Medications for opioid use disorder (MOUD) are a critical tool for individuals struggling with opioids. Research has repeatedly shown the efficacy of this pharmacological component in treatment. To date, there are three medications that are recommended by the World Health Organization (WHO) and approved by the US Food and Drug Administration (FDA) to treat opioid use disorder (OUD): methadone, buprenorphine, and naltrexone. All brand-name MOUD prescriptions include one, or a combination, of these three medications. Common brand names include Bunavail, Belbuca, Subutex, Suboxone, Naltrexone (Vivitrol), Sublocade, and Zubsolv.
In addition to FDA-approved MOUDs, there are a variety of alternative medicines and substances that individuals use either off-label or to self-treat their OUD and/or opioid withdrawal symptoms. This article discusses marijuana, what it is, and how it works in the context of OUD.
Marijuana is known by many names, including weed, herb, pot, grass, bud, ganja and Mary Jane. After tobacco and alcohol, marijuana was the most commonly used addictive drug in 2018. Marijuana is made of the dried flowers and leaves of the Cannabis sativa or Cannabis indica plant. The cannabis plant is composed of a closely related group of chemical compounds referred to as cannabinoids.
There are over 100 known cannabinoids. The two most prominent cannabinoids are delta-9 tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the defining ingredient of marijuana. It is a psychoactive compound that is responsible for many of the intoxicating effects or “high” individuals often experience when using marijuana. Any cannabis or cannabis-derived product with a THC concentration greater than 0.3% is considered marijuana.
Like the number of names it is known by, there are many ways marijuana can be consumed. Marijuana can be smoked in hand-rolled cigarettes (joints) or cigars (blunts), smoked in pipes or water pipes (bongs), or it can be inhaled with a vaporizer, some of which use liquid marijuana extracts. Marijuana can also be consumed through food products known as edibles and can be brewed in tea. Concentrated, THC-rich resins (dabs) can be smoked, a practice that is known as dabbing. Certain forms of marijuana act much faster than others. As with all substances, different forms and routes of administration can produce different effects.
The effects of marijuana are felt when THC activates the cannabinoid receptors in the brain. The neurological effects of marijuana can impact or interfere with, among other things, an individual’s memory, posture, coordination, reaction time, and balance. Many users experience a sense of euphoria and relaxation, heightened sensory perception, laughter, altered perception of time, and increased appetite.
However, the effects of marijuana vary drastically from individual to individual. While some experience an enjoyable “high,” others experience anxiety, fear, distrust, panic, psychosis, hallucinations, delusions, and a loss of the sense of personal identity. The effects a person experiences often depend on the concentration of THC, dosage, and an individual’s tolerance. Research into the long-term effects of marijuana use is ongoing.
While marijuana has not been approved for any medical use, the FDA has approved several cannabis-derived and synthetic cannabis-related drug products. Among the FDA-approved THC-based medications are dronabinol and nabilone. Both are synthetic forms of THC and are prescribed to treat nausea and vomiting induced by cancer chemotherapy. Dronabinol is prescribed to treat weight loss in patients with AIDS.
Other unapproved medical uses of cannabis-derived products include the treatment of epilepsy, chronic pain, and multiple sclerosis symptoms. According to the National Center for Complementary and Integrative Health (NCCIH), studies in animals suggest that supplementing opioids with THC may control pain with a reduced dose of opioids. Further clinical research is required to verify the efficacy in humans.
There are no evidence-based uses for marijuana in the treatment of OUD. The FDA has not approved marijuana as a legitimate treatment for OUD due to a lack of scientific research. Some preliminary studies have suggested that marijuana has the potential to reduce opioid overdose, withdrawal symptoms, misuse, and relapse. For example, a 2010 study found lower opioid overdose rates in states that legalized cannabis use for medical purposes compared with other states. In 2017, a methodologically similar study yielded diametric results. Moreover, a 2017 study found that cannabis use appeared to increase, rather than decrease, the risk of developing nonmedical prescription opioid use and opioid use disorder.
Ultimately, whether marijuana is an effective treatment for OUD remains unknown. The results of the 2010 study led several states to consider adding OUD to the list of qualifying conditions for medical marijuana. The existing body of research lacks scientific rigor and study findings have proven inconsistent. There remains a high need for randomized controlled trials to determine the efficacy of marijuana in the treatment of OUD.
Bicycle Health strongly discourages the use of marijuana to treat OUD given this lack of methodologically rigorous research and medical evidence of efficacy.
The legality of marijuana is a layered issue that is, ultimately, determined by the state you are in. Marijuana remains a Schedule I drug according to the Controlled Substances Act (CSA). The United States Drug Enforcement Administration (DEA) defines Schedule I substances as drugs with no currently accepted medical use and a high potential for abuse. This scheduling makes the use, possession, and sale of marijuana illegal under federal law. At the state level, however, the rules and regulations vary significantly.
Moreover, certain state legislation is entirely contradictory to federal regulation. For example, 2014 legislation, known as the Rohrabacher-Farr Amendment, prohibits the United States Justice Department from allocating funds on actions designed to interfere with the implementation of state medical cannabis laws. Essentially, in places where medical cannabis state law differs from federal law, the legislation gives priority to state law. An individual adhering to the medical cannabis regulations of the state they are in will not be prosecuted under federal law. Thus, the legality of marijuana use, possession, and distribution depend largely on location.
Bicycle Health is dedicated to helping people get off and stay off opioids. To learn more about the proven success of Bicycle Health’s telemedicine addiction treatment compared to other common treatment options, call us at (844) 943-2514 or schedule an appointment here.