Cannabis as an entrance to illicit drug use – fact or fiction?
The proponent/opponent debate on whether cannabis use at an early stage leads to addiction to more dangerous drugs rages on, and is almost like a case of he said/she said. Those who disagree with the premise that cannabis is a gateway drug are especially incensed when it comes to questioning whether or not a young patient should be treated with medical cannabis instead of many widely prescribed opioid medications. They would argue “Why would you withhold an effective available treatment option that has a good safety profile from patients who are teens?” Moreover, where is the compelling evidence that cannabis use leads to additional substance use or abuse or to significant morbidity or mortality for that matter?
The opposing side would likely go so far as to say medical cannabis is a hoax allowing legal access to an illicit substance. They would further argue that the use of cannabis is a slippery slope toward use of more dangerous illegal drugs. The evidence for this fear-driven argument has been addressed in this blog previously. It is time to put the gateway theory to rest.
All things considered, alcohol and tobacco are readily accessible, and their misuse by today’s adolescents is well documented. Perhaps the focus should be on alcohol and tobacco prevention rather than marijuana? Large-scale implications for more serious and lifelong complications are attributable to these two substances in our society such as deaths due to drunken driving and lung cancer. In fact, recent research showed that each year, approximately 5,000 youth under the age of 21 die as a result of underage drinking.
However, the use of alcohol and tobacco are more tolerated by society. That does not necessarily mean that their use equates to being any safer. Can you recall those posters that depicted doctor’s smoking menthol cigarettes touting that their use soothes the throat? Thankfully, we now know better. Much better!
Cannabis as an exit strategy from opioid abuse
In another recent blog, we highlighted the disturbing issue of young athletes who are prescribed opioids for pain or injuries and becoming addicted, or moving onto even more dangerous drugs such as heroin, in increasingly large numbers. The toll prescription opioid addiction and abuse takes is staggering. Consider all the layers of life that it impacts: workplace, healthcare use, criminal justice system, and the very fabric of intimate partner and family relationships. In recent years, death from drug overdose in middle-aged adults was the leading cause of death from injury even exceeding that of motor vehicle accidents!
There are compelling reasons to get patients who are addicted to, or require treatment with long term use of, opioids off them altogether if possible. An alternative goal would be to at least transition them to something that is less harmful if ongoing symptoms require treatment. Cannabis has been used as an “exit” strategy to get patients off of opioid medications. ”…Synthetic opioids kill, cannabis does not”, reports Dr. Uma Dhanabalan of Uplifting Health and Wellness in Natick, Massachusetts where patients are being treated with cannabis to decrease or discontinue their use of opioid medication.
Are you wondering why opioids that can and do kill are prescribed widely by doctors, whereas use of cannabis, which has a greater safety profile, is still illegal in many states and entirely illegal at the federal level?
Let’s compare the effects of opioids versus cannabis on an anatomic level. Cannabis makes use of an inherent cannabis receptor system in the brain, which can affect the perception of pain. In other words, in patients experiencing pain, cannabis can reduce their sensation of that pain. Opioids are a category of narcotics that belong to a family of morphine-like medications that include illegal drugs, like heroin, and prescription drugs like oxycodone, hydromorphone, hydrocodone and codeine to name a few. These drugs use a different system of receptors in the brain, and also have the beneficial effect of altering the perception of pain. Opioids have the potential adverse effect of suppressing respirations to a point where someone could potentially stop breathing if taken in large enough quantities. In fact, this is usually the mechanism by which patients die from narcotic overdose. A remarkably significant difference between opioids and cannabis? Cannabis receptors do not affect the respiratory awareness system this way, and therefore would not cause someone to stop breathing.
A Band-Aid for Overdose?
The significant problem of deaths from opioids has prompted novel recent release of over the counter availability of the opioid reversal drug, naloxone (also known as Narcan) in multiple states. This medication which has readily been available by emergency responders is one of the first “go to” interventions for a person found with an altered level of consciousness due to a suspected drug overdose. The reversal is remarkably abrupt, and can save lives in the field quickly instead of having to wait for treatment in the emergency room. It is like empowering large numbers of people to be able to do CPR or like having defibrillators widely available. The people who can do the most good in the least amount of time are those people most likely on the scene first. Imagine the relief a parent or spouse might have knowing that an addicted loved one near overdose, can be helped right away. The duration of naloxone working in the body is shorter than opioids, so that if a patient is treated with naloxone, they should still see an emergency provider.
According to the CDC, “the United States is in the midst of a prescription painkiller overdose epidemic”. Indeed, over 44 people die every day in the US from overdose of prescription painkillers. The CDC goes further into offering solutions to “safer, more effective pain management” – but cannabis is not among them. How many people fatally overdosed on marijuana in 2014? ZERO.
A FINAL THOUGHT
So aside from sheer ignorance or unwillingness to see the logic in transitioning patients away from opioids to medical cannabis – where exactly is the disconnect? Many believe that vigorous opposition from powerful groups like the pharmaceutical industry (who could lose billions in revenue if patients begin using medical marijuana for their treatment) and police unions (who also would face the loss of federal funding for the ‘war on drugs’) are presenting the biggest barriers. And even though acceptance and legalization of marijuana is evolving, turning a blind eye to the solution of seguing patients away from opioids with a much safer alternative such as cannabis, and continuing to keep it listed at the federal level as a Schedule 1 narcotic, just seems flat out absurd.