Making the Leap from Prescription to Cannabis
Opioid crisis has been a buzz word in the media for the last few years. Canadian statistics report that from January to September 2017 there were at least 2,923 apparent opioid-related deaths, of which 92% were accidental. 72% of these opioid related deaths involved fentanyl or fen-analogues compared to only 55% in 2016. These statistics are alarming and give insight into the severity of Canada’s opioid crisis. Canadians need better solutions for treating pain and this needs to be a national priority.
Can Cannabis Help Alleviate Pain?
There is increasing evidence to suggest cannabis has a role in alleviating pain. Cannabis can either substitute or decrease the frequency of opioid and illicit drug use. Medical cannabis programs are associated with a decrease in use of opioids and associated morbidity and mortality. Increasing access to medical and recreational cannabis has significant positive impacts on public health and safety. Cannabis is associated with less adverse side effects, better symptom management and is a safer option than opioids due to its lack of ability in causing respiratory depression.
Cannabis can reduce opioid use prior to starting opioids in treatment of chronic pain, as an opioid reduction tool for those already taking opioids, or as an adjunct therapy for methadone or suboxone therapy. Four out of five heroin users report that their opioid addiction began with prescription opioids. If we can reduce the number of people starting opioids, we can reduce the overall rate of addiction to other substances as well. A recent survey of Canadian veterans reports that a decrease of approximately 30% in the number of prescriptions for benzodiazepines and a 16% decrease in the use of opioids while using medical cannabis suggesting cannabis could play a key role in reducing opioid use.
Treating Chronic Pain
Chronic pain is one of the most expensive and common medical conditions and can cost up to $635 billion per year. Opioids are one of the most common medications used for chronic pain, despite the lack of evidence and high rates of addiction. In a chronic pain study, patients who were using medical cannabis for pain reduction reported a reduction in opioid use, less medication side effects and an overall improvement in quality of life. Cannabis and opioids work synergistically to improve pain and reduce overall pill burden.
Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Substitution with cannabis might be an alternative for those who cannot stop or do not wish to stop using opioids and could be a key player in improving Canada’s opioid crisis.
- Abrams, D. I., Couey, P., Shade, S. B., Kelly, M. E., & Benowitz, N. L. (2011). Cannabinoid–Opioid Interaction in Chronic Pain. Clinical Pharmacology & Therapeutics,90(6), 844-851. doi:10.1038/clpt.2011.188
- Boehnke, K. F., Litinas, E., & Clauw, D. J. (2016). Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain. The Journal of Pain,17(6), 739-744. doi:10.1016/j.jpain.2016.03.002
- Lucas, P. (2017). Rationale for cannabis-based interventions in the opioid overdose crisis. Harm Reduction Journal,14(1). doi:10.1186/s12954-017-0183-9
- Principles of Harm Reduction. (n.d.). Retrieved from http://harmreduction.org/about-us/principles-of-harm-reduction/
- Public Health Agency of Canada. (2018, March 27). National report: Apparent opioid-related deaths in Canada (released March 2018). Retrieved from https://www.canada.ca/en/public-health/services/publications/healthy-living/national-report-apparent-opioid-related-deaths-released-march-2018.html
- Reiman, A. (2009). Cannabis as a substitute for alcohol and other drugs. Harm Reduction Journal,6(1), 35. doi:10.1186/1477-7517-6-35