Cannabis specialist Dr Peter Grinspoon explores education and policy in US addiction treatment.
Dr Peter Grinspoon is a primary care physician, an instructor at Harvard Medical School, and a contributing editor to Harvard Health Publications. In his capacity as a specialist authority on addiction and medical cannabis, he has served as an expert witness, medical and scientific advisor, and consultant; he is currently a board member of the international non-profit Doctors for Cannabis Regulation.
MCN Quarterly speaks with Dr Grinspoon about the opioid crisis, the need for broader cannabis education, and the potential of November’s presidential election to transform cannabis policy.
Could wider distribution of medical cannabis in the treatment of chronic illness and pain help alleviate the opioid crisis?
Medical cannabis is helping to ease the current opioid crisis in a number of ways: first of all, it is a viable alternative to opiates for the treatment of chronic pain. Medical cannabis is evidently not as effective as opiates for acute pain, for instance post-surgery or for a broken bone, but it is certainly beneficial for chronic pain: in America, for example, millions of people are experiencing chronic pain as they become more rotund and develop higher rates of knee arthritis and back pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) are dangerous: they can damage the kidneys and the heart, they can cause ulcers. Paracetamol doesn’t really do very much; and opiates are harmful for a number of reasons: lowered quality of life, overdose, the risk of dependency. Cannabis is the obvious safer alternative for chronic pain.
Study after study has found that in regions where cannabis has been legalised, either for medical or adult use, opiate prescriptions have gone down; I personally have had countless patients who have switched from opiates to medical cannabis for pain control. Cannabis-based treatment helps people who are using opiates for chronic pain and want to stop; and it is a great option for new patients presenting with chronic pain. We often offer new chronic pain patients cannabis instead of opiates, because opiate-based treatment results in a very dreary lifestyle – you have to get drug tested; you have to sign these opiate contracts; you’re very constipated – it’s just a much better lifestyle to be on cannabis than to be on chronic opioid therapy.
Additionally, for patients who are already addicted to opiates, cannabis can really help them with the withdrawal symptoms. There is some evidence that using medical cannabis can help keep people in treatment for opiate use disorder; it has had similar results to buprenorphine and some studies indicated higher retention in treatment for cannabis than for buprenorphine. Cannabis can be very helpful both as a substitute for opiates in treating chronic pain, and as an adjunct for medication-assisted treatment of opiate dependency.
Methadone and buprenorphine have been proven to lower overdoses and deaths, whereas cannabis hasn’t yet been studied specifically with respect to that. There are a great many anecdotal reports – hundreds of people tell me that they have used cannabis to get off heroin and prescription opiates – but I don’t recommend it for that particular purpose, just because the evidence to date is stronger for methadone and buprenorphine.