The Rise in Opioid Use and the Safer Illegal Alternative
Written by Michele Vieux
Last week, two articles came across my news feed that when taken alone would provoke concern but when taken side-by-side are absolutely infuriating. Both were notices from government agencies regarding drug use – one touting the dangers of opioid addiction (opioids are a class of drugs approved by the FDA and commonly prescribed by doctors) and the other re-enforcing and expanding the the stand on criminalizing a safe alternative, Cannabidiol (CBD), an extract from the marijuana plant that can be used to treat pain and much more.
Cause for Concern – The Opioid Overdose Epidemic
Obviously it is concerning that opioid addiction and related deaths are on the rise. And if we look at the issue a little closer, additional concerns begin to surface like the rise in frequency and number of prescriptions written and viable, safe alternatives that doctors do not have the authority to prescribe – mainly medical marijuana – including CBD (the non-psychoactive component).
Opioids are commonly prescribed for pain. An estimated 20% of patients presenting to physician offices with noncancer pain symptoms or pain-related diagnoses (including acute and chronic pain) receive an opioid prescription (1). In 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills (2). Opioid prescriptions per capita increased 7.3% from 2007 to 2012, with opioid prescribing rates increasing more for family practice, general practice, and internal medicine compared with other specialties (3).
Amongst populations at higher risk of addiction and overdose are athletes. As of now, according to governing bodies’ guidelines, athletes are allowed use opioid medications for a short period of time and expect them to help with recovery from injuries. For those athletes (and regular people, too) who have chronic pain, there is research showing that long-term use of opioid medications can actually make pain worse (4) and can lead to addiction (5). A 2009 study (6) commissioned by ESPN found that a lot of NFL players may be misusing opioids during their careers, leading to long-term addiction.
Cause for Concern – Criminalizing a Safe Alternative
Marijuana might be of interest to some as an alternative treatment, but it doesn’t have the seal of approval from sports governing bodies for athletes looking to treat their pain and likely won’t until the federal government also says it’s ok. And though some states have made it legal for people to use marijuana for medical (and even recreational) reasons, it’s important to note that marijuana is still not a medicine approved by the FDA nor is it approved in any way, shape or form by federal law. I would like to point out that the government has continued to produce research about the dangers of opioids (which are legal) and addiction however has not produced the same concerns regarding the use of medical marijuana. Which leads me to the next point(s) of concern.
The US Drug Enforcement Administration (DEA) re-emphasized their position on cannabis extracts, including CBD oil in the December 14, 2016, Federal Register (item 21 CFR Part 1308) which serves to clarify and reinforce the DEA’s position on all cannabis extracts, including CBD oil – they are all federally illegal Schedule I substances. I repeat, they are Schedule I Substances – like the same way that opioids are classified.
That’s right, less than two months after many states legalized medical (and/or recreational marijuana), the federal government strengthened its position against this alternative treatment option. And this goes for ALL marijuana extracts including CBD oil derived from hemp (it was reclassified in this Register item) which is now commonly available nationwide via web sites and mail order services.
How Does this Affect You?
Because of this ruling, many will NOT have access to a much safer alternative to pain management and treatment of literally hundreds of ailments (see CBD – Great Green Hope or Hype?) and will have to rely on alternate treatments if they want to avoid opioids. And because of this, the opportunity to do research in the area is limited, if not halted, another cause for concern in itself.
If you live in a state with medical (or recreational) marijuana laws, it likely won’t affect you much other than possible shortages at the dispensary due to fewer manufacturers. Although the DEA considers CBD oil to be a federally illegal Schedule I drug, there are temporary safeguards in place that protect patients in many states from federal prosecution over possession of the oil. The Rohrabacher-Farr amendment is the most important of those protections. Originally passed in 2014, the amendment to a Congressional appropriations bill prohibits the Justice Department from spending funds to interfere with the implementation of state medical cannabis laws.
Besides making it more difficult for you to obtain, this could affect many jobs and growing businesses in the industry. If you live in a state where medical marijuana laws are not intact and must rely on hemp-based CBD products that can be purchased online, you will feel the burden from this as many of these suppliers will likely disappear. If you remember from above, hemp-based products were not previously illegal but according to this new classification, they now are.
There is still the question whether or not the DEA has the authority to create a new category under the law i.e. ‘marijuana extracts’ which is a whole other topic of discussion as is deciphering why the federal government is so vehemently against this apparently safe, easy to produce, natural and viable option.
Where Did this Come From and Where is it Going?
Back in the 1930’s the newspapers and government created untrue and negative stigma surrounding marijuana use – Reefer Madness – that hasn’t been let go by many still to this day. But if we really examine the truth, possibilities and myriad of politics surrounding this issue, it should be obvious this the argument against using marijuana as medicine is both antiquated and fueled by alternative motives. This excellent video lays out the story for you.
I encourage you to learn about the history surrounding medical marijuana and also the possibilities it promises for so many. Educate yourself. Talk to people close to you – share your story (here’s mine). Write to your state representatives. Join a policy reform group in your state. Share this article on social media! Let’s make sure everyone knows just how important and safe this drug alternative is.
1) Daubresse M, Chang HY, Yu Y, et al. Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000-2010. Med Care 2013;51:870–8.
2) Paulozzi LJ, Mack KA, Hockenberry JM. Vital signs: variation among states in prescribing of opioid pain relievers and benzodiazepines—United States, 2012. MMWR Morb Mortal Wkly Rep 2014;63:563–8.
3) Levy B, Paulozzi L, Mack KA, Jones CM. Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007–2012. Am J Prev Med 2015;49:409–13.
4) Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain
5) Chau, et. al. America’s Addiction to Opioids: Heroin and Prescription Drug Use, The Journal of Pain, February 2009. Volume 10, Issue 2.
6) Barr, J. Painkiller Misuse Numbs NFL Pain. Outside the Lines. ESPN 2009.
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