NORTHBUD, September 13 2018

EXPERT PANEL: CANNABIS AND THE OPIOID CRISIS

On February 9, 2018, the Center for the Study of Cannabis at the University of California, Irvine convened a workshop entitled Cannabis and the opioid crisis: a multidisciplinary view. The workshop was held at the Beckmann Center of the National Academy of Sciences in Irvine, California.

Susan Weiss from the National Institute of Drug Abuse was joined by Dr. Ziva Cooper (Columbia University), Dr. Daniele Piomelli (University of California, Irvine), Graham Boyd (Stanford University) and Dr. Rosalie Liccardo Pacula of the Rand Institute for a conversation, following the workshop.

Full excerpts from the conversation are published here.

The participants spoke in great detail about modern research, which shows a decline of opioid use in jurisdictions where cannabis is legally and freely available.

They discuss the meteoric rise of severe opioid addiction over the past 20 years, which is correlated with an increase of prescriptions.

“This crisis began with some well-intentioned attempts to more effectively treat pain, which in turn led to a large increase in the number of opioids being prescribed, up from about 70 million prescriptions in the early 1990s to more than 200 million by 2010.” Dr. Susan Weiss, Director, Division of Extramural Research at the National Institute on Drug Abuse (NIDA)

The discussion cites research from the Journal of Health Economics, which concludes that protections from cannabis-related prosecution had a significant impact on opioid-related mortality.

 …it is not so much having any medical marijuana law that mattered, that just recognizing the medicinal value of cannabis was not adequate, but it was actually the presence of having active and legally protected dispensaries that increased access to patients and had the significant impact on opioid-related mortality. In fact, when we conducted replication studies of an earlier study by Marcus Bachhuber and others, we found that just having any medical cannabis law, the impact of that disappeared, and it was only the persistence of open and legally protected dispensaries that mattered for reducing opioid-related mortality. Dr. Rosalie Liccardo Pacula, Director, Bing Center for Health Economics; Codirector, RAND Drug Policy Research Center; Senior Economist; Professor, Pardee RAND Graduate School

The good news is that when cannabis laws are changed, research shows that this has a direct impact on drug abuse rates, particularly opiates.

Researchers found that medical cannabis laws may be associated with a reduction in the number of prescriptions filled by Medicare and Medicaid. If you look more closely at the data, you see that there are suggestions that opioid analgesics are among the drug classes that are most affected by this decline. Dr. Daniele Piomelli, Professor, Anatomy & Neurobiology School of Medicine (UC Irvine); Louise Turner Arnold Chair in Neurosciences; Director, Institute for the Study of Cannabis

One of the speakers dove in deep to the analgesic potential for cannabis, in order to reduce the amount of opiates needed to treat pain.

…we measured the impact of cannabis combined with this very low oxycodone dose by eliciting a pain response using a standard pain test. We found significant analgesia, or a decrease in the pain response, when participants smoked the active cannabis in combination with this very low dose of oxycodone. We did not see pain relief in this model with cannabis alone or that dose of oxycodone alone. It was when we put the two together that we saw this ‘synergistic effect.’  Dr. Ziva Cooper, Associate Professor of Clinical Neurobiology (in Psychiatry), Columbia University.

Unfortunately though, despite the known potential for cannabinoids to aid with opiate dependence and other drug addiction, there are significant legislative hurdles for researchers in countries like the United States, where cannabis is illegal.

But it [cannabis] still is, literally, among the hardest substances to do any kind of medical research. You have to get a DEA registration, have security. You have to have a safe or a vault to keep the substance. The DEA visits you to make sure that it is secure enough. -Graham Boyd, Stanford Law School

The discussion ends on a positive note, with one of the researchers noting that, despite regulatory hurdles, the potential health benefits of cannabis are significant enough, and that the general public has taken notice.

Even though we are dealing with the immense regulatory hurdles discussed earlier, this is a really exciting time to be involved in this research because there are direct public health implications. The general public is eager to actually understand if this plant provides medical benefits and how can it be best utilized if it does produce therapeutic effects? Dr. Ziva Cooper, Associate Professor of Clinical Neurobiology (in Psychiatry), Columbia University.

In short, experts agree that there is a brighter future ahead for cannabis and cannabinoid research.

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