When it comes to curbing America's opioid epidemic, some experts believe the solution could be found in another contentious drug: weed.
Over the past two decades, the overuse of prescription painkillers has caused a surge in opioid addiction in the US. Ninety-one Americans die every day from an opioid overdose, including prescription painkillers and heroin, according to the Centers for Disease Control. And with the recent influx of fentanyl, a dangerous synthetic opioid, the risk is only increasing.
As public health and addiction experts scramble to find a way to curb this epidemic, a new debate is emerging over what, if any, role cannabis can play in preventing addiction, and helping addicts recover. Some argue it can provide relief of the chronic pain that often leads people to opioids in the first place, while other worry it could cause recovering addicts to fall off the wagon.
"The first problem with this whole debate is that people are reducing it to cannabis being either helpful or harmful—a black and white thing," said Laura Zielinski, the research coordinator at CanvasRX, a medical marijuana information website in Canada. "It's a lot more grey than that."
Zielinski has researched the impact of cannabis on individuals recovering from opioid addiction and receiving methadone maintenance therapy, or MMT. MMT is a method of treatment that uses methadone, a safer opioid that allows addicts to slowly wean off their dependency without painful withdrawal symptoms (though methadone can be abused, and cause overdoses, too).
Zielinski found that for women in MMT, cannabis use was associated with falling off the wagon. Women who reported using recreational cannabis while in MMT were 82 percent more likely to also use illicit opioids, according to Zielinski's study, published last month in Biology of Sex Differences. But she told me it's not a clear cause-and-effect happening.
"Women on methadone have worse clinical and physical comorbidities, and higher rates of chronic pain," Zielinski said. "This poor mental and physical health could be a confounding factor for increasing both cannabis use and illicit opioid use."
There's evidence that cannabis can actually be helpful in curbing the opioid epidemic
Other researchers have found that cannabis use has no association with how well someone manages to stay off opioids while receiving MMT.
And there's evidence that cannabis can actually be helpful in curbing the opioid epidemic, by preventing potential addicts from ever trying opioids in the first place. Because prescription painkillers are often used to treat similar issues as medical marijuana, so substituting one for the other at the outset could prevent people from going down a path to addiction.
Recent studies support this theory. One study published in 2014 found that states where medical marijuana is legal had a lower opioid overdose death rate than states where marijuana is banned outright. W. David Bradford, a health economist at the University of Georgia, co-authored a study published last year that showed that in states where medical marijuana was legal, the use of prescription painkillers dropped significantly for Medicare enrollees. He told me he has another study coming out this week that shows a similar effect with Medicaid enrollees.
"That initial use of opiates, quite frequently, is a legitimate use following oral surgeries or having some acute, short-term injury," Bradford told me. "If we can divert people away from that then the chances that we can divert them from misuse and abuse go up substantially."
But it's still not clear if, weed will help or hinder the recovery process of someone already addicted to opioids. Even so, many addiction specialists already recommend cannabis for recovering opioid addicts, to help manage chronic pain and side-effects of recovery.
Zielinski told me there's a possibility cannabis could be a useful tool in opioid addiction recovery, but it would need to be better understood and administered in a clinical way. Unfortunately, the legal red tape around studying cannabis makes it even harder to figure out what role medical marijuana could play in the effort to curb the opioid epidemic.
Bradford told me that if these rules around research were eased, and if cannabis was re-listed by the Drug Enforcement Agency (it's currently listed as a Schedule I narcotic, which by definition means it has no medical use) scientists would be able to pin down if, when, and how it's appropriate to use cannabis to treat opioid addiction.
Otherwise, we might be leaving our best tool for fighting the opioid epidemic on the table.
"We need to have all hands on deck," Bradford said. "I know the Attorney General is skeptical about medical cannabis. But he needs to be terrified of fentanyl."