Healing Mind, Body, and Spirit: Exploring the Role of Cannabis in Combating Opiate Abuse

This was initially published in the first Issue of CBD Health & Wellness Magazine published in 2019 and is being shared for educational purposes on this blog. Please cite as Bone, CB “Healing Mind, Body, and Spirit: Exploring the Role of Cannabis in Combating Opiate Abuse” CBD Health & Wellness Magazine, Volume 1, Issue 2 August/September 2019.

Amidst the worst opiate epidemic in recorded history, a growing number of CBD advocates, manufacturers, and physicians are exploring the role of cannabis in helping stem the rise of overdoses and create more accessible and worthwhile pain management solutions. Leading experts from across the industry gathered at the CBD Northwest Expo in Seattle recently to discuss these strategies and reflect on the current landscape of the hemp industry and opioid crisis. Present were Kayles Fioravanti, the co-founder of leader formulator of Tennessee-based Ology Essentials; James Schwartz R.N., the CEO of Oregon-based Cascade High Organic; Dr. Randy Fink, the Executive Director of Slyngshot Health; and Dr. Allen Manison of Noetic Nutraceuticals. Areas discussed included the role of cannabinoid therapies in pain management; market developments in the medical marijuana and hemp industries; barriers to research and coordinating care; as well as much more.

In the age of the opioid epidemic, the rising number of mental health drugs being prescribed, and a surge in methamphetamine usage nationwide, discussions kicked off with a reflection on personal experiences that shows the potential of CBD, and cannabis broadly, to act as a novel therapeutic innovation. For instance, there is evidence that suggests cannabidiol has been shown to modulate the endocannabinoid system in such a way that it helps to fight addiction on a cellular level. Cannabinoids represent a promising avenue in the treatment of substance use disorder because of their wide therapeutic range and very low potential for toxicity. As over 2 million Americans are affected by Opiate Abuse disorder, and over 130 people die a day of an overdose within the United States, creating effective alternatives for pain management is crucial. [1]

While the case for cannabis as a replacement therapy for opiates is receiving an increasing amount of positive reception [2] and grass roots support, a lack of extensive data on the clinical efficacy of these treatments is a barrier. However, one meta-review of current evidence suggests that there is a growing empirical basis to support these claims, however, other studies suggest that past correlations between cannabis use and reduced opioid mortalities may be reversing [3], creating a complicated scenario [4]. Clearer answers are needed, however, barriers to research, access, and stigmatization still create issues when effectively developing and implementing cannabinoid-based interventions in lieu of or in addition to opiate-based treatments. [5]

During the discussion, however, Dr. Manison pointed to several promising developments in cannabis research that are promising, including the upgrading of cannabis as a recommended pain intervention protocol. James dovetailed from these observations with his personal experiences working with the policymakers. He noted the dynamic interplay between research and policy liberalization, calling for more clinical research and creating curricula and educational materials on subjects such as the endocannabinoid system to begin educating a new generation of healthcare providers. Dr. Fink pointed out how despite the complex and costly hurdles to conducting clinical research, pre-clinical trials and patient feedback will help be the impetus for researchers on a broader scale and can’t be neglected even as we start to see more governmental involvement and regulation in the development of cannabis therapies.

Kayla chose this opportunity to share her personal experiences with drug abuse, and highlight the importance of patient advocates in guiding research and therapy development. Connecting her experiences working with consumers in the south with Dr. Manison’s clinical work painted a picture that illustrates the significance of patient-centered product development. As both panelists attested, the bio-psycho-social nature of pain means a multipronged intervention is key, while attenuating therapies to individual patients is critical to ultimate success. Indeed, substitution therapies may be effective, but they still require users to make a choice to change their consumption patterns. Working to develop a diversity of affordable and accessible cannabinoid-based products from topicals to edibles improves the potential for success as an opiate alternative on a wide scale.

At this point, the conversation turned toward the role of manufacturers, cultivators, and retailers in the context of these broader issues. Some of the mutually agreed upon factors relate to the need to coalesce around shared values and organizations. James shared his lobbying efforts with groups like the National Cannabis Industry Association to help influence the rule-making process by the FDA for CBD. Elaborating, he went on to describe opportunities for grants and research, identifying recent efforts to help push for the passage of the SAFE Bank Act as evidence of the importance of these groups. Indeed, the SAGE Bank Act would facilitate smoother partnerships both across and beyond the industry, creating the potential for consumer-supporting initiatives like insurance schemas, improved product diversity, and lower costs cited Dr. Fink for example. To these ends, elaborated Kayla, being able to compete with the affordability of traditional opiates while also overcoming generations of stigma represent important goals with the industries’ consumer and professional education agenda, and there are opportunities for certifications and continuing education courses to lead to these ends.

Building on the theme of education, all panelists were in agreement that targeted approaches were key. Kayla took the opportunity to talk about working with diverse groups of consumers and caregivers identifying the need to work to connect with communities differently, whether they be in recovery or suffering from chronic illness. However, as Dr. Fink mentioned, much of this process will take time and the industry as a whole is still very young. The FDA and USDA are still very early in the rulemaking processes for these types of products and the future will assuredly be volatile, so building brand evangelists through customers and patients will be critical as therapies are refined and laws are changed.

Here again, panelists were in agreement that creating novel formulations, form factors, and drug delivery systems was a worthwhile way to educate consumers while also creating more cost-affordable treatment options in the status quo. Dr. Manison pushed this point forward to point out how this lag between education and implementation will allow us to develop better products by pointing out the increasing awareness about cannabinoid-drug interactions and the potential for liver toxicity in new areas of research. Ultimately, this last point of needing to continue the hard work that has defined the liberalization of cannabis policy up to this point was widely shared amongst the panelists. While the potential applications for cannabis therapies are growing, there are basic issues that still must be attended to from our lexicon about this plant and its products to questions of how cannabis fits into the broader healthcare equation in the United States.

As companies like GW Pharma hold patents on FDA-approved cannabis medicines, the landscape is certainly murky, and with the fierce debate over the appropriate type of seed cultivars, the nature of manufacturing these products is far from settled. [6] Improving the coordination of our care, expanding on the research that has already been done, and directly supporting those still affected by the war on drugs, are all tangible steps cannabinoid businesses and advocates can take to keep up with this struggle.

References

[1] U.S. Department of Health and Human Services. “What Is the U.S. Opioid Epidemic?” HHS.gov, 22 Jan. 2019 www.hhs.gov/opioids/about-the-epidemic/index. htmlPeachman, Rachel Rabkin. “Can CBD Treat Opioid Addiction?” Consumer Reports, 23 Apr. 2019 www. consumerreports.org/cbd/can-cbd-treat-opioid-addiction/ Shover, C. L., Davis, C. S., Gordon, S. C., & Humphreys, K. (2019). “Association between medical cannabis laws and opioid overdose mortality has reversed over time” Proceedings of the National Academy of Sciences of the United States of America, 116(26), 12624–12626. doi:10.1073/pnas.1903434116

[2] Yanes, Julio & McKinnell, Zach & Reid, Meredith & N. Busler, Jessica & Michel, Jesse & Pangelinan, Melissa & Sutherland, Matthew & Younger, Jarred & Gonzalez, Raul & Robinson, Jennifer. (2019). “Effects of Cannabinoid Administration for Pain: A Meta- Analysis and Meta-Regression” Experimental and Clinical Psychopharmacology. 10.1037/pha0000281.

[3] Bone, Carlton. “Building Out Our Toolbox: Notes on Integrative Care with Cannabinoids and Opioids”, CBD Health & Wellness Magazine, January/February 2019 Issue.

[4] Drotleff, Laura. “What Is Hemp? Industry Members Debate Which Cultivars Fit Federal Definition Hemp Companies Are Speculating Whether the Agency Will Further Define Which Varieties and Cultivars Will Be Allowed to Be Used under the 2018 Farm Bill.” Hemp Industry Daily, 15 July 2019 hempindustrydaily.com/ what-is-hemp-industry-members-debate-whichcultivars-fit-federal-definition/