by New research from the University of Southern California shows that cannabis may help some people stop or reduce their opioid use.
“We surveyed 30 people who used opioids and cannabis and injected drugs,” said Sid Ganesh, a doctoral student at USC School of Medicine and lead author of the study.
Participants who received help at a methadone clinic and a needle exchange in Los Angeles said cannabis was a useful tool for controlling their opioid use, in part because it has become much more accessible in recent years.
Patients with opioid addiction often face many hurdles to access life-saving treatments such as Suboxone and methadone, as well as the overdose treatment drug naloxone.
The study, published in Drug and Alcohol Dependence Reports, received federal funding from the National Institute of Drug Abuse, which typically supports research that looks at the harms of cannabis rather than potential benefits. The study is particularly unique because it uses qualitative data and focuses on the lived experience of drug users.
Ganesh says qualitative research sheds light on what actually works for the populations being studied and why, especially when those populations are at risk and struggling with all sorts of issues that may not show up in one data point. Fifty-seven percent of participants in her study were homeless or lacked stable housing, and 70 percent earned less than $2,100 a month.
“You have to understand what is going on in people’s lives,” she said.
Any information that can help untangle the complicated relationship between opioid addiction, overdose, and cannabis use is urgently needed. Opioid overdose deaths have been rising in recent years, claiming more than 80,000 lives in 2022. Several studies suggest that cannabis legalization has helped people reduce their opioid use, but evidence of its impact on opioid overdose rates is mixed. Some studies find that there are fewer opioid overdoses in states with legal cannabis, others report the opposite. Still others say there is no difference either way.
Ryan Marino, an addiction medicine specialist and professor at Case Western Reserve University School of Medicine, says it’s hard to say what impact, if any, cannabis legalization will have on these numbers.
“Our drug supply is so toxic that overdoses continue to rise regardless because fentanyl is so prevalent and there are constant changes in it,” Marino said.
Ganesh and her colleagues found that cannabis could help study participants get through some of the most difficult phases of stopping or reducing opioids. They described that cannabis was used to relieve withdrawal symptoms as well as cravings and anxiety in the post-withdrawal period.
“When you smoke weed, you get over the hump and get the urge to get high for the first time,” said one participant. “That’s the thing about weed.”
People who have recently stopped taking opioids or reduced their use are particularly at risk of overdosing because their tolerance is lower. Marino, who treats patients with opioid use disorder, says he has seen some of his patients successfully use cannabis to get off opioids or at least use less, while others have tried in vain. He says there is no data yet to suggest that cannabis can help the majority of people with opioid use disorder, but “if it helps one person not use opioids or not overdose, that’s worth more than all the evidence. Honestly, a life saved is a life saved.”
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To truly understand how effective cannabis might be for treating opioid use disorder, researchers would need to conduct large-scale clinical trials studying the drug.
Marino says federal restrictions have made it extremely difficult to study cannabis in this way, though that may change in the near future. A small 2015 study looked at how cannabis might help patients endure detoxification treatment using injections of naltrexone. That study found that dronabinol, a legal, synthetic form of THC, helped ease withdrawal symptoms. The authors also tracked participants’ cannabis use after they left inpatient treatment and found that people who smoked their own cannabis during the outpatient phase were twice as likely to get their second injection and complete the detoxification program.
Participants in Ganesh’s study used cannabis not necessarily because it is the best available medication for opioid addiction, but because it was the only medication they could get.
One participant described using cannabis to reduce her fentanyl use while waiting for a prescription for Suboxone, which helps people get off opioids. Ganesh says the most important takeaway from her research is that people who use opioids need better access to all kinds of harm reduction tools, including treatments like methadone and Suboxone, clean syringes, naloxone and, yes, possibly cannabis.
Marino has already seen how changing attitudes toward cannabis are affecting his patients. In the past, he has seen patients kicked out of opioid treatment programs and even banned from taking Suboxone because they tested positive for cannabis. This, he believes, can lead to patients returning to use, getting arrested, and even dying from an overdose. Now, he sees a possible future where cannabis is no longer a barrier to treatment, but an acceptable treatment tool.
