Breaking the Cycle: How Medical Cannabis Could Help Ease the Opioid Epidemic. Dr. Jerry Harrison, M.D.
The opioid problem in the United States is undeniable. Its impact on Alabama is unimaginable.
Alabama prescribes more hydrocodone tablets than any other state in the country, with the four counties of Winston, Walker, Marion and Franklin at the epicenter. In fact, when you look at the overall distribution across the state, statistically, Alabama itself is the epicenter of hydrocodone prescriptions in the entire world.
Doctors overprescribe mainly because they’re compassionate people trying to help ease their patients’ pain, and opioids present the path of least resistance. It takes 30 seconds to say yes to a patient’s request for a prescription, but 30 minutes to say no, having to explain opioid-induced hyperalgesia, which is when, as the medicine wears off, the patient actually ends up hurting worse. Even when an explanation is offered, many patients choose not to believe it. On top of all that, doctors might have as many as 50 patients to see in a day, meaning they simply don’t have enough time to spend with each of them. So being able to give those physicians safer alternatives to opioids is a consideration in the right direction.
One of the big questions out there right now is whether or not medical cannabis could be such an alternative. The current data doesn’t specifically support it, but it doesn’t specifically discount it, either. There is a lot of anecdotal evidence to suggest it has value, along with research that aligns with things we do know about the ways cannabis works in the human body as it relates to pain management. We must continue to take the existing and evolving research to a validated conclusion.
The research tells us cannabis doesn’t actually kill pain. Instead, the THC in the cannabis releases dopamine in the brain, and when people have dopamine in their system, they simply don’t pay that much attention to discomfort. It’s almost a kind of misdirection, where the chemicals trick the brain into looking the other way and not noticing when pain is present.
Compared to the effect of opioids, the end result is the same. A good analogy would be cooking something in the oven versus cooking something in the microwave: both appliances work differently, but when you put the food on the table, if it tastes the same, then who cares about the process? If THC reduces or eliminates even the perception of pain, then the end result is the same as opioids. And if you’re able to achieve that without the use of dangerously addictive drugs, the patient is obviously far better off.
One group of Alabamians being affected that is particularly troubling is military veterans. At the University of South Alabama, Dr. Joseph Courier, a psychiatrist with expertise in PTSD, has observed how Alabama veterans are keenly aware of the addictive dangers of opioids. As a result, they tend to avoid them, either choosing to suffer in silence or leave the state to get relief from legal medical cannabis offered elsewhere. There should be better, easier, more acceptable options for those who have already sacrificed so much.
There are also those groups of veterans dealing with both battlefield injuries as well as post-traumatic stress disorder at the same time. According to the National Center for PTSD, physicians attempting to relieve both the physical pain of injuries with opioids and the mental distress of PTSD with sedatives such as benzodiazepines can dangerously increase the risk of overdose. It’s quite possible that medical cannabis can alleviate both without the threat of addiction or overdose. Again, more data is needed, but there is anecdotal evidence to suggest further studies in this area would be of great value.