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Cannabis V. Opioids

By Evan Bottsford

According to the Centers for Disease Control and Prevention, more than 14,000 Americans died in 2014 from unintentional overdose of prescription opioids, making this the leading cause of death in many states. Countless others continue to take opioids, but it is estimated that only a small percentage of users are treating legitimate pain. The larger majority enjoy feeling numbed or simply have not been presented with more appropriate and helpful therapeutic options. Chronic pain is a tremendous public health problem. The Institute of Medicine estimates chronic pain affects 100 million Americans at an annual cost of $600 billion.


At present, the opioid epidemic is almost a uniquely U.S. problem. According to the National Institute of Health, we constitute less than 5 percent of the world’s population, and we consume 80 percent of the world’s opioid supply.

Although a current analysis of the benefit/risk profile of these two classes seems to favor cannabinoids, U.S. physicians greatly favor opioids. Physicians favor opioids for pain management because that is what they are taught in medical school. Much of this distorted perception can be traced back to the 1960s or earlier, when opioids were considered effective for chronic pain. Thus opioids in use at that time were placed on the list of drugs approved by the FDA.


Most regulatory agencies, such as the Food and Drug Administration, evaluate potential therapies based on benefit versus risk, at both the level of the individual patient and the general public health.


Medical cannabis advocates have used scientific data and compelling patient accounts to show legitimate uses of cannabinoids outside of recreation, especially for conditions such as chronic pain, epilepsy and post-traumatic stress disorder, which are notoriously difficult to treat with standard therapies.


Although public opinion is shifting  toward accepting cannabis decriminalization and/or legalization, it is still a battle in the majority of the medical community.

The US government currently holds a patent for “Cannabinoids as Antioxidants and Neuroprotectants”. This begs the question: why is cannabis still a Schedule I drug? Especially when extracts or synthetic forms of cannabinoids are generally Schedule III. Rescheduling cannabis would allow doctors across the U.S. to prescribe an appropriate form of cannabis as medication. Additionally, it would allow families to pursue treatment for children’s disorders live Dravet syndrome in their home state instead of moving to a legal state to find treatment, which countless individuals have done.


The National Academies of Science, Medicine and Engineering found “strong evidence” showing cannabis is an effective treatment for chronic pain in adults, relative to a placebo. The National Academies study is the most thorough review of the literature on cannabis to date, conducted by some of the nation's leading substance use researchers. Across numerous trials and experiments, the report found, people treated for pain with cannabis were “more likely to experience a significant reduction in pain symptoms” compared to a placebo or doing nothing at all.


Finally, neither opioids nor cannabinoids should be used as first-, second- or third-line therapies for pain, as there are almost always many much more effective and safer nondrug therapies.


We can and should do better for our patients.



Michigan Medicine

American Public Health Association