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Is Cannabis the Next Opioid Epidemic?

A Q&A with NIDA Deputy Director Wilson Compton on the growing use of medical marijuana.

Wilson Compton, MD, NIDAWilson Compton, MD, NIDA (Source: NIDA)

A Q&A with Wilson Compton, MD, MPE, Deputy Director, National Institute on Drug Abuse (NIDA)

PPM: You spoke at the American Society of Regional Anesthesia and Pain Medicine (ASRA) 2018 annual meeting on the subject of “Cannabinoids: the Pain Solution or Next Epidemic.” Is there a clear answer to that title’s inquiry?
Dr. Compton: At the moment, it’s unclear if increased access to medical and/or recreational marijuana will make a meaningful difference in overall rates of opioid addiction or in the effective treatment of pain. There is evidence cannabis use and cannabis use disorders increase in states with medical marijuana laws.1,2 There is also some evidencence that inhaled cannabis may be effective for the treatment of chronic pain,3 and moderate evidence that nabiximols (which contain an equal proportion of THC:CBD) may be beneficial for the treatment of chronic neuropathic or cancer pain.

An important distinction to remember is that the category of “cannabinoids” encompasses many different chemicals. Some, like THC, can lead to addiction. Others do not appear to carry significant addiction risk; one example is cannabidiol, which was just approved by the FDA for the treatment of two rare seizure disorders. Therefore, the risks and benefits of various cannabinoid compounds are very different.

Prescribed cannabis.Prescribed medical marijuana or cannabis may help to alleviate some painful conditions (Source: 123RF).


PPM: Do you see cannabinoids as a potential common line of treatment for certain chronic pain conditions, or pain-related symptoms (ie, depression, insomnia), in the future? Why or why not?

Dr. Compton: The marijuana plant itself is not considered an ideal medication candidate for the following reasons:

  • It is an unpurified plant containing numerous chemicals that have not been fully characterized
  • The variability of active components makes it difficult to reproduce a consistent dose
  • It is often consumed by smoking, potentially contributing to adverse effects on lung health
  • Its cognitive- and motor-impairing effects may limit its utility.

Purified cannabinoid compounds, however, are viable candidates for medication development. As well summarized by a review carried out by the National Academies of Sciences, Engineering, and Medicine, there is variable evidence for the therapeutic effects of cannabinoid compounds.3 Current evidence shows that cannabinoids have promise for the treatment of some pain conditions and associated insomnia, and that they are not effective for associated depression symptoms.

PPM: What are the major challenges cannabinoids pose in terms of resulting in another medication-based epidemic in the US? What might be done to prevent such an epidemic from occurring?

Dr. Compton: Cannabinoids do not have the respiratory depressant effects that make opioids so deadly. Therefore, an overdose epidemic is highly unlikely to result from cannabis use. Rather, the major challenge posed by cannabinoids is that their medical use has outpaced the evidence base, so possible risks and benefits are not fully appreciated. Yet, they are widely used. 

As a result, the potential of medical cannabis to result in increased incidence of cannabis use disorder should be carefully monitored. Doctors and patients should always weigh the risks and benefits of any treatment course, including the risk of developing an addiction to opioids or marijuana used to treat pain.

PPM: Do you see significant differences in these challenges between medical cannabis and recreational cannabis?

Dr. Compton: There is a great deal of overlap of those using cannabis for medical and recreational purposes. More evidence is needed to determine the public health outcomes that will result from increased medical and recreational use of marijuana. Of particular concern to NIDA is the possibility that increased availability of medical and/or recreational cannabis could increase adolescent exposure to cannabis, which can have a detrimental impact on brain development.


Of note, in a recent PPM online patient poll, about half of respondents said they had tried medical marijuana to help alleviate their pain or pain-related symptoms. 




Last updated on: April 2, 2019
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A Commentary on Medical Cannabis
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