How medical marijuana could help curb the opioid crisis
As the number of overdoses from fentanyl continues to rise across the country, the opioid crisis has emerged as one of Canada's most serious public health issues — and some researchers believe medical marijuana could help combat the problem.
People working in the field agree that solutions are needed now. Last year, the city of Vancouver alone reported more than 750 opioid-related deaths. And the crisis continues to spread. This week, officials in Toronto hosted a meeting to prepare for a potential epidemic of overdoses from fentanyl.
While it's not known precisely how many Canadians are addicted to opioids, prescriptions for the drugs have skyrocketed in recent years — up roughly 20% between 2010 and 2014. According to the Globe and Mail, Canadian doctors wrote 53 opioid prescriptions for every 100 people in 2015.
Reiman is the manager of Marijuana Law and Policy with the Drug Policy Alliance, a not-for-profit group that advocates for liberalized drug laws.
She believes medical marijuana could help people reduce their opioid dependence and even prevent some patients from being prescribed opioids in the first place.
"If cannabis works for them, then sticking with that rather than moving to opiates would be a smart decision in terms of preventing dependence or potential overdose," Reiman says.
"When people are able to use opiates and cannabis in combination, they are able to use less opiates over a period of time. So the less opiates someone is taking in, the less chance of overdose.
Medical marijuana vs. opioid painkillers
Derek Pedro, a 44-year-old man from Hamilton, Ontario, says switching to medical marijuana made it possible for him to kick his opioid addiction.
"I am no longer on any opiates, and I attribute it all to medical cannabis," he says.
Pedro has used opioid painkillers for most of his life. He suffers from a condition called Ehlers-Danlos Syndrome, which left him with chronic pain starting at the age of six.
As a child, Pedro took Demerol pills with him to school. Over time, doctors prescribed more and more opioids to help him cope with his pain — including Percocet, Oxycodone, and fentanyl.
"The cycle was horrible," he recalls. "From the minute you wake up to the minute you go to bed, it's all about the pills and how many you have. I never want to go back to that life again."
Pedro says he became determined to kick his addiction when he realized his dependence on the pills was affecting his young daughter.
I am no longer on any opiates, and I attribute it all to medical cannabis.- Derek Pedro
"We were going away for a weekend and I was upset; I couldn't find my pills. And I see that she could already comprehend I was upset because I didn't have my pills. And that was really my turning point," he says.
By gradually increasing his cannabis use and reducing his use of opioids, Pedro was able to wean himself off of his prescription pills over a three-year period. He says he hasn't taken a single opioid drug since 2009.
"Over time, I basically stopped using opiates — to the point where my doctors didn't believe me and I would actually have a urine test to prove that there wasn't an opiate in my system. In other words, they were concerned I was buying it off the street."
How are other patients using medical marijuana?
Derek Pedro's story comes as no surprise to Reiman.
"I think that there are a great number of people out there with stories like Derek's," she says. "Unfortunately, because of the stigma around substance use and substance dependence, many people are afraid to reach out for help."
Reiman has conducted several surveys of patients' use of marijuana at dispensaries in California and other American states. She says thousands are using marijuana as a replacement for other substances — including alcohol and both illicit and prescription drugs.
"They prefer cannabis to their other medications, mostly because cannabis not only has a better effect for their illness — but because there are less side effects and less risk of dependence."
As evidence, she points to several survey studies conducted in the past 15 years in both Canada and the United States. In one study, published in the Harm Reduction Journal in 2009, 75 per cent of patients surveyed in Berkeley, California, were using marijuana as a substitute for prescription drugs.
A survey of patients at four dispensaries in British Columbia echoed those results, with just under 70 per cent of patients indicating that they were using medical marijuana as an alternative to prescription drugs.
A larger, one-thousand-patient study of medical marijuana use at 20 clinics across Canada is currently underway, backed by Canadian cannabis producer Tilray and the University of British Columbia.
While these studies rely heavily on patients' self-reporting, Reiman says they show that many patients are already using medical marijuana as a harm reduction tool.
There is data to suggest that legalizing medical marijuana could reduce opioid overdoses, Reiman says. According to one 2014 study, between 1999 and 2010, U.S. states where marijuana is legal saw 25 per cent fewer opioid deaths than states where marijuana is illegal.
"This is population-based data, but it is showing a trend," says Reiman. "And I think, given the number of people that are experiencing dependence and potential overdose [from opioids], it definitely should be investigated further, and we really should put our effort behind some more efficacy studies."
How effective is medical marijuana as a treatment for chronic pain?
Reiman acknowledges that not every drug will be effective for every person, and that medical marijuana — like opioids — may not be for everyone.
But she believes medical marijuana, which has been found effective as a treatment for neuropathic pain, could be a viable alternative for many patients currently taking opioids.
"We have had quite extensive research on comparing opiates and cannabis for neuropathic pain specifically, and we've seen that for some patients, not only does cannabis work as well, but it actually works better," Reiman says.
We have to be more careful that we're not treating pain that's a level two with an opiate that's a level 10 drug.- Amanda Reiman, Drug Policy Alliance
In some cases, doctors may be prescribing powerful opioids to patients even when less-potent analgesics like medical marijuana could provide adequate relief, Reiman says.
"We have to be more careful that we're not treating pain that's a level two with an opiate that's a level 10 drug," she says. "We are very indiscriminate about how we prescribe opiates, and I think that's part of the problem."
Reiman acknowledges that there is limited clinical data on marijuana's medical efficacy. But she argues FDA restrictions have made it very difficult for researchers in the United States to conduct those clinical studies.
In the absence of that clinical data, Reiman says physicians should pay attention to what patients are reporting and make medical marijuana available as an option for people who are seeking relief.
"Given that we've spent the past 40 years trying to gain access to the ability to do clinical research on cannabis with limited success, I feel that physicians have been, for better or for worse, the gatekeeper to this botanical medicine," Reiman says.
"Until we change that system, they have to be able to work with their patients around the current barriers."