Changing cannabis policy

[Brain]

Treatment for opioid use disorder must take into account changing cannabis policies to maximize people's opportunities for recovery.

The United States is experiencing a severe overdose epidemic that was initially caused by the abuse of pain pills and then took the lives of many due to heroin and the synthetic opioid fentanyl.

According to the Centers for Disease Control and Prevention, more than 81,000 deaths were reported last year due to opioid overdoses.​

Millions of Americans suffer from an opioid use disorder, yet as of 2021, four out of five of them were not receiving the necessary treatment. This explains the critical need to expand access to medication-assisted therapy to help people recover.

One of the major barriers to effective treatment is the restriction of cannabis use for potential patients. Currently, many programs helping people with opioid use disorder require participants to abstain from cannabis use in order to be eligible for treatment. This approach highlights a serious mistake in the field of addiction medicine: our conservative stance on cannabis often leads to the exclusion of people from programs that can help them.​

We have neglected to research the potential of cannabinoids without noticing that some of them may have therapeutic benefits. Such short-sighted policies have deprived thousands of people of the help they need and overlooked the potential of cannabis for public health.

To effectively address the opioid crisis, we need to rethink our attitudes towards cannabis and develop more inclusive and effective treatments, carefully analyzing the risks and benefits.

Over the past decade, attitudes towards cannabis in the United States have undergone significant changes as the opioid crisis has escalated. Cannabis has become the fourth most popular psychoactive substance in the world after alcohol, caffeine and tobacco and contains more than 550 different components, the best known of which are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD).

So far, 38 states and Washington, D.C., have legalized the medical use of cannabis, and some states have even recognized opioid use disorder as a basis for medical use, though reliable data is still scarce.​

The Biden administration recently proposed reclassifying cannabis as a less harmful substance at the federal level, which would effectively legalize its use for medical purposes across the country. This reclassification may represent a major change in federal policy, but the new regulation is at odds with traditional approaches to the treatment of opioid-related disorders.

In the United States, methadone, which is a lifesaving medication for opioid use disorder, is dispensed through federally regulated programs that prevent this addiction. These specialized clinics provide daily doses of methadone, as well as counseling and other support.

However, many have strict abstinence policies that deny treatment to people who are found to have cannabis or its components. This prohibition is based on the assumption that cannabis can interfere with the recovery process.​

With the increasing legalization of cannabis and changing public opinion, it is evident that traditional abstinence policies are becoming increasingly distant from the growing acceptance of cannabis in society. The emergence of the concept of «California Sober», in which people give up alcohol and other drugs but continue to use cannabis, further emphasizes this disconnect.

Abstinence policies are based on the perception that cannabis use may negatively impact the treatment of opioid use disorder. However, new evidence, including results from recent systematic reviews and a meta-analysis conducted in January, refutes this view.

The recent study, which covers 4-15 months of follow-up data, found no significant association between cannabis use and relapse to non-medical opioid use among those in treatment. These findings compel a reconsideration of the role of cannabis and its cannabinoids in the recovery process, as well as a reevaluation of how policies related to cannabis use affect treatment access and retention.​

Some mechanistic studies suggest that cannabis and its components may have positive effects in the therapy of opioid use disorder. For example, the absence of some studies indicates that THC can reduce the need for opioids in the treatment of pain, and CBD may help reduce drug-seeking behavior and cravings caused by external stimuli.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9117273/
However, more research is needed to confirm these findings. Very impressive steps must be overcome before any component of cannabis can be considered an approved treatment for opioid use disorder.​

In order for a drug to receive FDA approval, it must pass a rigorous gold standard evaluation: randomized, double-blind, placebo-controlled clinical trials involving human subjects.In such studies, participants are randomly assigned to groups where some receive the study drug and others receive a placebo. The agency typically requires a minimum of two well-designed trials involving more than 200 people before it can begin the approval process for a new drug.To date, only a small number of studies have specifically evaluated the efficacy and safety of cannabinoids in the treatment of opioid use disorder.

The agency typically requires a minimum of two well-designed trials involving more than 200 people before it can begin the approval process for a new drug.

To date, only a small number of studies have specifically evaluated the efficacy and safety of cannabinoids in the treatment of opioid use disorder. Therefore, until these findings are confirmed in larger studies, the idea of using cannabinoids to treat this problem should be approached with caution, relying on already tested and approved treatments.​

Recovery from opioid use disorder is a complex process. For some people, complete abstinence may be the ideal solution, but for many in the early stages of recovery, this is sometimes an unrealistic goal.

Harm reduction strategies that focus on minimizing risk provide a more compassionate and practical approach. Policy decisions that immediately exclude people from treatment programs because of their recurrent cannabis use do not take into account the complexity of recovery. Moreover, such measures may unintentionally push people to return to dangerous illicit opioids such as fentanyl and its derivatives.

Many studies show that policy changes are needed. Current evidence questions the appropriateness of zero tolerance policies that reject the possibility of treating opioid use disorder dependent on cannabis use. Yet access to life-saving medications remains critical to the recovery process.​

We emphasize that we are not calling for the use of cannabis in recovery from opioid addiction. Instead, we emphasize the need for careful and individualized assessments of the role of cannabis in therapy.

Health care providers should monitor substance use and frankly discuss with patients the impact of cannabis on their recovery, including the impact on pain, withdrawal, and the desire to use other substances for non-medical reasons.

The complex relationship between cannabis and recovery from opioid addiction needs to be explored. Future research should focus on the safety and efficacy of cannabis and its component in treating symptoms of opioid addiction, as well as how different cannabis products and consumption patterns affect treatment outcomes. Such research, combined with meaningful clinical conversations, may lead to more individualized and effective methods of care.​

 

[prophet]

This is a very interesting article and well written. Thanks for this information. I have been on opioids for over 25 years, and it is the war on prescription meds which led me to using Heroin about a year ago, prior to that I had only ever done presription only medications like oxy and other stronger meds. Sure, I had tried Heroin when I was younger but I did not like it because it was not always the same like meds are. With prescription medicine you know what you are getting every time. I took suboxone once for 4 years, and honestly it made me worse. It caused quite a few other issues for me which I will not share but everyone reacts differently to medications, and as far as suboxone goes I do no believe there has been enough long term study to prove it is any safer in the long term as a treatment medication because some people need long term, yet they use this as an excuse for cannabis yet we know far more about Cannabis than drugs like buprenorphine just not in any official capacity through official approved channels.

An interesting example; Buprenorphine alone can be affective for pain but it also binds to the mu receptor and as a result lessens the ability of drugs like oxy to work for pain management. A friend with cancer who is on a short acting and long acting oxy for pain had a Dr. who decided to test buprenorphine as a long acting with the short acting to replace the long acting Oxy, and this caused much pain and discomfort for this individual for over 2 months until I found out about it and explained to them why they were in more pain. Apparently their doctor did not know this, and their pharmacist who fills the meds did not say anything. Drs are not trained in pharmacology like they should be, only Dr's of pharmacy are. I say this because Cannabis helped this person alot during this time. I have also taken Methadone, self prescribed so not from a clinic but i did it the same way the clinical dose would have and for 14 months I did very well, then my supplier died, he had the tablets for his long acting med, along with his oxy for short term. There is a big push to replace traditional opioids with buprenorphine for the treatment of pain and not just for medication assisted therapy, and while they say it is quite strong alone for pain on their little charts, having taken buprenorphine alone without naloxone for pain, it was not this way for me. It does work for pain, but was not as good as traditional opioids are in my case. I use for pain and because of addiction, but I am not a nod out user, I am a maintenance user, I function in society.

I think Cannabis should be, and likely will be eventually used in some way for opiod use disorder but, it will not be for everyone just as other methods do not work for everyone. One of the biggest issues seems to be the lack of indiviualized care, there is no one size fits all treatment for OUD because we are not all affected the same way by opioids. It seems that Dr's as well as the policy makers who are more in charge of the medicines we are prescribed than our Dr's are these days do not seem to know this, and for the ones who do, money makes them look the other way, unless of course they care, which is rare. Access to good information and TRUE information needs to be made available to people who rely on Dr.'s and clinics, and only the information they are told which usually comes from places like the FDA, among others is almost always one sided, or at least enough that the other other side will be forced into silence, and for those who are not are so few that now they are just called crazy. Cannabis and its policies have been no different over the years and though things are changing, it is so mixed up and there is such a lack good honest information just like there is in politics, people will only choose to believe what they feel is right based on the particular mindset they have and the side they choose to pick.
I make cannabis gummies for my friend with cancer an it helps tremendously for them, so much so that they take less pain medicines at times because of how well it works for them. In my case, cannabis does not work for my pain and sure does not help me with my OUD. If I could get Methadone tablets prescribed for my OUD the same way my old now deceased friend did for his pain I would be able to not only get off the H, I would also be able to treat my pain at the same time. Going to a daily clinic is not something everyone has the ability to do, as in my case so as an individual I carry on and do what I must because the system in place has failed me and as it does will surely continue to fail many others like me. That is why we need places like BB as a forum and a market along with all the other information like the experts who write these articles and those who are willing to help others with harm reduction strategies and the ability to obtain certain things which may help in this regard.