America is in the midst of a drug crisis—and the War on Drugs may be making it worse.
There were 47,000 deaths in 2014 as a result of opioid overdoses (or some 128 overdoses per day), according to data from the Centers for Disease Control and Prevention (CDC). That figure isn't just more than any other year on record; it marks a 200 percent increase in opioid overdose deaths since 2000.
This is, as Vox points out, "more than the nearly 34,000 who died to car crashes, the almost 34,000 who died to gun violence, and the nearly 42,000 who died to HIV/AIDS during that epidemic's peak in 1995." And it's not just heroin or other illicit drugs driving this crisis: It's prescription drugs that are hollowing out entire pockets of the United States.
Over the weekend, some of America's top lawmakers decided to do something about it. The New York Times reports that the National Governors Association has decided to develop a new plan to combat the growing epidemic of opioid overdoses, focusing on "treatment protocols" for helping opioid addicts overcome their cravings, as well as new regulations for the pharmaceutical companies that produce and distribute the addictive drugs. "We must prioritize treatment for substance use disorder, a medical disease that needs our care and compassion," the NGA wrote in a statement. "Millions of Americans need help overcoming this disease, but the challenge lies in closing the treatment gap."
As far as the brain is concerned, opioids are the real gateway drug.
But weeks before the NGA issued their call for action, another lawmaker proposed a novel solution: Legalize marijuana. In a letter to the CDC, Massachusetts Senator Elizabeth Warren urged the agency to examine both the the effectiveness of medical marijuana as an alternative to opioids and the potential impact of marijuana legalization on opioid overdoses. "I hope that the CDC continues to explore every opportunity and toll available to work with states and other federal agencies on ways to tackle the opioid epidemic and collect information about alternative pain relief options," Warren wrote.
A growing body of research (neatly summarized by the Washington Post's Christopher Ingraham) indicates that legalizing marijuana could indeed help put an end to the opioid outbreak ravaging American communities. According to research published in a 2014 issue of the Journal of the American Medical Association, states that legalized medical marijuana saw a significant drop (24.8 percent) in overdoses, resulting in 1,729 fewer deaths in 2010 alone. While researchers said they couldn't necessarily draw a causal link between the decline, a 2015 working paper from the National Bureau of Economic Research found that states with marijuana dispensaries also experienced a significant drop in both opioid addiction (as measured by treatment admission) and overdose deaths.
So why do states with looser marijuana restrictions see fewer issues stemming from opioids? It's likely because medical marijuana offers a safer, less addictive alternative to prescription drugs, which are overprescribed as it is. As Ingraham points out, another JAMA study—this time, a meta-analysis of 79 studies—found that marijuana can be extremely effective at treating chronic pain, the most common symptom for which opioids are prescribed. And marijuana users tend to stick to marijuana: Ingraham notes that a 2015 study in Drug and Alcohol Review found that "80 percent of medical marijuana users reported substituting pot for painkillers, and 52 percent said they drank less when taking medical marijuana." By contrast, a much-cited 1997 study in Psychopharmacology found that opioids can make users more susceptible to other forms of addiction, in particular alcohol. As far as the brain is concerned, opioids, not marijuana, are the real gateway drug.
Similarly, marijuana can be used not just to help patients avoid opioid addiction, but to reverse it as well. A 2015 study from Columbia University showed that opioid addicts who were given dronabinol (a THC compound that uses the cannabinoids found in marijuana) reported significantly more mild withdrawal symptoms than those who went cold turkey. A similar study published in a 2013 issue of the American Journal of Addiction also found a decrease in withdrawal symptoms, including the anxiety and insomnia that comes from the body detoxing from chronic opioid abuse. Marijuana, it seems, can treat patients before and after they spiral into addiction.
Unfortunately for Warren, the type of research required by the CDC and National Institutes of Health to help turn marijuana into a weapon against opioid addiction likely won't be funded at the federal level. Research into the applications of marijuana has faced federal obstacles for years, and a recent analysis found that, from 2008 to 2014, $1.1 billion of the $1.4 billion the NIH spent on research focused on treating marijuana abuse, rather than exploring the potential benefits and applications of cannabinoids. These roadblocks led the Brookings Institution to accuse the federal government of "stifling medical research in a rapidly transforming area of public policy that has consequences for public health and public safety."
It's perhaps fitting that Warren's call for medical marijuana research preceded the NGA's new efforts to combat the nation's opioid crisis. With medical marijuana legal in 23 states and the District of Columbia, it's up to local and state governments to lead the charge in furthering the examination of the interplay between marijuana and opioids. In time, perhaps, America's opioid crisis will go up in smoke.