The history of opioids has evolved alongside human society, spanning back far before we ever had doctor-prescribed heroin. Yes, that’s right; heroin was once prescribed by doctors. In fact, one of the biggest drug companies in America, the Bayer Co., started its production on a commercial scale in 1898 and continued until the substance became illegal in 1924. But opioids have been around longer than pharmaceutical companies.
Poppies, the plant from which opioids are derived from, are as hold as the hills but it wasn’t until about 3400 BC when The Sumerians of Mesopotamia first learned how to cultivate the plant into a consumable product (Andrew Rosenblum, Lisa A. Marsch, Herman Joseph, Russell K. Portenoy, 2008). Unfortunately, the history of opioids does not make them any safer or any more ideal for managing pain in humans.
While a poppy seed muffin or bagel is unlikely to give you any sort of negative effects or lasting, the seed itself does contain both morphine and codeine, which can result in trace detection in a urinalysis test. Still, the real concern is not baked goods; it is opioid painkillers, which saw a significant rise in the 90s. On average, the number of prescriptions written during that time-period increased by two to three million per year. From 1995 to 1996, the rate increased by a starting eight million (Sonia Moghe, 2016).
Of course, not every person who uses opioids becomes addicted. Yes, the propensity is high, but the overall risk is often caused by complex abnormalities within the brain. Other factors, such as the duration over which the drug is prescribed and overall dosage, may also play a part in a patient’s risk – but we will cover that in a bit. Let’s talk about the numbers and the scope of this epidemic.
According to the National Institute on Drug Abuse, overdose deaths due to prescription opioid pain relievers have more than tripled in the past 20 years (Nora D. Volkow, 2014). In fact, over the course of just a single year, opioid addiction kills more than 29,000 Americans. Moreover, the fatality often occurs quickly after addiction happens. CNN states that one out of every 550 patients who are started on opioid therapy are likely to die within approximately 2.6 years after their first opioid prescription.
In short, the epidemic is causing a pandemic of addiction, and not just in the kinds of people you would consider addicts. It is happening to parents, siblings, aunts, uncles, neighbors, coworkers, and friends. People who were once functional and cared for their children. People who used to have regular jobs and just wanted to live a normal and healthy life.
Who is At Risk for Opioid Addiction and How Do They Get There?
While, clearly, opioids are a risk for nearly anyone, there is conflicting information about how opioid abuse and heroin addiction starts. An article in the Scientific American cites an annually repeated analysis from the National Survey on Drug Use and Health in their assertion that 75 percent of opioid misused starts with opioids obtained from family members, friends, or drug dealers (Szalavitz, 2016).
However, doctors like Peter R. Martin, MD, professor of psychiatry and pharmacology at Vanderbilt University say that addictions often start because a person has suffered a personal injury or undergone surgery (Gardner, 2015). At first, they take the drug as prescribed by their doctor, but then something happens in the brain and they continue to use the drug, despite no longer needing it.
Most often, users start by going from doctor to doctor, asking for prescriptions. They often complain of the same pain, or will even make up new ones to obtain the drug. Unfortunately, this method of collecting often catches up with the patient. Many turn to dealers when this occurs. Eventually, some may trade out prescription pain killers for heroin because it is often cheaper and easier to obtain. Once things get to this point, there is almost no going back.
But why, exactly, does the addiction occur?
To understand this, one must first understand the differences between dependence and addiction. Though often used interchangeably, these negative effects from opioid use are actually quite different. Dependence, which essentially means that the brain and body have become accustomed to functioning with the drug, can lead to unpleasant withdrawal symptoms. However, the brain abnormalities that form from chronic heroin, oxycodone, or other morphine-derived drugs do wear off after the detox period. This is not the case with addiction.
An article published in the journal, Addiction Science & Clinical Practice, tells us that some of the brain abnormalities that can lead a person to addiction are genetically predisposed. Addiction is a psychological inclination that produces cravings or desire for the drug, which usually continue, even after the body’s dependence on it has resolved. In short, dependence is a negative but short-term side effect of opioid misuse. Addiction is a chronic and lifelong illness.
“When heroin, oxycodone, or any other opiate travels through the bloodstream to the brain, the chemicals attach to specialized proteins, called mu opioid receptors, on the surfaces of opiate-sensitive neurons (brain cells). The linkage of these chemicals with the receptors triggers the same biochemical brain processes that reward people with feelings of pleasure when they engage in activities that promote basic life functions, such as eating and sex. Opioids are prescribed therapeutically to relieve pain, but when opioids activate these reward processes in the absence of significant pain, they can motivate repeated use of the drug simply for pleasure.” (Thomas R. Kosten & Tony P. George, 2001)
So who is more likely to experience addiction, rather than dependence?
Professor David Nutt, who was interviewed by celebrity Russell Brand in a documentary titled, “Russell Brand: From Addiction to Recovery.” says that only 10% of the populace that takes recreational drugs or drinks get addicted because of a deficiency in dopamine, or an overactive amygdala. Impulsive personalities are also at risk.
Scientific American states that, “Two-thirds of people with opioid addictions have had at least one severely traumatic childhood experience, and the greater your exposure to different types of trauma, the higher the risk becomes”. We also know that women are more likely than men to experience chronic pain, and as a result are more likely to be prescribed opioid painkillers.
Using Cannabis to Get Off of Opioids
When a study talks about using cannabis to get off opioids, one should not assume that they mean any and every type. Instead, it is important to point out the impact and purpose of each major cannabinoid; each has different effects on the body and the brain. Further, one must understand how the cannabinoids interact and work together to create optimal results during each phase of the addiction-fighting process. Also, be aware that these were studies done on rats. It is difficult to get human studies because of marijuana’s Schedule I drug classification.
One of the most comprehensive studies on the use of cannabinoids in fighting addiction can be found in the journal of Substance Abuse: Research and Treatment. In it, the researchers looked at cannabis use during three phases: intoxication, relapse, and the withdrawal phase. While CBD, alone, had a positive effect on relapse and intoxication phases of opioid addiction, its effect on the withdrawal phase was mixed (mostly ineffective). However, researchers found a notably improved difference when CBD was administered alongside THC (Prud’homme, Cata, & Jutras-Aswad, 2015).
In another study by the same authors, CBD inhibited the reward-facilitating effect of morphine without disrupting motor function. CBD is also known to work its magic through neural mechanisms that are relevant to addictive disorders. Its action in the endocannabinoid system works as a weak inverse agonist of CB1 receptors is one of those mechanisms, but CBD was also found to normalize the heroin-induced changes to the brain’s CB1 receptor mRNA expression in as little as two weeks.
Thanks to a systemic review of 13 different studies on the effects of cannabinoids, which was published in the journal Oral & Facial Pain and Headache, we also know that cannabinoids can provide effective analgesia (relief) from chronic neuropathic pain conditions that are otherwise unresponsive to other treatments (DG, G, G, & MF, 2015).
Further, a safety study found that quality-controlled herbal cannabis when used by pain patients for over 1 year, has a reasonable safety profile when used by pain patients for a year or longer (MA, T, S, JP, & team, 2015). The average dose was at 2.5 g of herbal cannabis a day. They studied 215 chronic pain patients in the cannabis group, compared to 216 controls (no-cannabis-group). There was a slight increase in the incidence of mild to moderate adverse events in the cannabis group (the types of adverse events were not defined in the study), but there was no increase of serious adverse events.
A more recent study, published in the European Journal of Pain found that topical CBD administration offers therapeutic potential in the relief of arthritis pain and inflammation without any evident side effects (DC, et al., 2016). In this application, it is clearly safer to offer or prescribe topical CBD medications for pain management instead of opioids. Unfortunately, this does not generally occur in states without medical marijuana laws. But there are a few places where opioid prescriptions are an exception, not a rule – and patients, families, and entire communities are benefiting from it.
In fact, doctors who reside in states where medical cannabis is legalized are already reporting a drop in the number of painkiller prescriptions they write. Further, Time Magazine reports an average of 1,826 fewer annual doses of painkillers are prescribed in states with legal marijuana, and states with medical marijuana laws saved $165.2 million per year in medical costs (Sifferlin, 2016).
Politicians that Push Back Against Medicinal Cannabis
Despite the growing consensus that medical cannabis could help people with heroin and opioid addictions, the White House and Trump administration have perspectives that are causing concern. Sean Spicer, White House press secretary, recently expressed in February 2017 that we could expect to see a greater federal crackdown on recreational cannabis, even in states in which it is legalized. Many are uncomfortable with this act of government regulation when, for the most part, people have operated under state laws. But what is perhaps more troubling is that Spicer ties this crackdown in with concerns about opioid use.
“When you see something like the opioid addiction crisis blossoming in so many states around this country, the last thing we should be doing is encouraging people,” Spicer said (Liptak, 2017). “There is still a federal law that we need to abide by when it comes to recreational marijuana and drugs of that nature.” But this quote seems at odds with the fact that states with legal marijuana are prescribing less opioid painkiller prescriptions.
But still yet, others are worried about Trump’s appointment of Jeff Sessions as Attorney General, who has been an outspoken marijuana prohibitionist. Sessions has also been known to tie opioid addiction and marijuana together – as if somehow the two are interconnected.
According to an investigative Mike Ludwig, some conservatives are actually trying to progress legislation regarding marijuana. More specifically, Representative Matt Gaetz is expected to propose placing cannabis on the Schedule II drug list (Ludwig, Marijuana Reforms Gain Momentum as Trump Administration Mulls a Crackdown, 2017). Moving cannabis to a Schedule II drug would put it on an even playing field with opioids, making it easier to conduct research and legally prescribe cannabis. Of course, most scientific research agrees that cannabis is not highly addictive, but this would still be a step in the right direction.
Moving forward, it could only stand to hurt people and the public, if we continue to treat cannabis as we have in the past. Heroin and opioids cause death. Cannabis does not. Behavioral changes that often occur during opioid addiction (difficulty maintaining employment, stealing, lack of interaction with family, isolation, etc.) are rare with cannabis. Further, and perhaps worst of all, the controversy is dividing families that should be supporting and encouraging one another through an extremely painful experience into one of two groups: those that want to try cannabis to help a family member fight addiction, and those that believe such treatment is nothing more than trading one harmful addiction for another.
Nothing could be further from the truth.