Floral design by Amy Merrick. Photo by Anja Charbonneau for Broccoli Magazine.
Cannabis in Light of the Opioid Crisis
It’s been hotly debated for years: Does cannabis have a legitimate medical use? It’s a Schedule I drug in the United States, meaning the federal government’s official view was—and still is—that marijuana has no legitimate medical purpose. Individual states, however, have recognized the research on marijuana’s clinical benefits for a variety of conditions. Now the first cannabis-derived drug—Epidolex, an oral cannabidiol (CBD) solution used to ease seizures in two rare forms of epilepsy—has been approved by the FDA, and the specific formulation rescheduled to Schedule V (meaning it has accepted medical use and low potential for abuse). This doesn’t affect the scheduling of other CBD products but may open the door for other cannabis-derived drugs in the future. And current research suggests they may be useful medications for pervasive and often debilitating conditions, including opioid addiction, which has been declared a national public health emergency.
Yasmin Hurd, PhD, the director of Mount Sinai’s Addiction Institute in New York City, studies the neurobiology of addiction. Hurd argues for a paradigm shift in the way we think about cannabis: It’s not just “weed”; it can be medicine in some forms—and policymakers should take it seriously. While the existing evidence is preliminary, preclinical studies suggest CBD might support people who are fighting addiction and trying to abstain from opioids. “It’s about preventing relapse,” Hurd says of using cannabis for opioid addiction treatment. And perhaps more pointedly: “It’s about saving lives.”
Still, Hurd says, cannabis is not a wonder drug—or necessarily always a safe one. While there is potential for a lot of help, there is also potential for harm. We spoke to Hurd about cannabis, opioid addiction, and how one may help with the other.
A Q&A with Yasmin Hurd, PhD
Detoxing someone from opioids is a relatively easy process—although it is difficult for that person, particularly the first two days or so. Detoxification is not the greatest problem; it’s the maintenance of abstinence that’s difficult. People relapse during opioid abstinence because they have intense cravings for the drug. Thus, it becomes nearly impossible to resist the urge to use the drug again.
People use methadone, an opioid substitution medication, to taper off of opioids—and CBD is being considered as an adjunct or alternative option. We can use it alone or in combination with methadone. There are no established opioid taper programs that include CBD, but we are currently trying to develop them. CBD decreases the cravings and anxiety that trigger relapse, and it also reduces opioid-seeking behavior—an effect we first discovered in studies where CBD reduced heroin-seeking behavior in rats.
Unlike opioids, CBD is not rewarding to the brain; since it’s not rewarding, people don’t become addicted to it.
Also, CBD may decrease long-term dependence and addiction in people maintained on chronic opioids for pain management, and we can help the process by introducing it early on in that treatment. We don’t have to wait for someone to become addicted to opioids for CBD to be useful. By combining CBD with opioid medications while those opioids are being prescribed, we can decrease the amount of opioids someone might need to manage their pain, as well as start to minimize some of the negative effects of long-term opioid use.
CBD is, unfortunately, still considered a Schedule I drug under the umbrella of “marijuana,” and so it’s restricted by state and federal laws that does not allow it to be officially prescribed. In the state of New York, for example, physicians who sign up for the Medical Marijuana Program can “recommend” medical marijuana for people, who then get a license to purchase it from a dispensary. They choose the form and amount depending on the company they choose to buy from. This is a major issue to me. For us to truly have “medical CBD,” it should be like all other medications that are obtained from legitimate pharmacies: through a physician prescription where the clinician provides informed guidelines regarding amount and frequency of CBD administration for the particular symptom or disorder.
Opioids are often prescribed for pain, and that’s where it became an epidemic: As physicians began giving them out in large and very potent doses for an extended period of time, people became addicted—and many died because of it. Research is still in progress, but small doses of THC might reduce the amount of opioids needed to manage pain.
We need a faster way to test whether something works or not. With so many people dying from the opioid crisis, time is of the essence.
The misconception is that cannabis is highly addictive and has no legitimate medical value. That’s simply incorrect—but in order to identify and isolate the compounds that have medicinal properties and formulate them into medications, we need randomized, double-blind, placebo-controlled studies. We’re in need of greater flexibility from the federal government to do that research.
Other researchers are studying cannabis around the world, so I hope we will soon have more data to determine whether or not there is sufficient evidence to start implementing cannabis in routine clinical processes.
Accumulated evidence has shown that opioid prescription rates are lower in those states that have legalized recreational marijuana. We don’t know the reason why yet. It could be that people are using THC as a replacement pain reliever. Or it could be that if they’re taking marijuana that has more CBD, the CBD may be having an effect on their craving centers. That’s why we need to do these studies to see whether the use of cannabidiol does decrease opioid use in a controlled setting.
It’s about educating politicians and educating the public. A lot of politicians who have voted for medical legalization don’t have a true understanding of the science. But when it became a point for election and reelection—and when one scientific breakthrough showed CBD could help kids with epilepsy—there was a bigger political push.
In addition, many people have used the term “medical marijuana” and pushed for medical legalization as an inroad to legalizing recreational marijuana. In doing so, they have corrupted the term “medical marijuana.” We should get rid of that term; I argue we should use “medical cannabinoids.”
The stigma has definitely decreased, but it’s still there because some people think that legalization efforts for medical marijuana are just about people trying to get high. People don’t always understand that CBD itself doesn’t make you high.
There is medicinal value to cannabinoids. I want the stigma to be associated with misuse, not clinical use under a physician’s guidelines.
I did not agree with legalizing marijuana for recreational use—about 30 percent of users will go on to develop a problematic use of cannabis—but I also see that marijuana use has helped with some medical and psychiatric disorders.
It’s unfair that the criminal justice system penalizes marijuana use, especially for black or brown people.
I want to emphasize that a lot of research still needs to be done, and I think there are medicinal benefits, but these are for people with certain disorders. I want the public to realize that just because CBD and other cannabinoids may have medicinal value doesn’t mean that we can now just start using it in regular daily life. They’re still drugs. We need to be diligent about what we’re taking. I don’t want people to get so comfortable that they don’t realize that there are issues with high-dose THC—it’s not a benign drug. High-dose THC does have a lasting, acute impact that can cause serious harm. We need to really be careful and educate everyone about the recreational and medical effects of cannabis.
Yasmin Hurd, PhD, is a professor of neuroscience, psychiatry, and pharmacological studies and the director of the Addiction Institute at Mount Sinai. She publishes research on the neurobiology of addiction as well as the effects of drug exposure on brain development.
This article is for informational purposes only, even if and to the extent that it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The views expressed in this article are the views of the expert and do not necessarily represent the views of goop.