When it comes to cannabis and opioids, there are important (and beneficial) chemical interactions between the two substances — but the real story is in how cannabis can push back against the opioid crisis.

The raw numbers of opioid abuse are enough to shock the system. From 1999 to 2017, the number of deaths from an opioid overdose increased nearly six-fold, from 8,048 to 47,600 in the United States, according to the National Institute on Drug Abuse. Throughout that period, prescription opioids account for about 40% of those deaths.

A full accounting of what is happening here is well beyond the scope of this post (this New Yorker article on the role of prescription drug companies in pushing opioid prescriptions is a good place to start), but it all comes back to one word: pain.

Do No Harm?

Pain is notoriously hard to track, especially at a population scale, and this is reflected in the range of estimates of how many people cope with it. According to the Centers for Disease Control and Protection, 11-40% of Americans experience chronic pain. That’s a huge range, but even at the low end, that means 35 million Americans have this issue, with the higher estimates over 100 million. Any way you slice it, that’s an enormous market.

Furthermore, opioids only treat the symptom — pain itself — not its underlying cause, meaning patients often need daily treatment. Opioids can be horrifically addictive, and often make one numb to everything, not just pain. And they can be fatal when over-consumed.

Enter cannabis.

While many people remove or avoid opioids entirely because they use cannabis to treat their pain, others may simply use both, with fewer opioids entering their system as a result. Research has found a 27% decrease in pain when cannabis was included alongside opioids — and importantly, it also found that cannabis did not cause an increase in opioid levels in the bloodstream.

Furthermore, the two may be used in concert at doses that, though too small to do much individually, cause a significant reduction in pain when combined.

A Substitute, If Not a Solution

The plant has been the direct cause of exactly zero reported deaths and has nowhere near the addictive properties of opioids. It also has similar palliative effects when it comes to pain, and we now have good evidence that states with legal and available cannabis (medical or recreational) show lower rates of opioid abuse. One study found a 64% decrease in opioid use among medical cannabis patients, alongside a 45% increase in quality of life.

We see these personal stories represented en masse in the statistics: One study found a 24.8% reduction in opioid mortality rates in states that have legalized medical cannabis. It is not an exaggeration to say that legalizing cannabis across the entire U.S. could potentially save tens of millions of lives.

So much of the public discourse on cannabis is on mitigating its alleged harms and deciding where and how it can be used. When it comes to opioids, it appears thus far that available cannabis is a tremendous win for public health — and though certain experts contest its efficacy for “solving” the opioid crisis, it could potentially hold treatment options for those struggling with addiction.  

But for the chronic pain experienced by tens, maybe hundreds of millions of Americans, cannabis may be the best medicine.