First the good news: Senator Orrin Hatch (R-Utah), the senior member and former chairman of the Senate Judiciary Committee, spoke on the Senate floor September 13 about removing bureaucratic red tape to allow researchers to study the potential benefits of marijuana as a safe medical treatment for a wide-range of diseases and disorders. Hatch also spoke on his Marijuana Effective Drug Study Act of 2017, or MEDS Act, which will encourage exploration on the potential medical uses of marijuana by streamlining the research process.

The National Institutes of Health (NIH) recently awarded researchers at Albert Einstein College of Medicine and Montefiore Health System a five-year, $3.8 million grant for the first long-term study to test whether medical marijuana reduces opioid use among adults with chronic pain, including those with HIV.

“As state and federal governments grapple with the complex issues surrounding opioids and medical marijuana, we hope to provide evidence-based recommendations that will help shape responsible and effective healthcare practices and public policies,” says Chinazo Cunningham, M.D., M.S., associate chief of general internal medicine at Einstein and Montefiore and principal investigator on the grant.

These actions come after Attorney General Jeff Sessions said in March that he was “astonished to hear people suggest that we can solve our heroin crisis by legalizing marijuana—so people can trade one life-wrecking dependency for another that’s only slightly less awful,” adding, “Our nation needs to say clearly once again that using drugs will destroy your life.”

Yes, they will. But it turns out that the drugs that are ruining people’s lives are prescription drugs prescribed by their doctors – who are creating a gateway to heroin use.

As academia and the political establishment gets on board to deal with the situation, the grim statistics confirm the story that most informed Americans already know: The opioid crisis is out of control.

There are 35 million opioid users worldwide, according to statistics from the United Nations Office of Drugs and Crime (UNODC). In 2015, there were 52,404 drug overdose deaths in the U.S. – 63 percent of those deaths were from opioid use.

Opioid consumption levels for pain treatment have risen in European countries, Canada, and the United States, especially for cancer pain, according to a report from the National Center for Biotechnology Information.

The latest World Drug Report by the UNODC stated that opioids were
 the most harmful drug type, and accounted for 70 per cent of the negative health impact associated with drug use disorders worldwide.

The report found that the opioid market in particular is becoming more diversified, with a combination of internationally controlled substances like heroin, and prescription medicines that are either diverted from the legal market or produced as counterfeit medicines.

In fact, findings suggest opioid use has been the gateway drug to heroin. Four out of five heroin users reported their opioid use began with prescription opioids.

The American Society of Addiction Medicine reported that, in 2015, there were 20,101 overdose deaths related to prescription pain relievers.

The number of opioid-related deaths in Maryland increased by 70 percent between 2015 and 2016, and has nearly quadrupled since 2010. Prescription opioid deaths in Maryland averaged more than one a day in 2016.

The studies supporting cannabis use as replacement therapy for opioids is just as dense.

An abstract published in Cannabis and Cannabinoid Research, a cannabis research organization, showed that the management of chronic pain impacts 11.2 percent of adults in the United States, with about 3 percent to 4 percent of these patients receiving long-term opioid therapy.

But new findings indicate that, used in combination with opioid pain medications, cannabis can lower opioid side effects, cravings, and withdrawal severity, as well as enhance the analgesic effects of opioids, allowing for lower doses and less risk of overdose. A previous clinical study reported that their subjects’ pain ‘‘was significantly decreased after the addition of vaporized cannabis’’ and suggested that cannabis treatment ‘‘may allow for opioid treatment at lower doses with fewer [patient] side effects.”

According to the report, 80 percent of medical cannabis users reported substituting cannabis for prescribed medications, particularly among patients with pain-related conditions.

A recently published white paper from the Harm Reduction Journal also pointed to cannabis interventions to help mitigate the opioid crisis by using methods of substitution, a treatment method similar to using nicotine patches as alternatives to cigarettes or methadone treatment as an alternative to heroin.

The author of the paper, Phillippe Lucas, a graduate researcher for the Centre for Addictions Research of British Columbia, Canada, proposed that cannabis for therapeutic use can play a role in reducing opioids use, and interrupting the cycle towards opioid use disorder, by introducing cannabis at the beginning of pain management treatment, weaning people off opioids, and using cannabis in addition to any methadone treatment to help the success rate of those being treated for opioid use.

Evidence suggests that substituting cannabis for opioids has already been working. States with medical cannabis laws had a 24.8 percent lower annual overdose mortality compared to states that did not have a legalized medical marijuana regime.

A recent retrospective survey of Michigan patients concluded that medical cannabis use was associated with a 64 percent decrease in opioid use, and a survey of 3,000 medical cannabis patients in California found that of the 30 percent who reported using opioids, 97 percent reported that they were able to decrease opioids use by using medical cannabis.

What’s more to the point is that the indications of the potential impacts of medical cannabis on opioid use are coming from traditionally conservative organizations like the National Institute on Drug Abuse (NIDA), which recently acknowledged the growing scientific support for substitution effect on its website, noting that while “research into the effects of cannabis on opioid use in pain patients is limited, data suggests that medical cannabis treatment may reduce the dose of opioids required for pain relief.”