Emerging Evidence for Cannabis’ Role in Opioid Use Disorder
Beth Wiese and Adrianne R. Wilson-Poe
Cannabis and Cannabinoid Research, 2018, Volume 3.1, 179-189.
Doi : 10.1089/can.2018.0022
Introduction : The opioid epidemic has become an immense problem in North America, and despite decades of research on the most effective means to treat opioid use disorder (OUD), overdose deaths are at an all-time high, and relapse remains pervasive.
Discussion : Although there are a number of FDA-approved opioid replacement therapies and maintenance medications to help ease the severity of opioid withdrawal symptoms and aid in relapse prevention, these medications are not risk free nor are they successful for all patients. Furthermore, there are legal and logistical bottlenecks to obtaining traditional opioid replacement therapies such as methadone or buprenorphine, and the demand for these services far outweighs the supply and access. To fill the gap between efficacious OUD treatments and the widespread prevalence of misuse, relapse, and overdose, the development of novel, alternative, or adjunct OUD treatment therapies is highly warranted. In this article, we review emerging evidence that suggests that cannabis may play a role in ameliorating the impact of OUD. Herein, we highlight knowledge gaps and discuss cannabis’ potential to prevent opioid misuse (as an analgesic alternative), alleviate opioid withdrawal symptoms, and decrease the likelihood of relapse.
Conclusion : The compelling nature of these data and the relative safety profile of cannabis warrant further exploration of cannabis as an adjunct or alternative treatment for OUD.
Keywords : cannabis; opioid addiction; opioid treatment; relapse prevention
The opioid epidemic has become an increasingly pressing problem with an estimated 26–36 million people abusing opioids around the world.1 At the time of this publication, the Centers for Disease Control reports that 115 people die every day of an opioid related cause in the United States, and more than 33,000 people lost their lives to an accidental opioid overdose in the United States in 2015 alone.1–4 The United States consumes 80% of the world’s supply of prescription opioid analgesics (POAs), and opioid prescriptions have climbed by 300% since 1991.5 The rise in opioid prescriptions has also widened the demographic of individuals dying from opioid overdose; historically, overdose was most prevalent in urban, minority adolescent males; however, today these lethal effects are similar
across race, gender, socioeconomic status, and geography. 7–11 The spike in prescriptions has also directly contributed to an increase in the number of first-time consumers of illicit opioids (heroin, which is commonly laced with fentanyl or its analogs), which has continued to climb since the mid 1990’s.6 Patients who become physically dependent upon POAs frequently switch to illicit opioids because POAs are more costly and/or difficult to obtain.3,8,12,13 However, ease of access is a dangerous tradeoff for the lethal risk that is associated with synthetic opioids. Fentanyl, for instance, is 100 times more potent than morphine, which partially explains why there was a 250% increase in synthetic opioid mortality between 2012 and 2015.14,15
This unprecedented public health crisis warrants the investigation of novel sustainable interventions which would directly address the current opioid misuse crisis, complement current treatment strategies, and prevent future misuse through alternative first line analgesics.