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Cannabis: The Future of Pain Management

Can Cannabis Crush Opioid Dependence?

Canada is embroiled in a serious and rapidly growing opioid crisis, according to a Special Advisory Committee on the Epidemic of Opioid Overdoses—a panel mandated by the federal government to address the issue. Not only are opioids such as fentanyl, oxycodone, hydromorphone and codeine highly addictive, they are far too easy to accidentally overdose on, often fatally. Opioids are most commonly prescribed for pain issues. These dangerous pharmaceuticals claimed the lives of almost 3,000 Canadians in 2016 and the total could surpass 4,000 once statistics for 2017 are tallied. Over 21 million opioid prescriptions were written in Canada in 2017—almost one for every adult in the country. In a desperate measure to save lives, Health Canada has ordered free widespread distribution of naloxone kits through pharmacies across the country. Naloxone is a medicine that blocks and counteracts the effects of an impending opioid overdose.

The Canadian government, in 2017, ordered doctors to reduce the quantity and frequency of opioid prescriptions—attempting to cull the growing problem. The Liberal government has recognized the severity of the crisis to the extent of earmarking $231.4 million over the next five years to try to combat the Canadian opioid epidemic. Even with recognition of the issue, and directives to curtail the expanding opioid usage, the medical community is scrambling to find an effective and safer substitute. Having run out of tangible alternatives, more segments of the medical community are finally taking a serious look at medical cannabis. This is being investigated as both a solution to issues, and as an effective means of safely weaning those who have fallen victim to the highly addictive nature of the pharmaceuticals.

The US Department of Health and Human Services also declared that country’s opioid crisis a public health emergency. American government statistics confirm the propensity of the problem. In 2016,an  estimated 2.1 million US citizens suffered from an opioid addiction and over 42,000 American deaths were directly attributed to overdoses. To highlight the problem and possible solutions, the National Academies of Science, Engineering and Medicine in the United States jointly created a ground-breaking compilation of over 100 studies related to the value of cannabis as a medicine for a wide spectrum of medical conditions. The resulting report extols the value of cannabis and cannabinoids, the active medicinal components contained in the plant, as a viable solution for pain management, opioid addiction, and a host of other public health issues. The resulting book, The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research, examines the intrinsic value of cannabis and investigates potential risks for a host of potential uses. These include problems such as pain management and opioid dependency, but also conditions like MS, mental health issues and cancer. The conclusion of the research paints medical cannabis usage in a positive light and as a realistic and effective substitute for pain issues.

Jeff Chen, who spearheads UCLA’s Cannabis Research Initiative, believes they have found a key to the efficacy of cannabis in weaning off of opioid addiction. "If there is a chronic pain component, the cannabis can address the chronic pain component. We also find opioid addicts have a lot of neurological inflammation, which we believe is driving the addictive cycle. We see in preliminary studies that cannabinoids can reduce neurological inflammation, so cannabis could be directly addressing the inflammation in the brain that's leading to opioid dependency." In other words, cannabis can not only relieve many patient’s chronic pain issues, it can simultaneously aid in weaning off any opioid dependency that they have developed.

Yasmin L. Hurd, PhD, of the Friedman Brain Institute, Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, Center for Addictive Disorders, Mount Sinai Behavioral Health System, has done extensive research that she believes reveals the biomechanics responsible for cannabis helping opioid addiction. "Our results suggest that cannabidiol interferes with brain reward mechanisms responsible for the expression of the acute reinforcing properties of opioids, thus indicating that cannabidiol may be clinically useful in attenuating the rewarding effects of opioids”. This means that cannabis disrupts the rewarding effects of the opioid high—reducing craving and desire.

Cannabis use for pain in Canada is becoming much more prevalent and accepted as Canadians prepare to welcome legal recreational use into society. The first and second waves of early medical use adapters have had notable success and people have taken notice as ill family, friends, neighbours and co-workers have demonstrated visible health improvement on medical cannabis. People are also increasingly aware of the negative and dangerous pitfalls in opioid use. Unfortunately, Big Pharma—the oligarchy of powerful pharmaceutical companies, have used their almost unlimited wealth and power to discredit and deter the growth of cannabis as a medicine. Pill pushers potentially stand to lose a significant chunk of the more than one trillion-dollar annual global pharmaceutical market share to safer, non-addictive medical cannabis use.  A University of Michigan study from 2016 showed that cannabis users who suffered from chronic pain issues experienced a 64% drop in opioid use. Legalization in Colorado resulted in an overall reduction of opioid related fatal overdoses by 6.5%, in 2017.

Interestingly, it was recently revealed that murdered Canadian billionaire Barry Sherman, founder of Apotex—a global pharmaceutical powerhouse—was working on a slow-release cannabis pill with Canadian licensed cannabis producer CannTrust. This proprietary patented technology is potentially a game changer that could have significant impact on the bottom line of Big Pharma. Fortunately, research has progressed far enough that the medicine may still come to fruition, with CannTrust pressing on toward clinical trials. The battle between Big Pharma and the medical cannabis industry will continue their tug of war. However, as more evidence grows revealing the destructive nature of opioid use and research evidence for the efficacy and relative safety of medical cannabis use, a paradigm shift toward safer, non-lethal, non-addictive medical cannabis is inevitable.

Rick Gillman is a medical cannabis patient, consultant, and veteran freelance writer. He is involved in medical cannabis research and breeding projects--creating more effective medicine. He works for Canadian Cannabis Clinics as a Medical Outreach Educator out of the Collingwood, Ontario clinic.