Is Marijuana the Solution to the Opioid Epidemic?

There was a lot of news this week on the potential to substitute marijuana for opioids to treat opioid addiction and chronic pain (here and here and here).  All of them are based on an article written by Yasmin Hurd in Trends in Neurosciences (February 2, 2017).  Dr. Hurd, a professor of psychiatry at Mount Sinai, argues that opioid addiction epidemic requires new and more adventurous thinking around the use of marijuana as a potential treatment for opioid use disorder.

Despite the catchy headlines, her paper does not propose a new treatment regimen using medical marijuana.  She does, however, argue that there are some promising chemical compounds found in the cannabinoids, suggesting that "cannabidiol (CBD) is the phytocannabinoid with perhaps the greatest potential for development as a therapeutic strategy for substance use disorders".  There have been some small scale studies that have indicated that CBD could someday be used to treat opioid addiction.

Mostly, her article argues that now is the time for government agencies to begin to take the potential of medical marijuana seriously in the fight against opioid addiction.

“. Although signifi-
cant momentum in the general public has
moved the pendulum regarding marijuana,
the scientific and medical communities
now need to play a more leading role via
evidence-based studies. In this way, scientific
and medical evidence will once
again serve to inform the public and to
develop efficacious and safe therapies.
However, such advances will require significant
and immediate actions to be taken
by the National Institutes of Health and
other federal agencies to help develop a
structure for fast-tracking the clinical use of
‘medical CBD’.”

— Hurd, Trends in Neurosciences, February 2, 2017

What I can't tell, as a layman, is what the prescription of CBD would look like.  Would Doctors prescribe that patients smoke a few grams of marijuana a day?  Would they prescribe THC candies?  Is she suggesting that the CBD compound should be isolated from the marijuana plant and reformulated as a pill or some other ingestible form?  From what I can tell, if just smoking marijuana cured people of their addiction to opioids, there would already be a lot fewer opioid addicts than we see now.  Maybe if it were prescribed in a more formal setting, combined with counseling, marijuana could substitute for medications like Suboxone?  

We will just have to wait, I guess.  It sounds from Dr. Hurd's article, that there is little current evidence that marijuana can effectively treat opioid addiction.  She is just asking that we leave no potentially promising stone unturned.

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