov/opioids/data/analysis-resources.html
3. Barlowe TS, Koliani-Pace JL, Smith KD, Gordon SR, Gardner TB. Effects of Medical Cannabis on Use of Opioids and Hospital Visits by Patients With Painful
Chronic Pancreatitis. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2019;17(12):2608-2609.e1. doi:10.1016/j.cgh.2019.01.018
4. Boehnke KF, Litinas E, Clauw DJ. Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of
Patients With Chronic Pain. J Pain. 2016;17(6):739-744. doi:10.1016/j.jpain.2016.03.002
5. Lucas P, Baron EP, Jikomes N. Medical cannabis patterns of use and substitution for opioids & other pharmaceutical drugs, alcohol, tobacco, and illicit
substances; results from a cross-sectional survey of authorized patients. Harm Reduct J. 2019;16:9. doi:10.1186/s12954-019-0278-6
6. Socías ME, Wood E, Lake S, et al. High-intensity cannabis use is associated with retention in opioid agonist treatment: a longitudinal analysis. Addiction.
2018;113(12):2250-2258. doi:10.1111/add.14398

7. Lucas P, Walsh Z, Crosby K, et al. Substituting cannabis for prescription drugs, alcohol and other substances among medical cannabis patients: The impact
of contextual factors. Drug Alcohol Rev. 2016;35(3):326-333. doi:10.1111/dar.12323