The use of synthetic opioids is a significant problem in the US. The traditional treatment medications, methadone or buprenorphine, remain limited in availability with demand far greater than supply, and even with treatment, the relapse rates are high. I am a pain physician, and I believe that cannabis can help reduce drug overdoses and improve the lives of my patients.
Overdose deaths are sometimes associated with the very medications being used to treat the addiction. This substitution approach, replacing one mu agonist with another, has been the best available therapy — until now.
Studies suggest that cannabis may play a role in reducing opiate use disorder. The cannabinoid-1 (CB1) receptors and mu opioid receptors (MORs) have overlapping expression and colocalization. However, the brain stem, which controls respiration, has a limited number of CB1 receptors but a large number of of mu receptors, which explains why marijuana does not cause respiratory depression, but opioid use does.
The National Academies of Science and Medicine confirmed the efficacy of cannabis for chronic pain in adults; individuals currently using opioids for chronic pain decrease their use of opioids by 40–60% and report that they prefer cannabis to opioids.
My recommendation is to view cannabis as a harm reduction tool. To date, we have had zero deaths from cannabis use in the medical literature but more than 100 deaths per day from opiates.
Cannabis Cannabinoid Res. 2018; 3(1): 179–189.
Published online 2018 Sep 1. doi: 10.1089/can.2018.0022