There is currently an opioid over-dose crisis in North America:
According to the U.S. Drug Enforcement Administration, “overdose deaths, particularly from prescription drugs and heroin, have reached epidemic levels.”:iii Nearly half of all opioid overdose deaths in 2016 involved prescriptions. From 1999 to 2008, overdose death rates, sales, and substance abuse treatment admissions related to opioid pain relievers all increased substantially. By 2015, annual overdose deaths surpassed deaths from both car accidents and guns.
Drug overdoses have since become the leading cause of death of Americans under 50, with two-thirds of those deaths from opioids. In 2016, 62,000 Americans died from overdoses, 19 percent more than in 2015, and had killed more Americans in one year than both the wars in Vietnam and Iraq combined. By comparison, the figure was 16,000 in 2010, and 4,000 in 1999. Figures from June 2017 indicate the problem has worsened. While death rates varied by state, public health experts estimate that nationwide over 500,000 people could die from the epidemic over the next 10 years.
Opioid epidemic, Wikipedia
There have been a number of proposed solutions to this crisis. One is “Opioid Substitution Therapy” or “OST”:
… the University of Victoria’s Centre for Addictions Research (CARBC) has produced a users’ guide to the world of prescription opioids such as methadone and suboxone, treatment and recovery. The handbook “Patients Helping Patients Understand Opioid Substitution Treatment” was co-written by a group of OST patients, supported by funding from the Province of BC. CARBC Assistant Director Dan Reist calls the handbook “an important tool in the face of BC’s overdose epidemic.” The 43-page handbook is available for download on the CARBC website; print copies are being distributed to methadone and other opioid-substitution dispensing pharmacies, social service agencies and authorized prescribers across BC.
Q? From the perspective of an Opioid Substitution Therapy (OST) patient, why is this handbook so important?
Garth Mullins: Patients suffer through a Byzantine bureaucracy of medical jargon and advice from well-meaning experts who haven’t experienced this life. The OST handbook is not trying to sell anything. It tells people looking to get treatment for addiction the often ugly truth about their options as well as the potentially life-changing possibilities.
Opium seeds are available online – users can substitute home-grown opium for their more-concentrated opiate habit. The more concentrated the opiate, the easier it is to over-dose.
Prescription heroin is another proposal being investigated:
According to recent research, a program of prescription injectable opioids could lead to savings for B.C. taxpayers, partly due to a reduction in criminal activity. In the NAOMI study conducted 2005-2008 in Vancouver, the yearly cost to provide a patient with diacetylmorphine — the active ingredient of heroin — was $16,983 compared to $3,953 for methadone, according to a 2012 paper published in the Canadian Medical Association Journal. A 2007 study published in the Journal of Urban Health found that in Germany, heroin-assisted treatment produced a net savings equivalent to about 6,000 euros per patient per year, whereas methadone-maintenance treatment did not lead to savings because of its inability to substantially reduce crime and criminal-justice-system costs. Substantial savings with heroin-assisted treatment were also reported in studies in Switzerland and the Netherlands. And at the Providence Crosstown Clinic in Vancouver, the treatments are “in fact, a cost-saving strategy,” physician lead Dr. Scott MacDonald said during an interview for a Postmedia investigation last spring.MacDonald said the cost to society for someone to use illicit heroin is at least $45,000 a year, whereas the cost for Providence to deliver its injectable treatments is about $27,000.
A total of six randomised trials from six countries have been included in this review. Based on the evidence that has been accumulated through these clinical trials, heroin-prescribing, as a part of highly regulated regimen, is a feasible and effective treatment for a particularly difficult-to-treat group of heroin-dependent patients. Diamorphine hydrochloride (pharmaceutical heroin) is now registered as a medicinal product for this indication in five European countries (Switzerland, The Netherlands, Germany, UK and Denmark). New research is now testing whether further improvements could be achieved with combination of SIH and incentive reinforcement (termed contingency management, CM) or other specific rehabilitation strategies.
Cannabis substitution therapy is yet another proposal being investigated:
Between 2015 and 2016, Briscoe observed that 25 percent of her patients reported being able to “kick” opioids with marijuana. “They state it calms down their cravings, relaxes their … anxiety and is helping to keep them off opioids,” Briscoe wrote in November to the Department of Health’s medical advisory committee, which approved the petition and passed it onto Gallagher. “If they are in pain, cannabis is helping relieve their pain, often to the point that they don’t need opiates anymore.” A 2014 study published in JAMA Internal Medicine, which examined data between 1999 and 2010, found that states with medical marijuana laws had 25 percent lower annual opioid overdose death rate compared to states without such laws.
“Among 1,500 medical cannabis patients, three-quarters that used opioids reported a reduction in their use after starting medical cannabis,” explained Brian J. Piper of Geisinger Commonwealth School of Medicine, the study’s corresponding author. “Over-two thirds also reported a reduction in anti-anxiety, migraine, and sleep medications.
In one study, Ninety-seven percent of the sample “strongly agreed/agreed” that they are able to decrease the amount of opiates they consume when they also use cannabis, and 81% “strongly agreed/agreed” that taking cannabis by itself was more effective at treating their condition than taking cannabis with opioids.
There is some evidence that cannabis and opium work better when they work together – requiring less opiates (more toxic than cannabis) to achieve the same effects:
Cannabinoids and opioids both produce analgesia through a G-protein-coupled mechanism that blocks the release of pain-propagating neurotransmitters in the brain and spinal cord. However, high doses of these drugs, which may be required to treat chronic, severe pain, are accompanied by undesirable side effects. Thus, a search for a better analgesic strategy led to the discovery that delta 9-tetrahydrocannabinol (THC), the major psychoactive constituent of marijuana, enhances the potency of opioids such as morphine in animal models. In addition, studies have determined that the analgesic effect of THC is, at least in part, mediated through delta and kappa opioid receptors, indicating an intimate connection between cannabinoid and opioid signaling pathways in the modulation of pain perception.
Researchers from the University of North Texas, University of Florida, and Emory University found that opioid-related deaths fell by 6.5 percent in the two years following the state of Colorado’s decision to legalize recreational marijuana. Published in the November edition of the American Journal of Public Health, their work looked at opioid-related deaths in the state over a period of 15 years, between 2000 and 2015.
Before recreational cannabis was legalized in the state in 2014, Colorado was experiencing an upward trend of opioid-related deaths. Authors write that the reduction in deaths “represents a reversal” of that trend, but that further research must be conducted to replicate the data in other states with legal recreational cannabis.
While the study looks at the impacts of recreational cannabis legalization, previous research has examined the impacts of medical cannabis.