Is marijuana an opioid?
Marijuana and opioids have some characteristics in common. Both drugs can be sedating, putting the user to sleep, or causing them to start to nod off. Cancer patients undergoing chemotherapy can benefit from both medicinal cannabis and opioids to make treatment more tolerable.
Both prescription opioids and marijuana have been used to treat chronic pain. Opioid painkillers are generally safe when taken as prescribed in opioid treatment, but the risk of addiction is higher, compared to cannabis. While medical cannabis can help with chronic pain, it may not be as effective for severe pain.
While these drugs have some things in common, marijuana is not categorized as an opioid. Marijuana works on cannabinoid receptors and opioids work on opioid receptors. These receptors are in high concentration in the same regions of the brain, but they do have distinct actions when activated by a drug molecule.
Medical marijuana may have some use in treating opioid addiction. For example, some patients claim that cannabis makes the tapering process of reducing Suboxone dosage more tolerable. While it is possible to use marijuana for opiate withdrawal, doctors are concerned about their patients developing medical marijuana addiction.
Can medical marijuana help combat the opioid epidemic?
With the initial treatment of opioid abuse, medicinal marijuana probably is not the right tool for the job. There are a variety of different strains of marijuana. And, the response to a cannabinoid is individual. Different people respond differently when they consume cannabis.
That being said, a medical marijuana program could serve as a useful adjunct to a traditional medication-assisted treatment plan. Medical cannabis could be helpful in the transition from opiates to buprenorphine.
One issue with quitting the highly lipophilic fentanyl analogs being sold on the streets as heroin is that they linger in the body for days, stored in the fat cells. The normal waiting period to go from last opiate use to the first dose of Suboxone (buprenorphine/naloxone) or Subutex (buprenorphine) is about 24 hours.
With street fentanyl, the waiting period can be as long as 3-5 days. If an opioid addict patient starts taking Suboxone before enough opioid has washed out of their system, they will have a precipitated withdrawal reaction, which can be very unpleasant.
During the waiting period to start Suboxone therapy, medical cannabis could possibly help to reduce the severity of opioid withdrawal symptoms and opioid craving. While there are already medications that can assist in this manner, cannabis may work better, with less side effects, for some patients.
What is the marijuana maintenance program?
There is an old joke told in the rooms of 12-step recovery meetings about something known as “the marijuana maintenance program.” The joke is that a person who claims to be clean and only smokes pot has created their own program of recovery. The implication is that they are doomed to fail and should not be considered clean by the standards of programs such as AA and NA.
In light of the opioid crisis and the failure of traditional abstinence-based programs to slow the opioid deaths that continue to mount, we must start to look elsewhere for solutions. This is not to say that peer support programs do not serve a purpose.
Groups and meetings do help many people to build strong networks of support to help them stay in recovery. However, as these programs teach to their members, we must always remain open-minded, honest about our limitations, and willing to accept new ideas. We can integrate new concepts that work for certain people into a larger scope of treatment in which our toolbox contains many more tools.
Incredibly, within the same meeting, you might hear chuckles and whispered criticisms when a group member says they still use cannabis, and then see tears as someone talks about burying another friend who relapsed.
Is there ever self-reflection about the program itself? Is the blame for failure always placed on the opioid overdose victim?
If someone is using cannabis without engaging in opioid use, then we might agree that they are on a successful program of recovery. Of course, this path to being drug-free is not for everyone, and probably not right for most people. But, we must consider that when something works, endlessly fighting against it may not be the best course of action.
Can you get a prescription for medical marijuana?
Unlike opioid prescribing, there is no marijuana prescribing. The way that medical cannabis works is more complex than getting a simple prescription from a doctor.
Medicinal cannabis has taken an unusual path to legalization. Some states allow for medicinal marijuana. Other states have legalized recreational marijuana. And, in the remaining states, marijuana laws still treat this plant-based drug as an illegal substance with no legitimate medical use.
At the federal level, marijuana is also still illegal. It is classified as a schedule I drug, which means that the federal government considers it to have no medical purpose. This category includes drugs such as heroin and LSD. Other drugs of abuse, such as methamphetamine and cocaine, are schedule II. This means that the US government acknowledges that they have medical use, but also high abuse potential.
The prescription drug narcotic scheduling system may seem confusing. Schedule V includes controlled medications that have some abuse potential, but not much. Schedule IV has a higher abuse potential, and schedule III is even higher. The confusion comes with schedule I, where at least some drugs seem to have less abuse potential than drugs lower down the scale.
Marijuana is a schedule I drug.
Proponents of marijuana use like to point out that no one has ever died of a marijuana overdose. And, they say, it is far safer than alcohol and many other drugs, including opioid analgesics, that are legal and less controlled.
The lack of coordination between federal and state law with respect to marijuana is disconcerting. Usually, the law that is more restrictive takes precedence. By that reasoning, federal law that outlaws marijuana should override any state medical marijuana law that allow it.
However, the fact is that you can get medical cannabis in many states right now, and recreational cannabis is available in some states. If you ask your doctor for a prescription for medical cannabis, the explanation for how it works may seem a bit complicated.
Because of the uneasy standoff between the state governments and Washington regarding medical cannabis laws, it is not possible to allow for medical marijuana to be a prescription medication. Doctors must answer to both state and federal officials. A doctor cannot prescribe a schedule I substance.
Therefore, the states have come up with systems of certified and credentialed doctors “recommending” cannabis and placing patients on a special registry. By following this procedure and giving the patient their medical marijuana card, the patient can then shop for the cannabis of their choice at a local dispensary.
Should marijuana be legal?
While it is true that marijuana is safer than many other drugs, this does not mean that it is harmless. Prescription painkillers can lead to overdose death with opioid misuse, making them far more dangerous than marijuana. Yet, marijuana can still have long-term effects on mental functioning, particularly in young people.
The goal of many marijuana proponents is full legalization to allow for recreational use of cannabis products. People who are invested in the growing and dispensary industry stand to make the most money from legal recreational cannabis.
Yet, no one is in favor of legalization to the extent of being able to buy marijuana flowers in the produce department, next to the cucumbers. The push for legalization makes more sense when you follow the money.
Decriminalization of marijuana may make more sense than legalization, because it prevents unfair sentencing of people who are caught using it. With appropriately implemented decriminalization, individuals could grow marijuana plants for personal use without fear of imprisonment or excessive fines.
Many people, especially children, equate legalization of a drug with relative safety.
Marijuana can have serious, permanent adverse effects on short-term memory and motivation. People under the age of twenty-five should take care and refrain from marijuana use unless absolutely necessary for medical purposes.
So, if marijuana were again outlawed, yet decriminalized, what about medical marijuana? Before the push for legalization, there was already a marijuana product on the market, approved by the FDA. I am referring to the medication, Marinol.
Interestingly, Marinol is the only controlled drug in history to have its scheduling level reduced. It went from being a schedule II to schedule III. Marinol is a THC product, indicated for treating chemotherapy-related nausea and physical wasting due to HIV.
The main problem with Marinol in the past was the cost. I have heard patients complain that a month’s supply of 30 tablets was thousands of dollars. As of this writing, I have checked the GoodRx website, and the current price for the highest strength is well under $100 for a month’s supply.
How does medical cannabis fit in currently with treating opioid addiction and opioid dependence?
There are certainly anecdotal reports of patients being helped by cannabis in quitting opioids. Additionally, there are cases where patients have reported success in tapering off of a Suboxone medication assisted treatment program with the help of medical marijuana.
Is medical marijuana the best solution to these problems? To answer this question, we will need more research to evaluate the effectiveness of the drug and comparisons to other available treatments.
While we already have effective treatments for opiate addiction, we do need to fill in some holes in the treatment process with additional therapies. For example, with buprenorphine, the active drug in Suboxone, there is often difficulty in starting treatment because buprenorphine can cause an uncomfortable precipitated withdrawal if it is taken too soon.
Patients may have a higher success rate in getting started on Suboxone if they have additional treatment to help get through the transitional period from taking the last opioid dose to taking the first Suboxone film or tablet. With current street heroin and fentanyl, this time gap can be longer than usual, compared to opioid prescription drugs, sometimes even several days.
Medical cannabis may help to make the few days of withdrawal symptoms and cravings more manageable. While we already have medications such as Lucemyra or clonidine to help with withdrawal symptoms, cannabis may be helpful as an add-on or alternative for certain patients.
Are there people who cannot tolerate THC or cannabis products?
I once sat in a lecture where the speaker brought up the topic of Marinol prescribing. He said that patient over 65 would not tolerate Marinol as well as patients under 65. His reasoning was that, at that time, patients under 65 were far more likely to have tried marijuana at least once in their lifetime. They had experience with getting high.
Since that lecture was probably about 20 years ago, and marijuana use has become more acceptable and widespread, it is likely that most adults have tried marijuana at some point in their lives.
So, if a doctor is trying to decide if medical cannabis is right for a particular patient, rather than making assumptions based on age, they should ask if the patient has had prior experience with the drug. Also, the topic should be brought up carefully, so that the doctor can assess how the patient feels about medical cannabis and cannabis in general.
Since there are nearly always alternatives to recommending medical cannabis, doctors should probably not be too pushy about it. If a patient is against marijuana, when their doctor starts to lecture them on the benefits of medical marijuana, the patient will probably not be open-minded about it at all.
Finding common ground and understanding is an important part of the patient-doctor relationship. Doctors must listen carefully to patients and understand their beliefs and preferences. We, as doctors, can learn a great deal by listening to our patients rather than always lecturing them.
So are you for or against medical cannabis and legalized recreational cannabis use?
When it comes to drug addiction, especially opioid and alcohol addiction, there is a high risk of serious illness and death. We must use whatever tools are available to us if these tools have been demonstrated to be beneficial.
While it would not be right to recommend medical cannabis to all patients recovering from drug addiction and drug abuse, for those patients for whom it does work, we should consider allowing continued use. Of course medical marijuana must be medically managed.
If a patient is in recovery, they should not be using any substance obtained from the streets. This point is of the utmost importance. I believe that a patient who follows a prescribed plan from their doctor for addiction recovery is in recovery. Yet, just because the doctor is open to the use of medical cannabis does not mean that it is acceptable to buy bags of weed from the local pot dealer.
For patients to be considered successfully in recovery, they must end the habit of using illicit substances obtained on the streets.
Medical marijuana must be recommended by a certified marijuana doctor and dispensed at a state-approved dispensary. I am not registered with my state for recommending marijuana. While I believe that we must be open to using tools that work in addiction treatment, I have my own reservations about the legalization of marijuana.
I do not approve of the implementation of medical cannabis being outside the medical pharmacy system, yet doctors are expected to be involved in facilitating access. Another currently illegal drug that shows promise in addiction treatment, psilocybin, is on the path to acceptance and approval.
Yet, psilocybin proponents insist that the drug must pass through appropriate, traditional channels, to become an FDA-approved, federally controlled substance that doctors can administer and prescribe.
Regarding recreational cannabis, as I said earlier, I am not in favor of legalization, but I am also not in favor of criminalization. The plant exists in nature and should be allowed to exist.
Adults who choose to prepare and consume parts of this plant should not be thrown in prison. At the same time, children should not be given the idea that the substance is legal, and therefore acceptable and safe. Similar reasoning might be applied to other currently legal substances, such as tobacco.
On the other hand, making a substance such as marijuana legal for recreational use may be beneficial in providing a standardized product, reducing drug-dealing-related crime, and creating additional revenue for the states to educate people on the risks associated with recreational marijuana use.
In conclusion: Marijuana for opioid addiction treatment.
The issue of marijuana legalization and its use for medical treatment, including for addiction and pain relief, is complex. My opinions are just that, opinions. I can see the pros and cons of both sides of the marijuana legalization debate.
Regarding addiction treatment, opioid and alcohol treatment in particular, we must consider being more pragmatic, using what works and what saves lives. Harm reduction literally means doing what it takes to reduce harm, including reducing the incidence of disease, injury, and death, particularly opioid overdose deaths.
While marijuana use may not be ideal as part of a traditional recovery program, if it saves lives, we should not block access to this currently legal drug.