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Research Investigating the Use of Cannabis as a Substitute for Opioids

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Warning: This information is for educational purposes only. We are not medical professionals, and no information on this website should be construed as medical advice. For more information please view our Medical Disclaimer.

The opioid epidemic continues to worsen, with the U.S. Centers for Disease Control and Prevention reporting 81,000 overdose deaths from 2019 to 2020. Meanwhile, 19 American states have legalized recreational cannabis. Could cannabis be used as a substitute for opioids or help lessen the harms? 

Cannabis legalization linked to decline in opioid-related emergency department visits

A recent study led by the University of Pittsburgh found that when recreational cannabis is legalized in a state, there was a short-term decline in opioid-related emergency department visits. People may use cannabis to manage pain and relieve opioid withdrawal symptoms, but it doesn’t directly treat opioid use disorder, write the authors.

The researchers found a 7.6 percent reduction in emergency visits in the four states studied that have implemented cannabis legalization: California, Maine, Massachusetts, and Nevada. Twenty-five additional states acted as controls. The reduction was seen mainly in adults aged 25 to 44, and in more men than other people.

This decline was only seen for six months after legalization, though, which may suggest there is not a long-term replacement. But researchers are positive that this is good news for policymakers, stating that opioid use could be decreased with recreational cannabis laws. 

“We suspect that people who use opioids for pain relief are substituting with cannabis, at least temporarily,” said lead author Coleman Drake, Ph.D., in a press release. “Cannabis can provide pain relief for persons using opioids, but cannabis ultimately is not a treatment for opioid use disorder.”

Medical cannabis could reduce prescription opioid use

Cannabis may reduce the use of prescription opioids and improve quality of life, found Canadian research published in the journal of Pain Medicine. The study included 1145 medical cannabis patients at 21 clinics across Canada. Participants were 57.6 percent female, with an average age of 52 years. 

After six months, there was a 78 percent reduction in opioid dosages used. Similar reductions were seen in four other types of prescription drugs being taken by participants. 

In addition to lower use of opioids and prescription drugs for chronic pain, participants also reported an improvement in quality of life. The authors suggest that cannabis may play a harm-reduction role in the opioid overdose crisis and potentially improve public health. 

Those with opioid use disorder may increase use when consuming cannabis

While cannabis may be used as a substitute for prescription opioids, research has also looked at the use of both by adults with problem substance use. Research published in the journal Addiction found that opioid use approximately doubled on days when cannabis was also used. 

The paper studied adults in the greater New York area that were defined as having problem substance use. They used non-medical opioids, ie, street drugs such as heroin, and may also use medical opioids more than prescribed or without a prescription. 

“Substitution of non-medical opioids with cannabis was unlikely, regardless of the presence of significant pain, results that applied equally to men and women and across OUD [opioid use disorder] severity levels,” wrote the authors. 

Research developing around the use of cannabis as a replacement for opioids

The direct links between cannabis and opioid use are still unclear. But there is promising research around the use of cannabis to replace some prescription opioids to treat pain. Initial cannabis legalization has been connected to a decrease in emergency department visits. Cannabis has been shown in some studies to be used in the replacement of opioids, but this may not be the case for those with problem substance use or opioid use disorder. 

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Lindsay is a freelance writer, editor, and podcast producer based between Canada and Portugal. She loves to travel and live around the world and learn about other cultures. She’s interested in the uses, histories, latest research, and innovations of the cannabis plant.

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