New research from the University of Southern California shows that marijuana can help some people stop or reduce their opioid use.
“We interviewed 30 people who used opioids and marijuana and injected drugs,” said Sid Ganesh, a PhD student at USC’s medical school and lead author of the study.
The participants, who received services from a methadone clinic and a syringe exchange in Los Angeles, said that marijuana is a useful tool to help manage their opioid use, in part because it has become so much easier to access in recent years.
Opioid use disorder patients often have to jump through hoops to access life-saving treatments such as suboxone and methadoneand the overdose reversal drug naloxone.
The study, published in Drug and Alcohol Dependence Reports, received federal funding from the National Institute of Drug Abuse, which has more typical support research which looks at the harms of cannabis rather than potential benefits. The study is particularly unique because it uses qualitative data and focuses on the lived experience of people who use drugs.
Ganesh says qualitative research provides insight into what really works for study populations and why, especially when those populations are vulnerable and dealing with all kinds of issues that might not show up in a data point. Fifty-seven percent of the participants in her study were unhoused or unstably housed, and 70% made less than $2,100 per month.
“You have to understand what’s going on in people’s lives,” she said.
Any information that can help unravel the complicated relationship between opioid addiction, overdose and marijuana use is urgently needed. Opioid overdose deaths have risen in recent years, killing more than 80,000 people in 2022. Various studies proposal that legalization of cannabis helped people reduce their opioid usebut evidence is mixed about its impact on opioid overdose rates. Some studies states with legal cannabis have fewer opioid overdoses, others report the opposite. Yet others say there is no difference.
Ryan Marino, an addiction medicine specialist and professor at Case Western Reserve University’s school of medicine, says it’s hard to know what, if any, effect the legalization of cannabis has on these numbers.
“Our drug supply is so toxic, overdoses have continued to increase regardless, because of the prevalence of fentanyl and constant changes in it,” Marino said.
Ganesh and her colleagues found that marijuana can help study participants get through some of the most difficult stages of stopping or reducing opioids. They described how they use it to manage withdrawal symptoms, as well as cravings and anxiety during the post-withdrawal period.
“When you smoke weed, it gets you over the hump and that urge to get high for the first time,” said one participant. “That’s what’s so special about weed.”
People who have recently stopped or reduced opioids are especially at risk for overdose because their tolerance is lower. Marino, who treats patients with opioid use disorder, says he has seen some of his patients successfully use cannabis to get off opioids or at least use less, while others have tried unsuccessfully. He says the data isn’t there yet to indicate that cannabis can help the majority of people struggling with opioid use disorder, but “if it helps one person not to overdose or not to have an overdose, I mean, it’s worth more than any amount of evidence. Frankly, a life saved is a life saved.”
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To truly understand how effective marijuana can be as a treatment for opioid use disorder, researchers will need to conduct large-scale clinical trials to examine the drug.
Marino says that federal restrictions have made it extremely difficult to study cannabis in this way, although it may change in the near future. One small-scale trial from 2015 looked at how cannabis could help patients stick to a detoxification treatment that involves injections of naltrexone. This study found that dronabinol, a legal, synthetic form of THC, helped ease withdrawal symptoms. The authors also tracked participants’ marijuana use after leaving residential treatment and found that people who smoked their own marijuana during the outpatient phase were twice as likely to receive their second injection and complete the detox program.
The participants in Ganesh’s study did not necessarily use cannabis because it is the best drug available to help with opioid addiction, but because it was the drug they could get.
One participant described using marijuana to taper off fentanyl while waiting for a prescription for suboxone, which helps people stop opioids. Ganesh says the main takeaway from her research is that people who use opioids need better access to all kinds of harm reduction tools, including treatments like methadone and suboxone, clean syringes, naloxone and, yes, possibly cannabis.
Marino has already seen how changing attitudes toward marijuana are affecting his patients. In the past, he has encountered patients kicked out of opioid treatment programs and even cut off from their Suboxone when they tested positive for marijuana, which he says can cause patients to relapse, get arrested and even die from overdoses. Now he sees a possible future where cannabis is no longer a barrier to treatment, but an acceptable tool for treatment.
