Overcoming the Opioid Overdose Crisis
Sitting Down With… M-J Milloy, Research Scientist at the British Columbia Centre on Substance Use, and the Canopy Growth Professor of Cannabis Science, Department of Medicine, The University of British Columbia, Canada.
Tell us about your role as the University of British Columbia’s inaugural Canopy Growth Professor of Cannabis Science.
It’s a privileged position: a professorship that supports research examining the potential of cannabis to address the opioid overdose crisis and other substance use disorders. The funding comes from arm’s length gifts to the university from Canopy Growth – a licensed producer of cannabis – and the Government of BC’s Ministry of Mental Health and Addictions. For a number of years, we’ve been focused on trying to better understand the opioid–cannabis relationship. In particular, we hope to characterize the relationship between chronic pain, opioid use, and cannabis consumption. A large proportion of individuals in our society are living with chronic pain, and many are now dependent on high-risk opioid analgesics. This is a crucial factor behind the ongoing opioid overdose crisis.
How does that translate into your research?
Last year, we published the results of an observational study investigating the impact of cannabis use in over 800 participants with chronic pain and opioid use disorder, who were at high risk of overdose (1). The results revealed that people using cannabis at least once a day were significantly less likely to take illicit opioids on a daily basis. This study adds to a body of evidence suggesting that cannabis could have value for people living with substance use disorders. For example, participants administered CBD in a controlled trial had significantly lower rates of opioid cravings when presented with a visual cue (2). We’re confident that our latest observational study provides valuable preliminary evidence, although we can’t conclude a causal relationship just yet. However, given the urgency of the opioid crisis and the need to find better ways to provide care to these patients, we cannot waste any time. More substantial trials are urgently needed.
What is the ultimate goal of this work?
Unlike other molecules under clinical and therapeutic investigation, cannabis and cannabinoids are already “in the wild” – in other words, people with substance use disorders are already using cannabis. In the first instance, I’m optimistic that our work will provide people living with substance use disorders, their care providers and families with some useful evidence to guide better self-medication. This is already a population that is tremendously stigmatized by society and often do not have strong relationships with the medical community. Ultimately, the aim is to provide the evidence doctors and patients need to determine whether cannabis could play a part in tackling what is the dominant public health crisis of our era.
Is cannabis a viable treatment for other conditions?
Recent reports by the National Academy of Science in the United States have added to the growing body of evidence that cannabis can be used as an analgesic; for years, survey after survey has reported that chronic pain is the most common target of self-medication and there are a number of hypothesized routes of action within the endocannabinoid system that could explain this phenomenon. Common sense suggests that there must be some analgesic action – how else can we explain the fact that a substantial proportion of chronic pain patients are able to reduce or eliminate opioids by adding cannabis to their regimen?
In addition to my research on pain and substance use disorders, I have also been supported by National Green BioMed Ltd., a local company seeking a license to produce medical cannabis, to study the potential therapeutic effects of cannabis for HIV patients, especially in the realm of HIV-associated pain.
What’s next on your agenda?
One important aspect of legalization in Canada was a series of reforms to the regulations surrounding the use of cannabis in scientific research studies; we’re hopeful this will remove some of the “red tape” around studies on cannabis and clear the way for larger human trials. We will soon be recruiting patients for a series of controlled trials exploring the risks and benefits of cannabis use for those living with chronic pain or dependence.
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- S Lake et al., “Frequency of cannabis and illicit opioid use among people who use drugs and report chronic pain: a longitudinal analysis”, PLOS Medicine, 16, e1002967 (2019). DOI: 10.1371/journal.pmed.1002967
- YL Hurd et al., “Cannabidiol for the reduction of cue-induced craving and anxiety in drug-abstinent individuals with heroin use disorder: a double-blind randomized placebo-controlled trial”, Am J Psychiatry, 176, 911–922 (2019). DOI: 10.1176/appi. ajp.2019.18101191