It’s no longer a secret that more and more people in America and around the world are using cannabis. This once demonized “gateway drug” is now opening doors and paving the way for a multibillion-dollar industry aiming to rival pharmaceutical drugs being used for a range of medical conditions; the most common being pain, anxiety, and depression (Corroon et al., 2017). The need for alternative treatments for conditions such as chronic pain is more pressing now than ever before due to this nation’s opioid epidemic. The long-term use of opioids has led to patients switching to heroin when physicians reduce their dose or cut them off from such pain medications completely (Dowell et al., 2016).

Cannabis has increasingly been used to navigate such dose reductions as well as replace prescription pain medication altogether (Sexton et al., 2016). A new 2017 study by Corroon and colleagues demonstrates the increasing shift from prescription drug use to cannabis as an effective substitute (2017). This does not mean cannabis can replace prescription drugs in every case across all medical conditions. However, there are clearly instances, such as the case with long-term opioid use, where cannabis does indeed prove to be a safer and more effective alternative (Lucas, 2012). This author believes medicine, like most things, is not simply binary, but complex and nuanced; the optimal and most progressive level of care is composed of a combination of therapies and treatments in which medical cannabis is most certainly included. From the start, this has been a patient-driven movement that is only gaining more steam and it’s time that we as a society gain a better understanding of medical cannabis and it’s potential as a potentially versatile medical treatment that can both complement and competes against its pharmaceutical counterparts.

Cannabis is beginning to play a significant role in lives of countless patients every day and thus, is finding it’s controversially unique place in the field of medicine. One intriguing phenomenon that is seemingly taking place as a result of this is the increasing trend indicating more patients are using cannabis as an alternative to their prescription drugs. “Bradford and Bradford reported a drop in filled prescriptions in such states between 2010 and 2013 for drugs under Medicare Part D for the treatment of conditions such as pain, anxiety, depression and others” (Corroon et al., 2017). With the opioid epidemic reaching epic proportions and recently declared as a national health emergency, finding alternative pain management treatments are imperative and cannabis may be one of the leading candidates in the search for a better option for pain relief. Cannabis does not generally cause severe withdrawals upon reduction or cessation of use, unlike withdrawal from opioids, which has led many opioid-dependent patients to switch to heroin (an incredibly potent opioid) for relief (Dowell et al., 2016). Current data shows that cannabis can act as an adjunct to opioid drugs, thus requiring a lower dose of opioid drugs to reach equal levels of analgesia when combined with cannabis (Lucas, 2012). Many patients have been able to replace opioid drugs altogether while others even report finding pain relief from treatment-resistant pain (Haroutounian et al., 2016).

Cannabis has also shown promise in the treatment of anxiety. Like the dangers of long-term opioid use in chronic pain patients, the long-term use of benzodiazepines (often called “benzos”) in patients with anxiety also carries significant dependency and abuse risks. Withdrawal from this class of medications, which include drugs like Xanax and Valium, can be dangerous and cause seizures in patients who cease taking them abruptly. Furthermore, combining this class of medications with the aforementioned opioids significantly increases the chance of overdose due to the synergy between the two drugs in their ability to cause respiratory depression. Some opponents of cannabis treatment stated that prolonged cannabis use could cause depression/anxiety, however, a 2016 study by Danielsson and colleagues demonstrated “no longitudinal associations between cannabis use and incidence of depression/anxiety” (2016). The increase in patients opting for cannabis over benzos for management of their anxiety is another example of how cannabis can replace more dangerous and addictive drugs.

While the biology of cannabis can most definitely be difficult to elucidate, the positive effects reported by countless patients who use it worldwide is not. In the case of pain, much of a patient’s experience is subjective and if cannabis can provide relief to a suffering chronic-pain patient, then do we really need to uncover the entire mechanism behind why this happens before providing access to this relatively safe treatment? By now, it is likely common knowledge that no one has ever overdosed on cannabis before.

This is due to the lack of endocannabinoid receptors in the brainstem, an area of the brain responsible for autonomic functions such as breathing. There are opioid receptors in that part of the brain, however, thus why an opioid overdose results in potentially fatal respiratory depression. As a scientist myself, I am eager to uncover more about the effects of cannabis on the human body as it will, in turn, help us learn more about our own endocannabinoid system that comes built into all of us. While humans have been using cannabis for centuries, we still do not have concrete data on the long-term effects of cannabis use in humans.  However, I also understand the safety profile of cannabis far outweighs the risks/hazards it poses, especially when contrasting it with drugs like opioid narcotics and benzodiazepines, in the treatment of certain medical conditions such as pain and anxiety. With further research and clinical trials, we may indeed uncover even more novel uses for cannabis as an alternative to prescription drugs.

By Gaurav Dubey

References

Corroon, J. M., Mischley, L. K., & Sexton, M. (2017). Cannabis as a substitute for prescription drugs – a cross-sectional study. Journal of Pain Research, 10, 989-998. doi:10.2147/JPR.S134330 [doi]

Danielsson, A. K., Lundin, A., Agardh, E., Allebeck, P., & Forsell, Y. (2016). Cannabis use, depression and anxiety: A 3-year prospective population-based study. Journal of Affective Disorders, 193, 103-108. doi:10.1016/j.jad.2015.12.045 [doi]

Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain – united states, 2016. MMWR.Recommendations and Reports : Morbidity and Mortality Weekly Report.Recommendations and Reports, 65(1), 1-49. doi:10.15585/mmwr.rr6501e1 [doi]

Fanelli, G., De Carolis, G., Leonardi, C., Longobardi, A., Sarli, E., Allegri, M., & Schatman, M. E. (2017). Cannabis and intractable chronic pain: An explorative retrospective analysis of italian cohort of 614 patients. Journal of Pain Research, 10, 1217-1224. doi:10.2147/JPR.S132814 [doi]

Lucas, P. (2012). Cannabis as an adjunct to or substitute for opiates in the treatment of chronic pain. Journal of Psychoactive Drugs, 44(2), 125-133. doi:10.1080/02791072.2012.684624 [doi]

Sexton, M., Cuttler, C., Finnell, J. S., & Mischley, L. K. (2016). A cross-sectional survey of medical cannabis users: Patterns of use and perceived efficacy. Cannabis and Cannabinoid Research, 1(1), 131-138. doi:10.1089/can.2016.0007 [pii]