In 2017, Canada broke a national record for the number of apparent opioid deaths, with those occurring between January and September surpassing the number of deaths from all of 2016.
For almost 10 years, there have been a smattering of studies published examining the potential for cannabis to be used in the fight against the growing North American opioid crisis, given its aptitude for chronic pain relief. The legalization of weed in Canada this coming summer has thrust this debate back into the spotlight.
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“Our research is showing that patients that go through the proper dosing methodology, approximately 80 per cent of those patients will reduce or stop using opiates,” said Bryan Hendin, the founder and president of the Toronto-based medicinal marijuana clinic, Apollo Clinics.
What does the research say?
The most recent studies that support this theory were published early in April in the JAMA Internal Medicine journal, and highlight how legalizing cannabis in certain American states coincided with a reduction in opiate prescriptions in those states.
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The first study examined how legislation that let people use weed to treat specific medical conditions could be linked to a six per cent drop in prescribing opioids for pain. The second found that Medicare patients living in states with medicinal weed dispensaries filled about 14 per cent fewer prescriptions for daily doses of opioids than those in other states.
“It’s definitely a viable option. The research definitely shows that cannabis works on opiates … to reduce or substitute opiates for a better quality of life,” said Dr. Michael Verbora, the medical director with Aleafia Medical Cannabis Care.
Cannabis contains several compounds, including tetrahydrocannabinol (THC, the main psychoactive component in cannabis) and cannabidiol (CBD). Beyond the psychoactive effects of these compounds, research released in 2008 has demonstrated that they also impact the bodily systems in charge of pain regulation.
An additional study was released by the International Journal of Drug Policy in 2017 which further explored the use of medical cannabis as a substitution for several prescriptions. The patients involved in the study reported it to be a successful substitute for many prescription drugs, including opioids.
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In conducting its own study involving over 300 chronic pain patients over three years, Apollo clinics concluded that participants reported a 20 per cent reduction in the severity of symptoms and a dramatic reduction in opiate use, though it depended on what Hendin referred to as the “dosing methodology” behind this treatment.
What do the experts say?
Several cannabis clinics across Canada have trialled a method known as the “substitution method,” but according to Hendin and Verbora, this strategy can be “incredibly effective” for patients only when properly employed.
“The answer is, definitely maybe,” said Hendin. “It has everything to do with the actual handling of the medical cannabis.”
He went on to explain how an understanding of the product and the limitations of the patient are key to whether or not the substitution method is successful.
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“You have to spend time working with the patient, going through the process. If you don’t go through that process, you’re just throwing a dart at a board. There’s no strategy to it,” he said.
A patient that suffers from severe anxiety, he added, shouldn’t be prescribed a cannabis strain with high levels of THC, for example. Furthermore, if a patient suffers from schizophrenia, prescribing cannabis with high THC could also pose several negative consequences.
Verbora agrees that in implementing this method, it’s vital to “go about it slow because otherwise, it can cause a number of unpleasant side effects.”
Patients with severe mental-health conditions or are pregnant should also exercise caution when considering cannabis as a treatment for chronic pain.
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However, Verbora adds that while several studies have proven its efficacy in treating opioid dependency in patients — as long as caution is exercised amid certain medical nuances — there are several financial barriers to accessing cannabis in Canada that aren’t in place for other prescription drugs, including opiates.
Is Canada ready to use cannabis to fight the opioid crisis?
Canada is currently the second-largest, per-capita prescriber of prescription opioids in the world. As these numbers have continued to escalate, calls for employing cannabis as part of a solution to this problem have grown louder and louder.
One Windsor doctor, Dr. Christopher Blue, for example, has become known for prescribing cannabis to patients with chronic pain and trauma. In addition, the former B.C. Health Minister Terry Lake, who’s now the vice-president at a marijuana company, has been vocal in pushing for further research into using cannabis to treat opioid dependency.
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“I’m not saying it’s the answer to the opioid crisis. I’m saying it’s one of the options we should explore,” said Lake, who chose not to run in last spring’s provincial election.
“It’s very promising and deserving of further research and there’s no better place to do that than in British Columbia,” he said.
At the same time, Canada is quickly approaching legalizing recreational cannabis sometime this summer, and the federal government just recently launched several research projects to better understand the impacts of medical cannabis on the human body and mind.
While the research indicates that weed could be part of the solution to opioid dependency in Canada, both Verbora and Hendin admit that there are some financial barriers for patients who wish to access medical cannabis.
Currently, medical cannabis prescriptions are not covered under most insurance plans and are subject to a number of sales taxes, unlike many other prescription drugs including opioids. For example, some medical marijuana patients are bracing for an uphill battle in their bid to convince the federal government to exempt medicinal cannabis from excise taxes.
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Their lobbying effort will begin once MPs start debating the government’s budget implementation bill, which in its current form would apply the taxes to all but a small group of cannabis-based drugs.
“It’s a bit biased, and it’s counter-productive. There should be no taxes on it,” said Verbora. “The reality is, patients don’t want to be sick and most patients don’t choose to be sick. It does appear discriminatory.”
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Verbora and Hendin remain confident that even legalization in the recreational market could have an impact on opioid consumption as more Canadians opt to try weed instead.
“Quite possibly, we could see a reduction of opioids consumed. We have seen unbelievable reduction,” said Hendin.
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Furthermore, Verbora predicted that recreational legalization might prompt a reduction in consumption of alcohol and tobacco in Canada as well. He notes that patients hoping to reduce their consumption of opioids with medical weed should consult their physician first.
While he emphasizes that the opioid crisis in Canada requires a more layered approach than relying only on substituting opioid prescriptions with cannabis, he believes it can serve as a “very viable alternative.”
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