Cannabis- Some Say Its a Viable Opioid Alternative to Manage Pain

Nov 02, 2018



Marijuana, or weed, is the slang term for portions of the Cannabis plant – one of the oldest psychoactive substances to man that dates back many centuries. There are numerous compounds in marijuana, and scientists attribute one specific compound to the drugs’ psychoactive effects: tetrahydrocannabinol (THC). This compound binds to regions in the brain responsible for pleasure, time perception and pain, according to the National Institute on Drug Abuse (NIDA). This triggers chemicals that stimulate dopamine production, a brain chemical often referred to as the “feel good chemical.” This effect makes recreational marijuana use highly popular and favored. 

Perhaps that’s why it’s no surprise the amount of THC in marijuana has grown over the past few decades, according to NIDA. In the early 90s, the average THC content in marijuana was about 3.74 percent. By 2013, THC content jumped to almost 10 percent, the NIDA reports. 

Like any other drug, marijuana has its pitfalls. Short-term use impairs thinking and coordination. In long-term studies on teens, those who smoke marijuana have lower IQs, as well as structural differences in their brains. Some experts argue this outcome may be due to habitual pot smokers seeking out less intellectually stimulating pursuits. A 2016 study by the University of Montreal offers a more serious look at the outcomes attributed to long-term marijuana use. The study, published in the Development and Psychopathology journal, found that teens who start smoking marijuana at age 14 do worse on cognitive tests by age 20 than those who don’t smoke. Smokers also experience a higher dropout rate. Those who start smoking around 17 reportedly don’t experience the same cognitive issues. 

It’s also important to note that NIDA links marijuana use to schizophrenia. The drug is also attributed to bronchitis, stroke and heart failure and other ailments, according to the New England Journal of Medicine. However, medical professionals across the country are looking to marijuana as an alternative to pain management, as opioid use, addiction and overdoses skyrocket. 

From opioids to medical marijuana 

When the late ‘90s hit, doctors, on the strength of false assurances by pharmaceutical companies, began prescribing opioids for pain management. They were told and believed the drug would not cause addiction, according to NIDA. By 2016, opioid-related drug overdoses killed approximately 116 people daily, with 42,249 dying from the drug annually and another 11 million misusing the drug, as reported by the U.S. Department of Health and Human Services. This highly addictive drug causes euphoria. Those addicted will resort to more accessible, less expensive and illegal opioids like heroin, when they lose access to prescription opioids. This is not only a public health issue, it is a national crisis. 

Increasingly, medical experts are turning to medicinal forms of marijuana, often referred to as medical marijuana or cannabis, to manage certain types of pain. They contend medical marijuana carries a much lower addiction risk than opioids. Here’s how it works: When a person uses cannabis, compounds in the drug bind to the human body’s own cannabinoid receptors. The receptors are a part of the body’s pain-mitigating network that produces the body’s own opiates, according to Dr. Donald Abrams, a professor of medicine at the University of California, San Francisco. 

“We have this whole system of receptors and internal cannabinoids that are probably present to help us modulate the sensation of pain,” he said. “That makes it sort of obvious that other cannabinoids – those that come from plants – could also have some benefit for pain.” 

To be clear, THC in marijuana is primarily responsible for the drug’s psychoactive effects. On the other hand, cannabidiol or CBD is another active cannabinoid that [does not] cause feelings of intoxication. Several industry studies back this up. In a June 2017 study in the journal Cannabis and Cannabinoid Research, patients surveyed who used both opioids and cannabis for pain management reported a higher satisfaction rate with cannabis than with opioids, as reported in the study by Amanda Reiman, a medical marijuana researcher and community relations representative for the cannabis brand Flow Kana. 

In that study, as well as others conducted by Reiman, patients typically reported the same three reasons why they opted for cannabis over prescription drugs for pain management. One, there was a smaller chance of experiencing withdrawals with cannabis; two, fewer negative side effects; and last, cannabis was more effective than their other medication.

Cannabis has its risks and other problems 

Cannabis contains THC, which may cause increased anxiety, worsening psychotic disorders, or mood disorders, as noted in several research studies. In elderly people, THC may cause disorientation which increases the risk of falls, according to Abrams. Additionally, cannabinoids may not be the best alternative for pain management for people with cardiac disease, as the compound can affect blood pressure and accelerate heart rate, Abrams also points out. 

There is another problem that people face who use cannabis: persistent social stigma. Reiman reported that people have a real problem making the paradigm shift to cannabis use out of fear of being negatively labeled. In that June 2017 study referred to earlier, she stated, “Though we were surveying medical cannabis patients in the state of California – where there is an active program – a great deal of our respondents said that they would be more likely to use cannabis as a substitute if it were less stigmatized and more readily available.” 

In a 2015 study published in the Journal of Psychoactive Drugs, researchers wrote, “Stigma emerged as a primary and recurring issue as it related to both the process of becoming a medical marijuana user and remaining one.” Study participants also reported that their decisions about using medical marijuana was negatively impacted by common stereotypes of all marijuana users as “stoners.” According to the study, this influenced whom they told about their medical marijuana use. 

November ballot contains three medical marijuana ballot initiatives. 

Missourians will have options on Tuesday, November 6, 2018, as there will be three marijuana initiatives on the ballot. Here’s how it shakes out: 

1. The New Approach Missouri measure is a constitutional amendment that would allow doctors to prescribe medical marijuana to patients with one of ten specified medical conditions. This includes cancer, glaucoma, epilepsy, chronic pain, PTSD and Parkinson’s. If passed, the measure would impose a four percent sales tax, and some of that revenue would be earmarked for veteran’s programs. The Missouri Department of Human & Senior Services would regulate sales, marijuana cultivation, and licensing. 

This is the only ballot initiative that would permit patients to grow their own weed – in state-registered facilities, after paying a $100 license fee. The Secretary of State’s Office estimates that the initiative would cost Missouri $7 million to operate annually, and would generate $18 million in tax revenue for the state, along with $6 million for local governments. 

2. The Bradshaw Amendment (named after Springfield attorney and physician Brad Bradshaw) would create a “state research institute” that consists of a nine-person research board led by Bradshaw. The petition states the institute would develop “cures and treatments for cancer and other incurable diseases or medical conditions.” The board would determine which diseases benefit from medical marijuana treatment. Sales taxes are estimated at 15 percent, with some of that revenue earmarked for veterans’ health care. The Secretary of State’s Office estimates the measure would cost the state $500,000 annually and generate $66 million from taxes and fees. 

3. The Missourians for Patient Care Act is a statutory amendment (the other two are constitutional amendments that can only be amended by voters) that could be amended by legislators down the road. The measure includes medical marijuana to treat cancer, epilepsy, glaucoma, intractable migraines unresponsive to other treatments, multiple sclerosis, PTSD, and seizures. It also includes a provision allowing “any other chronic debilitating or other medical condition...” at the professional judgement of the physician. It imposes a two percent sales tax. The Secretary of State’s Office estimates a one-time, initial cost of $2.6 million, annual costs of $10 million, and annual revenue of at least $10 million. Local governments would generate about $152,000 in annual revenue.

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