FINE LIVING

Side Effects

Could cannabis save us from opioids?

BY SIONA HENZE

If Oxytabshad a little THC, this world would be a safer place.”

Said the DEA, never.

But Falmouth-based integrative medicine physician Dustin Sulak found in a 2020 survey of over 500 patients at three medical cannabis practices in Maine and Massachusetts that 40 percent of patients with chronic pain stopped opioid use altogether when cannabis was added to their treatment plan; 45 percent reduced their opioid use; and 80–90 percent reported improved quality of life and ability to function. According to a review and analysis of 19 preclinical studies in the journal Neuropsychopharmacology, co-administration of THC with opioids can reduce the e ective dose of morphine 3.6 times, and codeine 9.5 times. In other words, addictive doses of opioids are no longer needed for pain management.

With Maine Public reporting a state death toll of 636 from opioid overdose in 2021, and the CDC reporting 107,000 opioid deaths nationally, why are some medical practitioners reluctant to treat their patients with cannabis? Dr. Sulak and longtime orthopedic surgeon Dr. Eric Mitchell of Livermore Falls agree that it’s a question of education. “Most physicians today have not been taught the endocannabinoid system,” says Dr. Mitchell. According to an article in the Journal of Drug and Alcohol Dependence, 85 percent of medical students report receiving no education in medical school or residency about medical cannabis, and only 9 percent of medical schools in the AAMC Curriculum Inventory database document any content on cannabis.

Although the CDC guidelines for prescribing opioids for chronic pain recommend against urine screening for THC in

opioid-using patients with chronic pain, Sulak nds that many patients who choose to co-administer cannabis and opioids to treat their symptoms are denied their prescriptions and/or discharged from medical care because THC has been detected in their urine. Yet “80 percent of heroin users start on prescribed pills.” Rather than blaming patients, Sulak believes “it is the provider’s responsibility to reduce the potential for addiction” by using the synergistic effect between the two substances to prescribe lower opioid doses initially and as treatment continues. While opioids “have side e ects instead of side bene ts, cannabis has global bene ts” that Sulak uses to treat patients with chronic pain, PTSD, depression, neurological disorders, and cancer. ough Sulak says there’s some evidence that cannabis can help with a pre-existing opioid addiction, “it could be a much easi-

er path if [medical proThey have this guilt viders] implement canabout using cannanabis appropriately instead of too late.” But bis that is really not ideal because of cannabis’s for their recovery. general exclusion from mainstream medicine, psychiatrists and support groups treating addiction—including opioid addiction— may seem to project so much bias about cannabis that patients “end up hiding things from their doctors. ey have this guilt about using cannabis that is really not ideal for their recovery.” e federal government “picked some of the most e ective medicine to make illegal.”

Medicine that could potentially alleviate Maine’s opioid epidemic, if we can get past the irony of prescribing a Schedule I substance appropriately to save thousands from getting hooked on Schedule II substances. n

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