In continuing opioid crisis, cannabis can’t be overlooked as a life-saving measure

Long derided as a gateway to so-called hard drug use, recent scientific findings have raised the possibility that cannabis might be an off-ramp from the overdose crisis. While the coronavirus pandemic dominates headlines, the overdose crisis is about to enter its sixth year, having claimed the lives of more than 16,000 Canadians. Sparked by the contamination of the unregulated drug supply with fentanyl, a powerful synthetic opioid, overdose death rates now exceed those for suicides, homicides, or motor vehicle accidents in British Columbia, the epicentre of the crisis. Although a variety of interventions have been shown to reduce the risk of overdose death—including supervised consumption sites; distributing naloxone, an overdose antidote; and treating opioid dependence with medications like methadone—Canadian governments have largely failed to make them available to those at highest risk. Although B.C.’s harm reduction-based strategy has saved thousands of lives, dozens continue to die each month. Clearly, new approaches are urgently needed. In Vancouver’s Downtown Eastside, new research by me and other scientists at the B.C. Centre on Substance Use involving thousands of people who use drugs at highest risks of overdose has revealed possible benefits of cannabis use. We have found that cannabis use is common among this group and often used for therapeutic purposes: for example, to address drug withdrawal, treat chronic pain, or avoid the contaminated drug supply. During in-depth interviews with them, some told us that they viewed cannabis as a type of harm reduction allowing them to reduce or eliminate the use of other far-riskier drugs, like crack cocaine or illicit opioids, like heroin or fentanyl. Findings from other studies we have conducted support these reports and raise the possibility that at least some people at highest risk of overdose can substitute cannabis for fentanyl-tainted illicit opioids. For example, in one study, we found that people using cannabis every day were far less likely to use illicit opioids every day. In two other studies, we observed that daily cannabis users injected illicit opioids less often and were more likely to cease injecting opioids altogether. Corroborating these apparent benefits were the results of urine drug tests reported in a fourth study: urine samples positive for tetrahydrocannabinol (THC), the major component of cannabis, were much less likely to be positive for fentanyl. Intriguingly, we also found evidence that cannabis might be helping people stay on treatment for opioid dependence—itself one of the best ways to protect people from overdose. In our study of 820 people beginning medications for opioid dependence, those also using cannabis every day were approximately 21 per cent more likely to still be on treatment at six months. Unfortunately, we also found that legal cannabis is largely unavailable to people who use drugs in neighbourhoods like Vancouver’s Downtown Eastside (DTES). High prices, minimum purchase sizes, the lack of specific preparations, the need for multiple IDs: all combine to ensure people in the DTES must rely on the unregulated cannabis market and products of unknown strength and composition. And as one of the major goals of the legal cannabis regime is to eliminate the unregulated market, this leaves them open to enforcement and criminalization. It must be emphasized that our studies identifying the possible benefits of cannabis are not conclusive. While encouraging, these preliminary results must still be tested in controlled trials, or studies in which people are randomly given either cannabis or placebo and the resulting outcomes, for example illicit opioid use patterns, are carefully tracked over time. Thanks to legalization, I and other Canadian researchers are finally able to conduct the sorts of trials which will provide conclusive evidence on the possible use of cannabis as medicine. That careful work will take time; meanwhile, people continue to die completely preventable deaths from drug overdose. Not content to wait for conclusive findings—and viewing cannabis as a life-saving intervention to address an unprecedented crisis—several community groups in Vancouver and Victoria have been distributing free cannabis from unlicensed producers to those at highest risk of overdose. Their efforts have won the support of some elected representatives in Victoria and Vancouver who recognize the many barriers to accessing legal cannabis faced by marginalized people at risk of overdose. Unfortunately, there does not seem to be a pathway in federal and provincial cannabis regulations for these innovative programs to operate within the law. Although some groups are seeking exemptions to the rules, their future remains uncertain. As Canada enters the third calendar year of legal cannabis, the benefits to some—including consumers and government treasuries—are clear. Hopefully, as our understanding of the possible uses of cannabis grows, those who might benefit the most are not left by the side of the road. M-J Milloy, PhD, is the Canopy Growth professor of cannabis science at the University of British Columbia, a position established through arms-length gifts to the university from Canopy Growth, a licensed producer of cannabis, and the Government of British Columbia’s Ministry of Mental Health and Addictions. His research is funded by the United States National Institute on Drug Abuse and the Canadian Institutes of Health Research. He has no personal financial relationships with the cannabis industry. The Hill Times

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In continuing opioid crisis, cannabis can’t be overlooked as a life-saving measure

Hopefully, as our understanding of the possible uses of cannabis grows, those who might benefit the most are not left by the side of the road.

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