Cannabis-Based Medicine Shows Promise for Opiate Dependence

According to the Associated Press, “Sales of the nation’s two most popular prescription painkillers, oxycodone and hydrocodone, have exploded across the U.S. in the last decade.” The increasing abuse of Percocet and other opiate drugs is also leading to an increase in heroin use, and a skyrocketing amount of people seeking treatment for opiate dependence.

The Substance Abuse and Mental Health Services Administration said that over 100,000 individuals were admitted to emergency departments in 2004 for painkiller abuse, such as a Percocet overdose. By 2008, the number of admissions to emergency departments had almost doubled to over 300,000. Emergency Department visits involving oxycodone products, such as Percocet, increased by 152 percent between 2004 and 2008. The Drug Abuse Warning Network issued a report in 2010 that detailed how the non-medical use of prescription pain relievers continues to be a public health issue in the United States that warrants serious concern.

Treatments for opiate dependence with drugs such as methadone or conventional medications run the risk of making the patient addicted or dependent on the new medication. Conventional treatments for opiate dependence can induce severe withdrawal symptoms if the medication is stopped abruptly. A great need remains for the development of non-opioid drug therapies that have less dependence and abuse liability.

Since the 1970s, the primary active ingredient in the Cannabis plant, THC, has shown promise as a treatment of opiate dependence and withdrawal. However, it has so far been excluded from existing medical marijuana laws, despite strong evidence of its benefits. The plant remains off the table because of its federal status as Schedule I narcotic.

The use of Cannabis to treat drug dependence is an old idea. In the late 1800s, the Lancet published an article on a fairly successful treatment for opiate addiction, available in the form of a Cannabis tincture. Use of the Cannabis plant to treat substance abuse disorders also appears in ancient Indian texts and Ayurvedic literature. A recent survey of medical marijuana patients suggested that there is a significant population currently using it as an “exit drug” or as a less harmful substitute for alcohol and other drugs. Furthermore, intermittent marijuana use has been shown to improve retention in opiate dependence treatment programs, which were otherwise hampered by poor adherence.

The active ingredients in Cannabis interact with the endocannabinoid system within our body. This system consists of receptors, ligands (endocannabinoids), and proteins for synthesis and breakdown of endocannabinoids. Modern day researchers are studying these receptors and the natural THC-like compounds already existing in our body to treat various aspects of opiate dependence and withdrawal. For example, researchers in the laboratory of Dr. Aron Lichtman are studying a drug code-named JZL-184. This drug inhibits the proteins that breakdown endocannabinoids, thus increasing the amount of endocannabinoids available to interact with receptors. In Dr. Lichtman’s animal study, high doses of JZL-184 significantly blocked all signs of opiate withdrawal.

As more states pass laws allowing the use of medical marijuana, opiate addiction should be under consideration as a qualifying medical condition. In addition to bringing a viable alternative to a severely afflicted and growing population, this would greatly help researchers to overcome the barriers to studying Cannabis and refining the plant as a medicine. There is a great need for new effective treatments of opiate addiction that are non-toxic, have a low addiction potential, and do not cause severe withdrawal symptoms in opiate dependent patients. Cannabis can help us address that need.

Jahan Marcu, Ph.D., is the Vice-Chair of the Americans for Safe Access Multidisciplinary Scientific Advisory Board and is currently investigating the pharmacology of cannabinoid receptors at Temple University.

Reprinted with permission from Americans for Safe Access‘ Press Room.