Marijuana and Opiates

August 2016

Medical Marijuana Today

Twenty-five states and the District of Columbia, have
passed laws since 1996 legalizing the use of medical
marijuana for qualifying patients under state law. While
state medical marijuana programs differ from one
another in significant ways, most allow medical
marijuana for the treatment of severe, intractable pain.
Opioids remain the most commonly prescribed
medicine to treat severe, chronic pain and are an
important tool in the medical arsenal. However, many
people do not want to take opioids given the side
effects and risks associated with their use. Marijuana,
effective in treating certain kinds of pain, affords new
options.
Safety and Efficacy of Medical Marijuana
Marijuanas medical safety and efficacy is well
supported particulary for the treatment of various
types of severe and chronic pain.i
In February 2010, the University of California Center
for Medicinal Cannabis Research released a report of
its findings after a decade of randomized, double-blind,
placebo-controlled clinical trials on the medical utility of
inhaled marijuana. The studies concluded that
marijuana should be a first line treatment for patients
with painful neuropathy and other serious and
debilitating symptoms, who often do not respond to
other available medications.
Another trial assessed the use of marijuana as a
treatment for patients suffering from multiple sclerosis.
That study determined that smoked marijuana was
superior to placebo in reducing spasticity and pain in
patients with MS, and provided some benefit beyond
currently prescribed treatments.ii
This evidence is supported by previous research. A
literature review of 38 studies evaluating medical

marijuanas efficacy for treating pain found that 71

percent concluded that cannabinoids had empirically
demonstrable and statistically significant pain relieving
effects, whereas 29 percent did not. The review found
that marijuana may be helpful for difficult to treat pain
conditons such as HIV neuropathy. And, that for some
conditions, marijuana was the only treatment that
provided relief. More recently, a 2015 meta-analysis of
79 studies found a 30 percent or greater reduction of
pain with the use of cannabinoids compared to
placebos.iii A third authoritative review article
summarizing the state of the research found that
smoked marijuana reduces symptoms of
chronic/neuropathic pain, spasticity associated with
multiple sclerosis, and other conditions and does so
with an acceptable safety profile.
Despite the growing evidence, many doctors are still
wary of reocmmending marijuana as an alternative to
opiate based therapies. It is recommended that
doctors be allowed to weigh the benefits against risks
of medical marijuana therapy just as they do with any
other medicine. Authors of the research suggest that
this hesitation is related to the Schedule I status of
marijuana, saying, The classification of marijuana as
a Schedule I drug as well as the continuing
controversy as to whether or not marijuana is of
medical value are obstacles to medical progress in this
area.
Opiate Overdose in the United States
Accidental overdose deaths are now the leading cause
of accidental death in the United States, exceeding
even motor vehicle accidents among people ages 25
to 64. In 2014, there were 14,000 overdose deaths due
to opiates in the United States with about 78 people
impacted per day. The United States holds about 25%
of the worlds population but ingests 99% of the worlds
hysdrocodone.iv With several high profile deaths

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recently stemming from accidental opiate overdose,

the conversation has shifted to alternative treatments
not only for the condition for which pain medication is
needed, but to help those dependent on pain
medication reduce or elminate their use. Research has
suggested that some medical marijuana patients are
looking to marijuana as a safer alternative.v
Medical Marijuana & Prescription Opioids
Not only is medical marijuana effective for treating
chronic and intractable pain, but inhaled marijuana has
also been found to complement prescription opioid
pain medicines well, enhancing the efficacy of (and
safely interacting with) these more powerful narcotic
medications and easing withdrawl symptoms.
Used in combination with opioid pain medications,
marijuana can lower opioid side-effects, cravings and
withdrawal severity as well as enhance the analgesic
effects of opioids, thereby allowing for lower doses and
less risk of overdose.vi,vii An important recent study
reported that their subjects' pain "was significantly
decreased after the addition of vaporized marijuana",
and suggested that marijuana treatment may allow for
opioid treatment at lower doses with fewer [patient]
side effects." The authors concluded that their results
demonstrate that inhaled marijuana safely augments
the analgesic effects of opioids."viii Research published
last year found 80 percent of medical marijuana users
reported substituting marijuana for prescribed
medications, particularly among patients with painrelated conditions.ix
How has access to medical marijuana inpacted the
use of opiates? A 2014 study published in the Journal
of the American Medical Association found that states
with medical marijuana laws are associated with a
significant reduction in mortality from opioid abuse;
these states saw a 25 percent reduction in opioid
overdose deaths, compared to states without such
laws, resulting in 1,700 fewer deaths in 2010 alone.x
Another working paper from the RAND BING Center
for Health Economics notes that states permitting
medical marijuana dispensaries experienced a 15 to
35 percent decrease in substance abuse admissions
and opiate overdose deaths.xi Similarly, another recent
report by Castlight Health, an employee health benefits
platform provider, found almost double the rate of
opioid abuse in states that did not permit access to
medical marijuana. Specifically, in those states, 5.4

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percent of individuals with an opioid prescription

qualified as abusers of the drug, whereas only half or
2.8 percent of individuals with an opioid prescription
living in medical marijuana states qualified as opioid
abusers.xii
Elected officials, including Senator Elizabeth Warrenxiii
and Congressman Earl Blumenauerxiv, have recently
expressed their support for the use of medical
marijuana to treat chronic pain as a way to help
address the opioid crisis. Given medical marijuanas
pain-relieving benefits, it presents a promising solution
to reducing the morbidity and mortality associated with
prescription opioid use in the United States.
Policy Implications
There are several policy changes at the state and
Federal level that can support the use of marijuana in
conjunction with opiate therapy. First, states with
medical marijuana laws can ensure that opiate
dependence is a qualifying condition for becoming a
patient. This would allow doctors to recommend
marijuana for patients who are or are at risk of
becoming dependent on opiate pain medication.
Secondly, the Schedule I status of marijuana should
be lifted so that more rigorous research can be done
and doctors can more freely learn about and
recommend marijuana for their pain patients. Finally,
marijuana should be viewed as a viable treatment
alternative for pain by the insurance companies and
should be utilized in substance dependence treatment
to assist those experiencing withdrawals from opiates
or other substances.

i
Ware, M.A., Doyle, C.R., Woods, R., Lynch, M.E., Clark, A.J.
(2003). Marijuana use for chronic non-cancer pain: results of
a prospective survey. Pain, 102(1-2):211-6.
ii
Jody Corey-Bloom et al., "Smoked Marijuana for Spasticity in
Multiple Sclerosis: A Randomized, Placebo-Controlled Trial,"
Canadian Medical Association Journal 184, no. 10 (2012).
iii
Whiting, P. F., Wolff, R. F., Deshpande, S., Di Nisio, M.,
Duffy, S., Hernandez, A. V., & Schmidlkofer, S. (2015).
Cannabinoids for medical use: a systematic review and metaanalysis. Jama, 313(24), 2456-2473.
iv
Centers for Disease Control and Prevention, Injury
Prevention and Control: Opioid Overdose. Available at:
http://www.cdc.gov/drugoverdose/data/overdose.html
v
Harm Reduction Journal, Cannabis as a substitute for other
drugs. Available at:
https://harmreductionjournal.biomedcentral.com/articles/10.11
86/1477-7517-6-35

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nyc@drugpolicy.org | 212.613.8020 voice | 212.613.8021 fax

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vi

Degenhardt, L., Lintzeris, N., Campbell, G., Bruno, R.,

Cohen, M., Farrell, M., & Hall, W. D. (2015). Experience of
adjunctive marijuana use for chronic non-cancer pain:
Findings from the Pain and Opioids IN Treatment (POINT)
study. Drug and alcohol dependence, 147, 144-150.
vii
Haroutounian, S., Ratz, Y., Ginosar, Y., Furmanov, K., Saifi,
F., Meidan, R., & Davidson, E. (2016). The Effect of Medicinal
Marijuana on Pain and Quality of Life Outcomes in Chronic
Pain: A Prospective Open-label Study. The Clinical Journal of
Pain.
viii
D I Abrams, et al. "Cannabinoid-Opioid interaction in
chronic pain," Clinical Pharmacology &
Therapeutics (2011); 90 6, 844851.
ix Lucas, P., Walsh, Z., Crosby, K., Callaway, R., BelleIsle,
L., Kay, R., & Holtzman, S. (2015). Substituting marijuana for
prescription drugs, alcohol and other substances among
medical marijuana patients: The impact of contextual factors.
Drug and Alcohol Review.
x
Bachhuber, M. A., Saloner, B., Cunningham, C. O., & Barry,
C. L. (2014). Medical marijuana laws and opioid analgesic
overdose mortality in the United States, 1999-2010. JAMA
internal medicine, 174(10), 1668-1673.
xi
Powell, D., Pacula, R. L., & Jacobson, M. (2015). Do
Medical Marijuana Laws Reduce Addictions and Deaths
Related to Pain Killers? (No. w21345). National Bureau of
Economic Research.
xii
Castlight Health. (2016). Report: The Opioid Crisis in
Americas Workforce. Retrieved from:
http://www.castlighthealth.com/typ/the-opioid-crisis/
xiii
Warren, Elizabeth. Letter to CDC re Opioid Epidemic
Research. Available at:
http://www.warren.senate.gov/files/documents/2016-28_Letter_to_CDC_re_opioid_epidemic%20research.pdf;
Accessed: 3/1/2016
xiv
C-SPAN. (2016, February 24). Blumenauer on Opioid
Abuse Epidemic. [Video File]. Retrieved from: http://www.cspan.org/video/?c4582196/blumenauer-opioid-abuseepidemic

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| 131 West 33rd Street, 15th Floor, New York, NY 10001

nyc@drugpolicy.org | 212.613.8020 voice | 212.613.8021 fax

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