“The opioid crisis is an emergency, and I’m saying officially, right now, it is an emergency. It’s a national emergency. We’re going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis… There’s never been anything like what’s happened to this country over the last four or five years.”
- President Trump
In a recent press conference, President Trump publicly declared that the federal government will be backing the fight against the deepening opioid crisis by declaring it a national emergency. The announcement came after the opioid epidemic commission, led by New Jersey Gov. Chris Christie (R), Massachusetts Gov. Charlie Baker (R), North Carolina Gov. Roy Cooper (D), former Rep. Patrick Kennedy (D), and Dr. Bertha Madras, put forth recommendations to the President to combat the crisis in a new report.
By far, this is the deadliest drug overdose crisis in US history. Overdoses are particularly common and lethal with this class of drugs which includes opium, codeine, fentanyl, heroin, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, paregoric, sufentanil, and tramadol.
According to the Center for Disease Control and Prevention (CDC), in 2015, overall drug overdose deaths, largely as a result of opioids, reached a new historic record — surpassing deaths from guns that year. Things got worse in 2016 as drug overdoses likely killed more Americans than the entire wars in Vietnam and Iraq, based on a New York Times analysis of state data.
Now according to the commission’s interim report, with approximately 142 Americans dying every day, America is enduring a death toll equal to September 11th every three weeks.
Realizing that the national opioid epidemic has now reached critical levels, the President hopes that this latest move will help to contain – or at least slow the spread – of the growing drug problem. With the boost in federal support and financial aid, many people affected by the crisis are praying that the commission’s recommendations are carried out sooner rather than later.
- Expanding capacity for drug treatment under Medicaid;
- Increasing the use of medication-assisted treatments, like buprenorphine and suboxone, for opioid disorders;
- Encouraging the development of non-opioid pain relievers;
- Mandating that every local law enforcement officer in the nation carry naloxone, the drug that rapidly reverses opiate overdose;
- Broadening “good Samaritan” laws that shield individuals from prosecution when they report a drug overdose to first responders or law enforcement officials.
These recommendations are what public health experts and drug policy reformers have been advocating for for years. They are in line with the CDC’s long-standing strategy for how to respond to heroin abuse:
PREVENT People From Starting Heroin
Reduce prescription opioid painkiller abuse.
Improve opioid painkiller prescribing practices and identify high-risk individuals early.
REDUCE Heroin Addiction
Ensure access to Medication-Assisted Treatment (MAT).
Treat people addicted to heroin or prescription opioid painkillers with MAT which combines the use of medications (methadone, buprenorphine, or naltrexone) with counseling and behavioral therapies.
REVERSE Heroin Overdose
Expand the use of naloxone.
Use naloxone, a life-saving drug that can reverse the effects of an opioid overdose when administered in time.
Unfortunately, many people feel that the strategies put forth by the commission are essentially more of the same, ineffective policies that allowed this problem to fester in the first place. Furthermore, the rise in popularity of the deadly drug fentanyl has done inexplicable damage in a very short amount of time and may require a more aggressive approach to tackling the problem. Fentanyl is one of the strongest opiates on the market and is individually responsible for numerous overdose deaths in the country and abroad.
Epidemics such as the one we’re in now require a paradigm shift in thinking about all possible solutions. Instead of beating a dead horse, we need to try something new – like increasing funding for research into promising pharmacological interventions that have the potential to drastically turn the tide on this war against opioids. More specifically, research into cannabis provides a foundation for the therapeutic development of medicinal cannabidiol or CBD to address the current opioid abuse crisis.
The need for a change
Now more than ever, there is an urgent need for creative, public health-oriented solutions to the increasingly intractable problems associated with the U.S. opioid epidemic.
We’ve written in the past about how pharmaceutical companies and academic research institutions should be further engaged in developing novel pharmacotherapies for opioid use disorder (OUD) that can be accessible to a range of populations. We’ve also written about how the non-intoxicating compound called CBD that’s found in the cannabis sativa plant has the potential to be a future treatment for addiction.
But as a novel pharmacotherapy, more needs to be done to test the drug in controlled, double-blind clinical trials before it can be approved for any kind of use. Although some studies have been completed to date, they have been small experimental studies in the initial phases in the development pipeline.
Yasmin Hurd, Professor of Neuroscience for Psychiatry and Pharmacology & Systems Therapeutics at the Icahn School of Medicine at Mount Sinai has been at the center of this movement. A small pilot study in humans, led by Dr. Hurd, mirrored findings found in previous animal studies on CBD and opioid addiction.
The first step of Dr. Hurd’s human study was to determine the safety of CBD when combined with a powerful opioid. In a double-blind, placebo-controlled cross-over phase I study in healthy subjects, her team demonstrated that CBD co-administered with intravenous fentanyl was well tolerated and did not exacerbate adverse effects associated with intravenous fentanyl administration such as respiratory depression or cardiovascular complications.
The next pilot phase was to evaluate CBD as a potential treatment for heroin craving by assessing its effects in heroin abusers. Again, after conducting a small double-blind study on opioid-dependent individuals, her team found that CBD was able to reduce their heroin-related, cue-induced cravings. The study also showed that CBD was powerful in reducing the anxiety induced by heroin cues – which is one of the main factors that contributes to relapse.
These early clinical findings, along with the growing acceptance of medicinal cannabis, provides an impetus to more seriously and expeditiously consider the potential of CBD as a therapeutic agent for opioid addiction.
But although the results so far have been extremely promising, one small clinical study is not enough to prove that CBD is the answer to the national drug crisis. Nevertheless, Dr. Hurd believes it serves as an important foundation, along with accumulating evidence in animal models, to warrant expedited efforts for additional clinical studies to evaluate the potential therapeutic benefits of CBD for opioid addiction.
The time to act is now. Probably more than anyone, Dr. Hurd understands the urgency of the situation and is already pushing ahead with additional research.
She has collaborated with GW Research Ltd. (the research arm of British biotech company GW Pharmaceuticals) on a new clinical trial. Called “Acute and Short-term Effects of CBD on Cue-induced Craving in Drug-abstinent Heroin-dependent Humans”, this latest study is meant to more fully characterize the effects of CBD administration on cue-induced craving in drug-abstinent heroin-dependent subjects. Using a random double blind design during a post-acute (greater than 6 days since last use) heroin withdrawal period, the participants will be administered CBD during 3 test sessions and studied for the effects on cue-induced craving during those sessions as well as one week after the final CBD administration on the final test day (session 4). The estimated study completion date is in October 2017.
Hopefully the results will further enhance the case for the use of CBD as a treatment option for OUDs. If we are to get serious about tackling the opioid crisis in this country, then we need to put our full support behind cutting edge research that actually shows promise in fixing the problem instead of backing the tired, old, ineffective strategies we currently have in place.
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