If asked to think about who has been hit hardest by the opioid crisis, many people think of street-entrenched drug users. But it’s not just homeless people or marginalized groups that are impacted by this epidemic, according to Dr. M-J Milloy - UBC’s inaugural Canopy Growth Professor of Cannabis Science.
"We are all in this together," Milloy told Civilized while pointing out that addiction doesn’t discriminate. "The opioid crisis, particularly evident in Vancouver’s downtown east side, has really brought home the fact that this impacts everyone across the board regardless of your socio-economic background."
In Dr. Milloy’s new role as professor of cannabis science, he is hoping to expand the research that he and his colleagues have done in respect to the role cannabis could play in combating the opioid crisis that claimed the lives of nearly 4,000 Canadians and over 49,000 Americans in 2017 alone. That turned opioid-related fatalities into the leading cause of death among Canadians aged 30 to 39.
Now Dr. Milloy hopes to curb those devastating numbers.
'We're pretty confident that you can't overdose on cannabis'
To begin his new position, Dr. Milloy says "the first task I want to undertake is to investigate if and how cannabis could play a role in this crisis. There is evidence that people abusing opioids are 20 percent more likely to continue treatment for opioid addictions if they use cannabis once a day. We don’t know if this is a causal link, or something else, but we want to learn more about the role that cannabis could play in the health and wellbeing of people who are at risk of overdosing. We want to understand how it could help them stay on treatment, so they don’t go into withdrawal or turn to the illicit market to obtain opioids."
In a best-case scenario, Dr. Milloy is hopeful that cannabis may be a solution to this crisis. There has been a lot of evidence from research done on rats as well as humans to support the hypothesis that medical marijuana - especially the cannabis compound CBD - can help minimize withdrawals and cravings, which would help recovering addicts avoid relapsing into illicit drug use. On top of that, he plans to work toward getting cannabis recognized as a safer alternative to opioids like fentanyl, oxycodone and morphine for treating chronic pain and other conditions.
"We know you can overdose on opioids and we’re pretty confident you can’t overdose on cannabis, so there’s a lot of potential for cannabis to be a part of the solution."
Of course, we've heard that for years, so it might seem surprising that the medical community is still on the fence about cannabis. But that's because prohibition has prevented Milloy and other marijuana researchers from fully understanding the plant's medical benefits.
“Cannabis research has been hindered due to prohibition and regulations for scientists possessing cannabis or administering it to patients,” noted Milloy, who hopes that Canada's decision to legalize cannabis last October will benefit the scientific community by ensuring that participants in upcoming studies are protected from prosecution for using cannabis.
Stigmas remain a major obstacle for cannabis researchers
Although Canada's drug laws have changed, stigmas around cannabis use remain. And institutional biases against marijuana are still very much in effect within the scientific community.
"This is a largely unexplored territory and there remains a stigma against cannabis from some areas," Milloy explained. "Many in the medical community are dead set against it as part of client care. I’m hopeful that as we learn the benefits it can offer, the barriers fall away so we can in an appropriate way maximize the benefits and minimize the risks."
This isn't the first time that misinformation has hindered patient care. Years ago, the medical community failed to grasp the risks of opioid-based medications when they flooded the market because doctors and pharmacists were told they were not addictive. Given how the introduction of opioids has catastrophically backfired, it's not surprising that many doctors are hesitant to gamble on medical marijuana until it has been thoroughly tested. Some of those worries are rooted in the fear that cannabis is a 'gateway' drug to harder substances.
Dr. Milloy points out that there’s good reason why this theory persists despite evidence to the contrary.
"The gateway theory plays into people’s fears for their children. All parents want to protect their children from harms and risks and this is an attractive way of explaining how parents can protect their children. The idea that there is a sequence of drug use that escalates is a common experience. When you think about it, cannabis is never the first drug, in fact caffeine, tobacco, alcohol - those could all be seen as an escalation within that sequence."
A few years ago, Milloy and his research partners published a paper that explored the gateway theory. The research was focused on younger people who were not yet injecting illicit substances. During periods where these individuals used cannabis at least once a day, they were 35 percent less likely to inject drugs. So cannabis appeared to be a self-management system for their drug use that lowered the risk of moving toward dangerous drug use.
Furthermore, Japan, Nigeria and many other countries that do not have substantial access to cannabis nevertheless have people who use so-called harder drugs (e.g., cocaine, heroin and amphetamines). "What we think we know about cannabis, doesn’t match scientific evidence," Dr. Milloy said. "We now have the opportunity to correct this discrepancy."
But some critics are concerned that Milloy's research may not be sufficiently impartial given that his position is being funded by the cannabis company Canopy Growth. However, that source has no control over what he’ll say or what he’ll publish, and Milloy would have declined the position if that had not been part of the deal. "I would not take a job that would limit my academic integrity," he told Civilized.
"We need evidence," Dr. Milloy shares. "Without accurate evidence on the potential harms, we can get into a bad situation [similar to the opioid crisis we’re facing now]. Doctors need in their hands better treatment options and better evidence for alternative treatment options. Because of prohibition, cannabis has been largely off the table. As we generate more evidence about the risks and benefits, hopefully we will see change."
And hopefully that change can help turn the tide of the opioid epidemic.