International Overdose Awareness Day | August 31st
By Darlene Agostini, RPh
Edited by Markita Wilburn, PharmD
I have been a licensed, practicing pharmacist since 1989. We are now all familiar with the term, “opioid epidemic” because tragically, the opioid epidemic has affected virtually every single one of us, either directly or indirectly. It is a national emergency here in the United States, as well as a global crisis. As a pharmacist who was trained in the 1980’s, practiced in the fast paced retail pharmacy setting for decades and more recently having transitioned over to the medical cannabis industry, I feel that I have had a front row seat watching this tragic epidemic grip this nation — and our world. My view of opioids, and my professional opinion regarding the subjects of addiction and overdose have changed drastically and no longer resemble the beliefs that I once held when I began my profession.
In the 1980’s, as a student of pharmacy, what we were taught about opioids is drastically different from what pharmacy students are taught today. We were taught that a person who is truly “in severe pain” will not develop a dependence on opioids due to intrinsic safety mechanisms contained within the body while a person who is not experiencing legitimate pain would indeed be in danger of dependence.
Fast forward to 2023, and we now understand the complex relationship that exists between pain and pharmaceutical medications. In fact, studies have shown that with chronic opioid usage, a patient’s pain tolerance decreases as their opioid tolerance (and dosage) tend to simultaneously increase over time. In fact, the National Library of Medicine states, “over the past several decades, an increasing number of laboratory and clinical reports have suggested lower pain thresholds and heightened atypical pain unrelated to the original perceived pain sensations as hallmarks of Opioid-Induced Hyperalgesia (OIH).
August 31st has been designated International Overdose Awareness Day. Many people will outwardly showcase their support with a display of black balloons, accompanied by community signs of solidarity against this disease. The dark cloud of shame surrounding this disease is being lifted as the light of education, compassion, and solidarity shine through the darkness. Thankfully, there are huge efforts to increase awareness, compassion and education regarding the impact this tragic epidemic has had on those dealing with the disease either directly, or indirectly with friends, family and loved ones.
According to whitehouse.gov statistics, the latest CDC report shows “109,940 predicted overdose deaths in the 12 month period ending in February 2023. Most of these deaths are caused by illicit synthetic drugs, likely clandestinely manufactured fentanyl and methamphetamine, often in combination with other drugs, including cocaine and heroin.” Additionally, the White House supports efforts to increase access to naloxone, which can reverse opioid related poisonings.
Opioid Addiction + MMJ
In spite of the official categorization of marijuana on a national level, the National Institute on Drug Abuse (NIDA) recognizes marijuana may indeed have a place in combating the opioid crisis, but caution more research is needed before any conclusions can be made by national (and, federal) authority. One study cited by the NIDA suggested US states with medical marijuana laws experienced slower rates of opioid analgesic overdose deaths compared to states without such laws, but did not demonstrate an overall reduction in opioid related mortality rates.
According to PubMed Central (PMC), “when given access to cannabis, individuals currently using opioids for chronic pain decrease their use of opioids by 40%-60% and report they prefer cannabis to opioids.” Patients in these studies reported fewer side effects with marijuana than with their opioid medications (including a paradoxical improvement in cognitive function) and a better quality of life with marijuana use, compared to opioids. The article goes on to say that a possible explanation for these observations may be linked to marijuana potentially interacting in a synergistic fashion with traditional medicinal therapy, thus decreasing the need for opioids. It states, “because patients report substituting cannabis for several types of pharmaceutical drugs, including opioids, benzodiazepines, and antidepressants, analgesic synergy may not entirely explain the opioid-sparing effects of cannabis in pain patients…Patients report that their reasons for substituting cannabis for other medications include less severe side effects, less withdrawal potential, ease of assess, and better symptom management for their conditions.”
PMC also states the general consensus is to initiate therapy with a CBD dominant oral product in the daytime, and gradually add THC by beginning with 0.5mg of THC to 3mg of THC, gradually increasing THC as needed by 1 to 2 mg once or twice weekly up to 30 to 40 mg per day or until a sufficient dose has been reached. The corresponding opioid tapering schedule is 5-10% of the Morphine Equivalent Dosage (MED) every 1 to 2 weeks.
We have a much better understanding of our own internal endocannabinoid system, and are beginning to understand the complexity of this system and how it either directly or indirectly affects a wide range of physiological responses within the body. Though more research is imperative, we are thankful to have general guidelines medical professionals can utilize to help patients find medical marijuana as an effective option to decrease opioid consumption.
Maitri Pharmacists are passionate when it comes to educating our community about the benefits medical marijuana has on opioid addiction and recovery. We are a safe place for patients to feel comfortable discussing their medical history with which stigmas have traditionally been attached. We take our time when we counsel our patients because we understand communication, education, compassion and understanding can change the trajectory of this epidemic — one patient at a time.
References
https://www.cnn.com/2022/11/03/health/opioid-prescription-cdc-recommendations/index.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165032/
https://www.cdc.gov/marijuana/health-effects/chronic-pain.html
https://nida.nih.gov/publications/research-reports/marijuana/marijuana-safe-effective-medicin
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135562/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6590307/