Could Marijuana help solve the opioid epidemic? Many are starting to believe it can.
Though for those who remember the 'Gateway Theory,' this newfound belief in marijuana will come as a surprise.
Popularized by Robert DuPont in the 80's during the Reagan presidency's 'War on Drugs,' the Gateway Theory suggests that those who smoke cannabis would develop an appetite for further illicit substances, and spiral down a path of harder and harder drugs.
Presumably the weed smoker would acquire these drugs through their dealer, who possesses a host of other drugs and tries to sell them to the smoker to make more profits.
The fame of this theory comes largely from a guide DuPont published entitled 'Getting Tough on Gateway Drugs: A Guide for the Family' which outlined the consistency between those who used hard drugs, and their likelihood to have tried marijuana.
DuPont believed that marijuana use would "prime" the brain for harder drugs, and potentially increased the probability that marijuana smokers would go on to use heroin. The theory couldn't have come at a better time for those that opposed the plant, with the War on Drugs ramping up and Nancy Reagan's "Just Say No" campaign running alongside it – which urged individuals to reject all drugs.
The stance toward cannabis and other illicit drugs during the War on Drugs was essentially to imprison anyone found with an illicit substance – and so they did.
During this time, incarceration rates skyrocketed, and yet, so did illicit drug use. During the mid 70's to 80's, the use of illicit drugs from high school seniors were at their highest levels.
Though does the Gateway Theory have legs? Is there any legitimacy to the argument?
Well, yes and no. Heroin users are indeed very likely to have tried marijuana, just as they would have tried tobacco or alcohol. The issue comes with proving the causation of cannabis in leading one towards heroin use – that gets a little murkier.
Firstly, let's assume that there was causation, would the War on Drugs be the right approach to preventing cannabis use? It turns out no, the War on Drugs wasn't the best approach. In fact, evidence is proving the opposite to be true.
It seems that if you want to dissuade children from trying marijuana, you're better off legalizing the drug. In states where marijuana was legal, use among children actually decreased by around 1%. And while 1% isn't something to scream and shout about, it's certainly no indication that the War on Drugs was the right approach.
Although the War on Drugs may have missed the mark, that's not to say there weren't issues with drug use – many of which are at their worst today.
The Opioid Epidemic
In the 1990's in the United States, opioid deaths began to sharply rise eventually leading to 47,600 deaths in 2017 – over 130 deaths a day.
Readily prescribed for pain relief, opiates were the go-to solution for many doctors and healthcare providers for a growing number of ailments, leading to a massive spike in prescriptions. Prescriptions for opioid painkillers leaped from 76 million to 207 million between 1991 and 2013.
Drugs had broken through the perimeters of the War on Drugs, and it was now doctors, instead of dealers, that were prescribing dangerous substances.
In 2017, 1.7 million Americans reported suffering from substance misuse issues relating to prescription opiates.
There were 58 opioid prescriptions per 100 Americans in 2017, with rates higher in cities with greater unemployment.
It seems like the current "Gateway Issue" is simply having access to healthcare, as many unquestioningly take what their doctors prescribe them when they're in pain. In fact, studies have shown that 70% of heroin users had previously first misused opioid prescriptions.
Though for most, they simply continue to take the painkillers. After their injury heals, the pain goes away and users find themselves continuing to take the painkillers because of the euphoria they get from them. Then, before they know it, they have developed a dependency on the drug.
Unsurprisingly, athletes find themselves in this exact bind, as their jobs require intense physical activity, often leads to injury, which often leads to a prescription of opiates. A Study performed by Washington University's School of Medicine found that 7% of NFL athletes had misused opioid prescription painkillers, nearly four times higher than the general public.
So what can be done? Is all hope lost for those suffering from chronic pain? To receive an opioid prescription is both a powerful solution to your pain, but also a risky tightrope to walk upon. Well, now many are considering a new solution: cannabis.
Gateway Drug or Exit Drug?
This is where things get interesting. If there were ever a counterargument against the Gateway Theory, this would be it.
As Medicinal marijuana rises in popularity and becomes increasingly legal across the globe, doctors are beginning to prescribe it for anxiety, pain relief, insomnia, appetite loss and many other symptoms.
And perhaps most interestingly, in states where marijuana is legal, opioid prescriptions go down. This is a concept we covered with athletes who use cannabidiol, the non-psychoactive compound found within cannabis known as CBD, as an alternative to prescription painkillers.
Athletes in the NFL and the UFC are beginning to turn to CBD, as they can still experience pain relief without the negative physical effects or addictive tendencies that come from opioids.
And, as awareness continues to rise, more people are taking a similar tact to athletes, and self medicating using cannabis products as an alternative to opiates.
According to a study based on survey data from 2897 medical cannabis patients, patients overwhelmingly reported that cannabis provided equal relief to their other medications, but without the unwanted side effects. Ninety-seven percent of the sample also "strongly agreed/agreed" that they are able to decrease the amount of opiates they consume when they also use cannabis.
Now, given the fact that all this evidence flies in the face of marijuana being the "Gateway Drug," a new theory is emerging, that marijuana is actually the "Exit Drug."
Holding the torch for the 'Exit Drug' theory, is WeedMaps, an online community which helps cannabis users find out about local vendors and dispensaries.
To help push cannabis to the forefront of the opioid debate, WeedMaps created a documentary, entitled 'The Exit Drug,' which is a fifteen minute analysis into the potential for cannabis to be a replacement for opioid prescription painkillers.
The documentary involves many health and medical professionals, as well as those who fell into the grips of addiction with opiates.
Dr. Adie Wilson-Poe, a neuroscientist and advisor to WeedMaps, has analyzed the link between cannabis and decreasing opioid abuse for the past 13 years. Wilson-Poe strongly believes there is huge potential for cannabis as a potential opioid painkiller replacement.
On the topic, the neuroscientist has stated that "there are 115 opioid-related deaths every day in this country — nearly three deaths a week in New Mexico during 2016. More than 2.5 million people across the country are suffering from opioid addiction, yet action and interventions have been stalled. This crisis drains $500 billion annually from our national economy, but even that isn't enough to bring cannabis into the discussion."
"When patients have access to cannabis, they fill fewer opioid prescriptions, consume fewer opioids, overdose less and stay alive. No other policy, clinical intervention, law or pharmaceutical therapy has the kind of impact that cannabis does when it comes to opioid use."
– Dr Adie Wilson-Poe, Neuroscientist and advisor to WeedMaps
As medical marijuana continues to grow in popularity, and the FDA decides on CBD's place in the foods and beverages industry, cannabis is increasingly embedding itself into our daily lives. In the coming years we may continue to see a decline in opioid misuse, both in legal and illegal opiates due to the increased supply of cannabis, a natural, far less dangerous alternative.
And, as the list of benefits to cannabis use grows, we may soon see "curing opioid addiction" added to the list.