It isn’t easy to write about the epidemic of opioid abuse in the USA when you have never seen it in person. The statistics1 are terrifying to look at: in 2014 alone, 19,000 Americans died from opioid overdose, and the number of opioid prescriptions has increased by four times since 1999. However, for so many people, including veteran Stephen Mandile, the word “opioid” represents decades of hell.
“I was getting about two hours of sleep every few days, not caring about anything except for my next dose,” Mandile said. He would count his pills all day to prepare for the withdrawal symptoms when he ran out of Fentanyl, and once wanted to die. Five years of Fentanyl left him “like a zombie”, with no desires of any type. Fortunately, he received a medical cannabis authorisation in Massachusetts in 2012, but he had to wait three years for the first dispensaries. “I was amazed at the pain relief I got from cannabis”, he said, with the wait being worthwhile in the end. “It helped with my migraines, my anger, my depression and my anxiousness. Within five months, I was finished with
most of my VA meds.” He is not alone: US states with cannabis legal for at least medical use have, on average2, a 25% lower mortality rate from opioid use. On the other hand, some US states have more opioid prescriptions than people, with the greatest concentration of these in the conservative South. California has one of the lowest rates of opioid use, but it is still high.
So how could cannabis, or hemp – the very low-THC strains of the plant – have helped Stephen and many others? It may not be just the well-documented effects of the cannabinoids against pain, but cannabidiol (CBD) could also relieve the symptoms of addiction. Left alone, opioids produce euphoria and act on the brain’s reward pathways; over time, they desensitise these pathways and more is needed for the same effect. Sudden withdrawal leads to intense symptoms such as pain, nausea, vomiting and anxiety. Part of CBD’s effect on opioid addiction is to do with some ability to act on the opioid receptors, but that’s not all. Associations between the addictive substance and something otherwise innocent in a person’s life, such as a friend or street with a certain bar in it for alcoholics, are major contributors to addiction. This is known as “cue-induced cravings”. However, CBD can help to break these associations by acting on the serotonin system, as serotonin (the neurotransmitter considered to be deficient in depression) plays a role in addiction. In a study on people with heroin addictions (heroin is a type of opioid), CBD reduced anxiety and cravings compared to the placebo3. This was the case one hour, one day and one week after CBD administration. While the opioid epidemic is definitely a large-scale tragedy, there may be hope with hemp.
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