Marijuana helps people with substance misuse disorders stay off opioids or reduce their use, maintain treatment, and manage withdrawal symptoms, a new federally funded study finds.

Researchers at the University of Southern California (USC) set out to investigate the relationship between cannabis consumption and injecting opioids, recruiting 30 people in Los Angeles at a community site near a syringe exchange service program and methadone clinic to analyze the relationship.

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The study, was published by the journal Drug and Alcohol Dependence Reports this week and was partially funded by the National Institute on Drug Abuse (NIDA), supports a sizable body of scientific literature indicating that access to marijuana can offset the harms of the opioid epidemic, either by helping people limit use or giving them an offramp altogether.

From July 2021 to April 2022, researchers conducted interviews with the participants to learn about how cannabis has affected their opioid use.

“Cannabis provided rapid relief from opioid withdrawal reducing frequency of opioid use.”

Among the themes that emerged was that marijuana co-use “assisted in developing patterns of reduced opioid use in a number of ways: 1) maintain opioid cessation and/or adhere to opioid use disorder treatment by managing cessation-specific symptoms, 2) manage symptoms of opioid withdrawal episodically and, 3) decrease opioid use due to low barrier accessibility of cannabis.”

“Participants reported using cannabis substitution or co-use to manage the pain from withdrawal symptoms such as body aches and generalized discomfort which led to decreased opioid injection frequency,” the researchers found.

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“Participants reported myriad benefits of opioid and cannabis co-use for reducing patterns of opioid use,” the study says, adding that there are two key harm reduction implications.

First, they concluded that distributing marijuana via peer programming can significantly influence opioid use patterns. Second, they said cannabis could be added as an opioid treatment option alongside other existing medication, which “may improve efficacy of uptake and treatment outcomes and goals.”

The report included samples of interview transcripts that speak to the findings. Here are some examples: 

• 26-year-old male: “I was really trying to get off of opiates, and using weed really helps to not have the first urge to use opiates. When you’re addicted and you have a habit, then you have to use opiates. But when you don’t have a habit, and you’re not getting sick from it every day when you’re smoking weed, it gets you over the hump and that urge to get high for the first time. And that’s what’s so special [about] weed.”

• 32-year-old male: “When I was clean with methadone, I tapered down [my methadone], but I was using methadone and marijuana only. And that helped me stay clean, and then I used marijuana after I completely went off all opiates. And it did help me stay away from it.”

• 26-year-old male: “[S]ome people can use pot to stay off of it. Whereas doctors will say, ‘Oh no, it’s not true. People that use pot, they’re just jonesing to get high.’ Some people really use weed as a maintenance to stay off opiates. I truly believe that. And doctors need to look into it and start really being okay with that…Marijuana, maybe this is a real thing.”

Another main takeaway from the study was the importance of ease of access to cannabis. Several participants described their preference for accessing marijuana products from licensed dispensaries and their appreciation for the increased number of retail locations in their areas, linking it to their positive changes in opioid use.

“Using cannabis to provide rapid and ongoing relief from opioid withdrawal symptoms led to less frequent opioid use.”

“Concurrent with existing literature, our findings support the use of cannabis with [medications for opioid use disorder],” the study authors said. “Participants in our study described using cannabis post opioid cessation to manage symptoms such as cessation-related anxiety and cravings. Some participants did this by using cannabis along with MOUD for self-initiated opioid cessation.”

“Participants emphasized low barrier access due to legalization and numerous dispensaries as a resource that facilitates co-using cannabis for reduced opioid use,” the study concludes. “These findings support the extant literature on cannabis and opioid co-use for pattern changes among vulnerable populations.”

“Low barrier access to cannabis due to legalization facilitated co-using to decrease opioid use.”

As the authors noted, these findings are largely consistent with a growing body of scientific literature on the potential benefits of cannabis for people with substance misuse disorders.

For example, another recent study out of Ohio found that a large majority of medical marijuana patients in the state say cannabis has reduced their use of prescription opioid painkillers as well as other illicit drugs.

Another report published recently in the journal BMJ Open compared medical marijuana and opioids for chronic non-cancer pain and found that cannabis “may be similarly effective and result in fewer discontinuations than opioids,” potentially offering comparable relief with a lower likelihood of adverse effects.

And federally funded study published in May concluded that even some cannabis terpenes may have pain-relieving effects. That research found that an injected dose of the compounds produced a “roughly equal” reduction in pain markers in mice when compared to a smaller dose of morphine. Terpenes also appeared to enhance the efficacy of morphine in mice when the two drugs were given in combination.

Another study, published late last year, found that marijuana and opioids were “equally efficacious” at mitigating pain intensity, but cannabis also provided more “holistic” relief, such as by improving sleep, focus, and emotional well-being.

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The same month, research published in the Journal of Dental Research found that pure CBD could alleviate acute dental pain about as well as an opioid formula commonly used in dentistry.

A study published last summer linked medical marijuana use to lower pain levels and reduced dependence on opioids and other prescription medications. Another, published by the American Medical Association (AMA) in February, found that chronic pain patients who received medical marijuana for longer than a month saw significant reductions in prescribed opioids.

About one in three chronic pain patients reported using cannabis as a treatment option, according to another AMA-published report last year. Most of that group said they used cannabis as a substitute for other pain medications, including opioids.

Other research published last year found that letting people buy CBD legally significantly reduced opioid prescription rates, leading to 6.6 percent to 8.1 percent fewer opioid prescriptions.

A 2022 research paper that analyzed Medicaid data on prescription drugs, meanwhile, found that legalizing marijuana for adult use was associated with “significant reductions” in the use of prescription drugs for the treatment of multiple conditions.

Written by Kyle Jaeger for Marijuana Moment | Featured image by Gina Coleman/Weedmaps

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