Is marijuana a safer drug to use for some people than an opioid painkiller?
A study published today in the journal Trends in Neurosciences is bringing that issue and related topics to the forefront.
The study was narrowly focused, looking at the potential use of an extract of cannabis found in medical marijuana to reduce the symptoms and cravings of people who use heroin.
But the study author, Yasmin Hurd, professor of neuroscience, psychiatry, and pharmacology and systems therapeutics at the Icahn School of Medicine at Mount Sinai in New York, and other experts, say the findings do highlight a need for the scientific community to further investigate the potential therapeutic uses of marijuana components.
This line of thinking, Hurd notes, is particularly critical now because of the opioid epidemic sweeping the United States.
She notes that 2.5 million people in the United States have opioid use disorder and more than 80 people die every day from opioid overuse.
She adds that 200 million opioid painkiller prescriptions are written in the United States every year.
“We have to do something urgently,” Hurd told Healthline.
What the study showed
For her research, Hurd used information from a small human trial as well as a number of animal studies.
She focused on cannabinoids, an extract of cannabis legally sold as medical marijuana.
Hurd said both cannabinoids and opioids regulate the perception of pain.
However, she concluded, the two drugs affect different parts of the brain as well as how the sensation of pain is communicated from neuron to neuron.
Cannabinoids tend to have a stronger effect on inflammation-based chronic pain.
Opioids, such as painkillers like hydrocodone, are better at relieving acute pain. That’s why they are used in situations such as post-surgery recovery.
Hurd said the downside to opioids is they are more addictive than cannabinoids. In addition, it is nearly impossible to overdose on cannabinoids, while it is possible to overdose on opioids.
“If you look at both drugs and where their receptors are, opioids are much more dangerous, in part because of the potential for overdose — the opioid receptors are very abundant in the brainstem area that regulates our respiration, so they shut down the breathing center if opioid doses are high,” Hurd said in a statement. “Cannabinoids don't do that. They have a much wider window of therapeutic benefit without causing an overdose in adults.”
She noted that younger people can overdose from consuming too much edible medical marijuana.
Hurd said that some people addicted to heroin might be better off using cannabinoids.
She said cannabinoids have the potential to reduce the users’ cravings and symptoms with less chance for addiction.
Hurd noted that states that have passed medical marijuana laws have noticed a decrease in opioid prescriptions and opioid overdoses since legalization.
The experts weigh in
Several experts interviewed by Healthline found merit in Hurd’s findings.
Dr. Thomas Strouse, medical director of the Stewart and Lynda Resnick Neuropsychiatric Hospital at the University of California, Los Angeles (UCLA), said the study brings up some “very interesting” points and issues.
Strouse, who also oversees a palliative care program, said some of his patients who experience acute pain from surgery or chemotherapy need to stay on opioids.
However, some patients who experience long-term chronic pain might be better served using components of marijuana.
He agreed that the effects from cannabinoids are not as serious as they are from prescription painkillers.
“Marijuana dependency is milder compared to opioids,” Strouse told Healthline.
He and Hurd did agree that people under the age of 25 whose brains are still developing should avoid marijuana-based treatments.
Officials at the National Institute on Drug Abuse (NIDA) also saw promise in Hurd’s research.
“It’s important to note that the focus of this paper is on cannabidiol (CBD) — a nonpsychoactive component of the marijuana plant — and that preclinical and preliminary evidence in human trials suggest that it may have therapeutic potential for treating some components of an opioid (and other) addictions,” Dr. Susan Weiss, NIDA’s director of the Division of Extramural Research, said in an email to Healthline.
Weiss added that the best way to administer such treatment is through “purified extracts of the plant or synthetic formulations of cannabinoids that can be reliably produced and administered through nonsmoking routes.”
Paul Armentano, deputy director of the National Organization for the Reform of Marijuana Laws (NORML), also agreed with the study’s basic findings.
He told Healthline that cannabinoids have been proven to be less addictive than opioids, tobacco, and alcohol.
He said people who use marijuana products rather than opioids usually came out ahead.
“When you weigh the ‘pot positives’ against the ‘pot negatives,’ you come out with a net positive,” he said.
The experts also urged the scientific community to continue researching marijuana’s therapeutic advantages.
Hurd noted that so far the policy on marijuana laws has been made at the ballot box, not in the nation’s laboratories and university halls.
Strouse had the same concern.
“I hope we are guided by science on this issue,” he said.