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Millions of people around the world are affected by an addiction. Some are addicted to opiates, others to alcohol or sleeping pills. Some are able to overcome the problem successfully, others prefer to eliminate the addiction by taking an alternative substance. What role can cannabis play in this context?
Drug addiction continues to be rampant in every part of the world. As many as 2% of the world's population (about 158 million people) has developed an addiction to alcohol, prescription drugs, or other substances. This problem constitutes 1.5% of the world's diseases. There are different schools of thought on the topic of addiction: some say the issue is purely chemical in origin; others say psychological issues, including trauma, are involved.
Treatment options are equally diverse.Some drug users attempt, with great difficulty, to detoxify in rehabilitation centers, while others overcome their addiction by replacing the drugs to which they are addicted with other, less dangerous substances.
Currently, scientists are evaluating the potential of cannabis to replace various substances, including opiates, nicotine and alcohol. However, this plant is often labeled as a “gateway drug,” that is, a substance that introduces the individual to the world of drugs, progressively stimulating him to consume more dangerous substances, which create greater dependence.
However, the data to date indicate that, under appropriate circumstances, the action of cannabis could be diametrically opposite.
If you’ve done any research on cannabis, you know that human studies are extremely limited. Decades of prohibition and legal restrictions have prevented in-depth analysis of the plant’s potential effects. As a result, doctors are reluctant to prescribe cannabis as a replacement for problematic drugs, in part because there is no definitive evidence to support this strategy.
However, researchers can conduct epidemiological surveys (large population studies) and collect the subjective experiences of individuals in certain groups to gain useful information. A 2015 study published in the journal Drug and Alcohol Review took this approach in an attempt to understand why drug users choose to use cannabis to overcome addiction to hard drugs.
The experts recruited 97 “Baby Boomers” (people born between 1946 and 1964), residents of the San Francisco Bay Area, and subjected each volunteer to questionnaires, health surveys and audio recordings. The group provided different answers regarding the reasons for choosing to use cannabis. According to some participants, cannabis is less associated with violent crime and reduces irritability. For others, however, the herb exhibits a better safety profile than other substances.
Interestingly, some users reported that after replacing other drugs with cannabis, their lives remained active and exciting. They viewed this as a positive aspect, especially when compared to the strict “clean and sober” approach of Narcotics Anonymous.
This survey provides useful information on the perceptions of those who choose to use cannabis as a substitute for other drugs. But what is the scientific opinion regarding considering cannabis as a valid substitute for treating withdrawal and symptoms of various health conditions?
Opiates are some of the most effective painkillers on the market. Although they can significantly reduce pain, they also carry a high risk of addiction. These medications have a powerful effect on the brain's reward centers and stimulate the release of endorphins, hormones that induce feelings of pleasure and well-being. Unfortunately, the over-prescription of these painkillers has led to an opioid crisis.
In 2015 alone, doctors in the United States wrote a whopping 250 million prescriptions.
According to data from the Centers for Disease Control (CDC), more than 760,000 people have died from prescription drug overdoses since 1999, with opioids contributing to two-thirds of those fatalities. Additionally, more than 10 million people over the age of 12 misused opioids in 2019.
In the United States, cannabis is still illegal at the federal level, but 36 states have legalized the plant for medical use, and doctors can prescribe it for numerous ailments and conditions.
So, could cannabis help address the opioid crisis? And what is the connection between cannabis and painkillers? Of course, it is interesting to note that since cannabis was legalized, opioid-related deaths in some states have decreased by 25%. Studies published in JAMA Internal Medicine collected U.S. cannabis laws and death certificates by state between 1999 and 2010. The results show a sharp decline in opioid-related deaths in states where medical marijuana has been legalized.
Scientists have formulated several hypotheses to explain this trend. First, they noted that about 60% of overdose cases involved patients with legitimate prescriptions. According to experts, if these people had access to medical cannabis, they might have chosen it.
Second, medical marijuana laws may have helped reduce polypharmacy (the regular use of at least five different medications) and, consequently, limited opioid-related deaths. The combination of benzodiazepines and opioids, in particular, can amplify the sedative effect and inhibit breathing.
Finally, the authors of the study wondered about the role of cannabis in opioid withdrawal. If the herb helped reduce the use of these drugs, patients could more easily overcome their addiction and stop using opioids at the right time.
However, some recent studies show a completely opposite trend, so it is right to remain skeptical about the fact that cannabis can reduce deaths from opioid abuse.
Opioids have a very high risk of abuse and a poor safety profile, especially when prescribed too frequently. However, of course, they are not the only drugs that cause addiction. Below, we will examine three different substances that can cause addiction and try to understand if cannabis could be a valid substitute.
Europe is the world’s largest alcohol consumer: over a fifth of the European population aged 15 and over drinks large amounts of alcohol at least once a week. In 2019, one in twelve people in the European Union drank alcohol on a daily basis. Excessive alcohol consumption has serious health consequences, but even small amounts consumed frequently can be harmful.
Could cannabis help reduce alcohol consumption in those who tend to use weed as a substitute? Experts are trying to answer this question. A study published in the journal Alcohol and Alcoholism sought to determine whether cannabis could serve the role of a “substitute drug.” To fall into this category, these substances must meet certain criteria, such as:
They must reduce alcohol consumption and related harms
Any abuse must be limited, compared to alcohol abuse
They must be safer in case of overdose
They must be less harmful than alcohol
Cannabis meets almost all of the above requirements, but scientists say further research is needed to determine its true effectiveness.
Nicotine, found in plants, is a deterrent to herbivorous animals. In humans, it is both a stimulant and a sedative and is highly abuseable. Nicotine is the second leading cause of death worldwide, and in the United States alone, cigarette smoking causes more than 48,000 deaths each year. Smoking is widely implicated in cannabis and nicotine use, but could marijuana help reduce the craving for smoking? The results of a 2021 study published in the Journal of Substance Abuse Treatment seem promising. Just like the reduction in opioid use observed after cannabis legalization in the United States, tobacco use may also be affected by marijuana.
The researchers conducted a cross-sectional online survey, asking 2,102 cannabis users how the herb affected their use of other substances. Of the survey participants, 650 were also current or former tobacco users. Of those, 320 reported reducing their tobacco use after starting cannabis.
However, in-depth studies on humans are needed to determine whether cannabis is truly effective in this context. Population studies are notoriously unreliable, and subjective questionnaires do not fully reflect reality. Scientists also want to identify the most effective cannabis molecule in this regard. Current research is examining the effects of compounds such as beta-caryophyllene on nicotine-dependent animal models.
Sleeping pills, such as benzodiazepines, can cause dependence in many people. For this reason, experts recommend taking the lowest dose possible and for the shortest possible time. In addition, it is preferable not to stop taking these drugs abruptly. Patients should gradually reduce the dosage to avoid the onset of potentially dangerous withdrawal symptoms.
In the UK, around 1 in 10 adults regularly take sleep-promoting pills. However, dosage guidelines suggest that people should only use these substances for short periods of time. Could cannabis be a suitable substitute? Unfortunately, there is very little scientific research on this. Although there are human trials of both substances, scientists are still trying to understand how cannabis might affect sleep. For example, a study published in 2019 looked at the impact of CBD and THC on the circadian rhythm, the body clock that regulates your sleep/wake cycle.
So, does cannabis get people into harder drugs or away from them? Without adequate clinical studies, there’s no definitive answer. However, some of the fears surrounding cannabis as a gateway drug are greatly overblown. Some research even shows a connection between cannabis use and reduced addiction to harder drugs. That said, there’s some evidence that cannabis may be pushing teens toward opioid use, and cannabis use disorder is a real problem that affects many people.
As always, it is important to proceed with extreme caution. However, many scientists agree that cannabis deserves to be studied more thoroughly, as alcohol and drug addiction have become a global problem.
