Is Cannabis a Viable Exit Drug
As medical cannabis is legalized in more areas, the notion that cannabis is a gateway drug is beginning to fade from popular opinion.
Opioid abuse is an international epidemic that took the lives of approximately 1,036 Canadians between January and March 2018. There is a growing body of research that suggests that cannabis, once villainized as a substance that put people on the path to destruction, may actually be what will help many of the people currently in the clutches of addiction. A 1999 report from the Institute of Medicine, explains how this is not the case: “In the sense that marijuana use typically precedes rather than follows initiation into the use of other illicit drugs, it is indeed a gateway drug. However, it does not appear to be a gateway drug to the extent that it is the cause or even that it is the most significant predictor of serious drug abuse; that is, care must be taken not to attribute cause to association.”
What is addiction? How do we classify it?
The National Institute on Drug Abuse classifies addiction as the following: “Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain. It is considered both a complex brain disorder and a mental illness.”
According to HelpGuide.org approximately 23 million Americans—almost one in 10—are addicted to alcohol or other drugs and opioids are among the top three narcotics causing addiction. A major indication for medical cannabis is chronic pain, something most frequently treated with opioid analgesics. Opioid use releases endorphins which mask pain while simultaneously boosting feelings of pleasure. The catch is that when you take opioids for an extended period of time, your body produces fewer endorphins leaving you with an increased tolerance and a desire to up your dosage to achieve the same effects. For many people, this is where the problem really begins; physicians, aware of the potential harms will often refuse to prescribe higher dosages or extend a prescription, leaving patients feeling as though they have no choice but to find the relief they need elsewhere.
"The latest data suggest that the (opioid) crisis is not abating," said Chief Public Health Officer of Canada Dr. Theresa Tam and Dr. Robert Strang, Nova Scotia's chief medical officer of health and co-chairs of the Canadian government's special advisory committee on the opioid overdose epidemic in a joint statement.
What does the research show us about cannabis as an exit drug?
When countries establish access to medical cannabis, they may potentially change overdose mortality related to opioid analgesics. "Research suggests that people may be using cannabis as an exit drug to reduce the use of substances that are potentially more harmful," Zach Walsh, associate psychology professor at UBC's Okanagan campus, said. In the journal Drug and Alcohol Dependence, data published in April 2017 also reports a dramatic decline in opioid pain reliever related hospitalizations following legalization. In fact, in jurisdictions where cannabis use is regulated, it has been reported that abuse and mortality related to opioid use has declined year over year. Cannabis regulations were associated with 24.8 % lower rates of overdose mortality in states with medical cannabis laws versus in states without legal cannabis.
Both the Institute of Medicine and the Rand Corporation’s Drug Policy Research Center concluded that “[M]arijuana has no causal influence over hard drug initiation." Cannabis as an opioid addiction treatment is showing promise, and recently the University of British Columbia announced the hiring of M-J Milloy for a research position intended to lead clinical trials into the potential of using cannabis to help people getting treatment for opioid use disorder. "To have the resources and the security and the freedom to investigate this idea—and hopefully produce evidence to help address the overdose crisis—it's why I became a scientist," he told CBC News.