M-J Milloy: Can cannabis help with opioid addiction? Let the evidence—not police—decide

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By M-J Milloy

Last Friday, Sarah Blyth, director of the Overdose Prevention Society (OPS) in Vancouver’s Downtown Eastside, posted a video to social media showing officers from the Vancouver Police Department taking a small quantity of cannabis from a table in a local street market.

The cannabis was from the OPS’s High Hopes Foundation. By selling cannabis at below-market rates to low-income substance users, the High Hopes Foundation seeks to help people at risk of overdose access cannabis to use as a substitute for illicit drugs that have become increasingly contaminated by fentanyl and other potent opioids.

The aggressive police presence was bad enough, as strong evidence tells us that these actions tend to drive people who use drugs away from life-saving harm reduction services like overdose prevention sites. But the seizure also interfered with the work of a cutting-edge effort to protect people from overdose.

Long vilified as a gateway to so-called “hard” drugs like heroin and cocaine, there is an emerging body of scientific evidence documenting how cannabis might actually reduce the risk of overdose and even provide an exit strategy for people suffering from addiction to other substances. 

In 2014, the first breakthrough study was published in the high-profile JAMA Internal Medicine journal by a team of researchers in Pennsylvania. Analyzing U.S. death records from 1999 to 2010, they found that states with some form of legal access to cannabis— either medical, recreational or both—had 25 percent lower rates of opioid overdose deaths than states with no access to legal cannabis.

Several follow-up studies added more support to the idea that cannabis might have a beneficial role to play in addressing the overdose crisis, an ongoing disaster that claimed 70,000 lives in the U.S. last year, and more than 3,000 in Canada.

One study showed that the number of doses of opioids, a class of medications commonly prescribed for pain, dropped by millions in states with medical cannabis systems, suggesting that some people were switching from opioids to legal cannabis to manage their pain.

Another study reported a decline in the number of opioid overdose deaths in Colorado after that state legalized non-medical cannabis.

Here in Vancouver, we have begun to document how some people participating in our research studies at the B.C. Centre on Substance Use are apparently using cannabis in ad hoc strategies to reduce the harms from other drugs.

Last year, we reported on a group of 122 participants who told us they used cannabis as part of an intentional strategy to reduce or eliminate crack cocaine use. When we analyzed their crack use patterns over time, we found that periods of intentional cannabis use preceded significant declines in the frequency of crack use. In about a quarter of the cases, individuals stopped smoking crack altogether.

More recently, we have published studies showing that using cannabis every day was linked to a lower risk of starting to inject drugs—an important risk for overdose—and a greater likelihood of staying on methadone, the first-line therapy for opioid use disorder.

Although the participants in our research studies come from the same population of people who use the High Hopes Foundation, it is too early to conclude whether there has been a beneficial impact on overdose risk. Determining that will take more study, including a planned randomized trial—the gold standard for medical evidence—to better understand the relationships between cannabis, dependence on opioids and other drugs, and other important factors like pain, anxiety, and trauma.

But while we await that evidence, the opioid crisis continues unabated. The activists who try to prevent our most vulnerable citizens from dying of overdoses by handing out cannabis—an activity that poses no threat to public health or safety—deserve our support, not raids from police.

The VPD use its discretion everyday by electing to leave the dozens of unlicensed retail cannabis dispensaries in Vancouver undisturbed. They should do the same for the High Hopes Foundation.

Safe access to medical cannabis is a right recognized by the Supreme Court of Canada. In the middle of public health emergency, recognizing that right must be paramount.

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