Addiction to opioid medications and heroin is at crisis levels within the United States. Emergency room physicians have started adopting new strategies in the care of patients with pain by prescribing different kinds of medications, such as buprenorphine, ibuprofen, and even acupuncture. General practitioners have dramatically reduced the number of prescriptions they write for opioids due to the growing numbers of abuse and overdose that have arisen in just a short amount of time. Stricter prescribing guidelines have resulted in increased utilization of illicit street drugs such as heroin, which is stronger and cheaper than opioids. This has only further worsened the problem.
Many individuals addicted to opioids and heroin have been enrolled in a pain management program that is based on transitioning an individual from opioids or heroin and stabilizing them onto methadone. While methadone is still an opioid, it is used to manage an individual’s pain in addition to reducing the toxicity that is associated with traditional opioids and heroin. It also helps to reduce the number of withdrawal symptoms, reduce addictive drug-seeking behaviors, and does not induce a “high” effect like other opiates and heroin. Because of this it has been the primary standard for transitioning people from addiction to harmful, and even deadly, opioids and heroin to a managed care structure in which other avenues of treatment may be employed to alleviate the cause of an individual’s pain.
The first phase of transition from opioids or heroin to methadone is referred to as stabilization. It is associated with very high levels of stress and extreme vulnerability for relapse due to withdrawal symptoms from the use of a low to moderate level pain reliever. It is well known that many individuals enrolled in methadone treatment programs use other illicit drugs, most commonly cannabis.
In 2013, researchers Scavone et al from the departments of Neuroscience and Psychiatry from Thomas Jefferson University in Philadelphia wanted to better understand the impact that cannabis usage has on individuals transitioning from opioids and heroin to a maintenance dose of methadone. To understand if patterns of cannabis usage were associated with any benefit or harm for individuals transitioning to methadone treatment, the researchers conducted a review of their patient chart records and examined the reported objective usage of cannabis during treatment and its association with opioid cessation, the dose required to stabilize an individual on methadone, and overall compliance with treatment. It has been documented by other researchers that there exists an interaction between cannabinoids and opioids that greatly assists individuals during their transition to methadone.
It was hypothesized that cannabinoid interactions with opioid receptors would help relieve pain and lessen the severity of withdrawal symptoms. It was also thought that a potential synergistic effect may be observed with combined cannabis usage alongside methadone treatment. Scavone et al further hypothesized that cannabis usage would increase during the beginning of treatment and that this elevated usage would impact the initiation and stabilization dose of methadone.
Scavone et al obtained patient data from chart records from December 1, 2005 to July 1, 2009, including 500 patients total. In order to be included in the study, patients must have been involved in at least nine months of treatment, received monthly urine drug screening, daily attendance for treatment compliance, and have a documented history of at least one year of opiate use. After a thorough review, it was determined that 56 individuals met the criteria and would be compared against a random sample of non-cannabis users enrolled in the treatment program during the same time.
An alarming finding in the study was the discovery of the length of time individuals had been using opiates and how much was spent daily on them. 51 individuals had been in a similar methadone treatment program an average of 2.42 times. 71 of the individuals had been using opiates for an average of 15.62 years and spent a daily average of $108. It was then statistically tested to determine if cannabis users actually used less opiates than their non-cannabis using counterparts. It was found that cannabis using individuals did not use as many opiates as non-cannabis users, even though the severity of pain symptoms was deemed equal among the two groups. Further, it was discovered that cannabis users spent much less per day on opiates and in turn had less of a need for opiates to manage their pain.
Researchers noted that there appears to be some overlapping in the brain that lessens the severity of pain in individuals who concurrently use cannabis and opiates which causes them to purchase and use less opiates. Although there have been some studies suggesting that cannabis users are more likely to use many other illicit drugs, develop addiction to heroin, to not be able to follow through with treatment programs, or even to be forced to discharge early from treatment programs, this clinical based study found no evidence to support these ideas. This study found there was no risk for injury, early termination from treatment, or any other adverse effect associated with cannabis use during a methadone treatment program.
The researchers noted that cannabis using individuals did report less pain symptoms and fewer withdrawal symptoms compared to non-cannabis users. This is hypothesized to be due to interactions between cannabinoids and opioids within the brain that reduce pain and lessen withdrawal symptoms. This is confirmed from multiple animal studies that have documented beneficial synergistic effects between cannabinoids and opioids.
In summary, this study utilized an objective reporting measure of an individual’s cannabis usage, via a urinary drug screen, on a subset of a sample population. It was observed that individuals using cannabis during a methadone treatment program used less opiates in general, exhibited more tolerable pain management during methadone stabilization, and reported fewer withdrawal symptoms. Based on these findings, cannabis appears to show a strong benefit for individuals in a methadone treatment program for opiates and heroin cessation to reduce pain and prevent withdrawal symptoms. Further studies are now warranted in large scale trials to gain more detailed knowledge to better understand the unique synergistic interactions between cannabinoids and opioids.