Spiraling Out Of Control
Part 1: America’s Opioid Epidemic Drives Development Of Cannabis Treatments For Addiction
Public health officials call it the worst drug crisis in American history.
The U.S. is in the midst of an unprecedented opioid epidemic that is rapidly spiraling out of control. According to the U.S. Department of Health and Human Services (HHS):
- More people died from drug overdoses in 2014 than in any year on record, and the majority of drug overdose deaths (more than six out of ten) involved an opioid.
- Since 1999, the rate of overdose deaths involving opioids—including prescription opioid pain relievers and heroin—nearly quadrupled, and over 165,000 people have died from prescription opioid overdoses.
- Prescription pain medication deaths remain far too high, and in 2014, the most recent year on record, there was a sharp increase in heroin-involved deaths and an increase in deaths involving synthetic opioids such as fentanyl.
In fact, on an average day in the U.S., there are more than 650,000 opioid prescriptions dispensed and there are 3,900 people who initiate nonmedical use of prescription opioids. Of those 3,900, 580 people initiate heroin use and 78 people die from opioid-related overdoses every day.
Not surprisingly, the economic impact is staggering as well. The opioid epidemic is costing an estimated $55 billion in health and social costs related to prescription opioid abuse each year and $20 billion in emergency department and inpatient care for opioid poisonings.
Sadly, without a strategic crisis plan in place, it’s expected to get much worse as public health officials struggle to contain the spread of addiction.
But there is hope.
Many solutions have been proposed to combat rampant opiate abuse. Vivek Murthy, the Surgeon General of the U.S. suggests that a multi-pronged approach that includes the expansion of drug treatment, the arming of first-responders with naloxone (a lifesaving overdose antidote), the training of health care providers on how to treat pain, the coverage of alternative pain management medication by insurers, and better education will be critical in turning the tide on addiction.
But aside from that, researchers are working to develop novel pharmacological approaches to treat drug abuse including one that has shown immense promise so far: targeting the endocannabinoid system.
The Endocannabinoid System and Opioid Addiction
Drug addiction is a chronically relapsing disorder characterized by the compulsive desire to use drugs and a loss of control over consumption. When it comes to opioid addiction, the urge to use is particularly powerful and signs and symptoms can be physical, behavioral, and psychological.
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. Although treatment differs for each person, the standard approach to fight addiction is to help the user detox and to avoid relapse.
But because the success rate for treatment is particularly low, researchers are looking at novel ways to treat opioid addicts and studies have shown that the endocannabinoid system (ECS) is involved in the common neurobiological mechanism underlying drug addiction.
In a 2006 article published in TRENDS in Neurosciences, Spanish researchers reviewed the scientific literature and found that the ECS participates in the addictive properties of all different types of drugs of abuse in at least 3 ways.
First, through the release of endocannabinoids (cannabinoids produced in our bodies) into the natural reward circuitry area of the brain, the ECS has been shown to be involved with the rewarding effects of drugs including cannabis, nicotine, alcohol, and opioids.
Second, when it comes to the motivation to seek opioids, endocannabinoids could be involved by linking the reward to a ‘hedonic experience’ in the prefrontal cortex through CB1 receptors. Surprisingly, this mechanism has been found to be independent from the release of dopamine in the brain (dopamine is a neurotransmitter that normally plays a major role in reward-motivated behavior).
And third, the ECS also participates in the common mechanisms underlying relapse to drug-seeking behavior by mediating the motivational effects of drug-related environmental stimuli and drug re- exposure. Studies have shown that endocannabinoids, acting as retrograde messengers, mediate brain activity in several addiction and memory-related brain areas.
Because it has been demonstrated that the ECS is so closely linked to drug addiction, this could have promising clinical consequences for the future of cannabis-based treatments. Researchers have begun to explore this possibility by looking into the potential therapeutic effects of cannabis compounds on addiction, especially with cannabidiol (CBD) and hemp oils.
In part 2 of this report on America’s opioid epidemic, we dive into the potential for CBD to fight on the front lines of this critical drug war.
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