Cannabis won’t solve the opioid epidemic and that CBD and heroin use study didn’t find what you think it did
In a somewhat uniquely American way, opioid use disorder has become a marketing boon for the emerging cannabis industry. Advocates and industrialists alike have focus-grouped America’s deadliest epidemic into a modern-day Pepsi Challenge; a double-blind, peer-reviewed taste test where four-out-of-five addicts prefer medical marijuana.
Companies and lobbying groups have dedicated paragraphs, if not pages to the latest in buzzworthy scientific research on the matter. From MedMen to WeedMaps to Medical Marijuana, Inc. to NORML and more, consumers could be forgiven for thinking that perhaps the opioid epidemic had been solved.
It’s all reminiscent of that early moment on “The Wire,” where Detectives Herc and Carver find the low-rise towers empty while on a rooftop stakeout.
“Maybe we won,” proclaims Herc about the never-ending drug war, unaware that most everyone is on the other side of town participating in a city-wide basketball tournament.
And like detectives Herc and Carver, the cannabis community shares a misguided enthusiasm based on internal biases; it’s a rooftop stakeout for proof-positive science while the truth runs ball uptown.
Last month, for example, a team led by Dr. Yasmin Hurd, director of the Addiction Institute at the Icahn School of Medicine at Mount Sinai in New York published, in The American Journal of Psychiatry the results of a small, exploratory study examining cannabidiol as a treatment option for heroin use disorder. Forty-two test subjects — drug-abstinent individuals with heroin use disorder — were given either 400mg or 800mg of CBD (or a placebo) and shown triggering images in a controlled, laboratory setting.
But, while the study results were promising, researchers noted that there was much more work to be done.
“CBD’s potential to reduce cue-induced craving and anxiety provides a strong basis for further investigation of this phytocannabinoid as a treatment option for opioid use disorder,” read the paper’s conclusion. And that’s not to mention several instances in the study where causal links were questioned.
But cannabis advocates and their media collective pushed a different message. Spurred by an early CNN headline misinterpreting the study as finding “CBD effective in treating heroin addiction,” a celebratory mood rose up; incremental progress needing much more study quickly turned into a bacchanalia of settled science where the focus shifted away from those with substance use disorders and onto the cannabis community itself.
“This is a really big deal,” wrote Leafly deputy editor Bruce Barcott in a whisper-down-the-lane retweet of the aforementioned CNN headline.
He proceeded to congratulate his journalists for making the discovery themselves a full two years before the scientists at Mt. Sinai, pushing an I-told-you-so goal-post moving article purporting to show the link between marijuana — not CBD — and opioid use disorder.
“As Yasmin Hurd's study on CBD-aided heroin recovery hits the national news today, I'm doubly proud of our @Leafly team for publishing this information nearly two years ago,” he tweeted.
That particular article was an up-close-and-personal with Philippe Lucas, a founding board member of both the Multidisciplinary Association of Psychedelic Studies Canada and the Canadian Drug Policy Coalition (and fun fact — Lucas is also Vice President of Patient Research and Access at Tilray, the cannabis production company owned by Privateer Holdings, which also owns Leafly).
His research — or, rather, his review of other people’s research led him to believe that cannabis can be a useful tool in combating the opioid epidemic. In a paper he wrote at the time, “Rationale for cannabis-based interventions in the opioid overdose crisis,” Lucas cited the same statistics cannabis companies have been quoting ad nauseam, most notably, that states with legalized medical cannabis have shown a decrease in opioid-related deaths.
But those states have shown no such thing.
What cannabis advocates often fail to mention is the nuance behind those findings. As noted in Vox Media last year, the original study found decreases in opioid misuse and death in states with medical marijuana dispensaries, not in states with medical marijuana programs. Moreover, in those states, only illegal opioid use declined; it had no bearing or effect on people who were legally prescribed painkillers.
Most importantly, as is often repeated in these circumstances, these studies only show correlation and not causation. As Vox noted, editors from the journal Addiction added a caveat onto much of this research.
“Ice cream sales and the number of drownings are correlated positively, but eating ice cream does not cause drownings,” Vox quoted the editors of Addiction as writing. “Rather, sales of ice cream are higher in the warmer summer months when more people go swimming.”
Unfortunately, the cycle is repeating itself today with Dr. Hurd’s study on heroin use disorder and CBD. But, as Dr. Sheila Vakharia of the Drug Policy Alliance noted, “I get that people are excited about the CBD and heroin use study, but it didn't find what you think it did.”
“In no way was this study aiming to do something that lofty...”
The media’s tenuous rapport with the scientific community has always produced zealously-written headlines, but the cannabis media born of the legalization movement of the last five years has had a more troublesome relationship with science, at times pushing a pro-legalization narrative in lieu of the truth.
After all, and somewhat — somewhat — understandably, a cannabis journalist is most likely a pro-cannabis journalist, and, for almost a century, science was hardly objective in the other direction.
But these are reasons and not excuses.
Take, for example, Tom Angell and the Marijuana Moment, the go-to for politicoes, journalists, and policymakers in the space.
Angell’s rag published an article a few weeks back under the headline, “CBD Might Help You Cut Back On Drinking Alcohol And Reduce Its Damaging Effects, Study Says.” French and Belgian scientists undertook a review of the literature on CBD’s effects on alcohol use disorder, highlighting several promising studies from the past 26 years — none of which included human trials, a fact Marijuana Moment neglected to mention until paragraph three.
But to Angell, the science was settled.
Tweeting out to his 22,000 followers that same day, he wrote, “New scientific review finds that CBD can: reduce alcohol consumption, heal alcohol-induced liver damage, reduce alcohol-related brain damage.”
While alcoholic hepatitis may be reversible if — and only if — a person stops drinking permanently, cirrhosis or late-stage alcohol-related liver damage isn’t. CBD can heal alcohol-induced liver damage as well as angels, faith-healers, and the essential oils sold by hucksters on the subway.
Similar reactions abound in the cannabis media’s response to Dr. Hurd’s study.
Leafly senior editor Ben Adlin, for example, whose typical beat is politics and the law wrote about the findings in an article titled “CBD Can Help Curb Heroin Cravings, New Study Finds.” And while his headline was less unsound than CNN’s, his column was more subversive.
It took him no less than two lines to mislead his readers.
“[A] new study suggests cannabinoids may actually help people wean themselves off deadly drugs,” Adlin wrote about a study that suggested no such thing.
His sleight of hand was easy to miss, having introduced the study properly in his title, before misdirecting the audience in the body of his work. See, it’s subtle, but Hurd’s team never once claimed to treat addiction nor wean anyone off of drugs.
“I don't want to disparage the study, and there isn't much to disparage — it's actually a really promising study in examining what it was trying to examine,” Dr. Sheila Vakharia of the Drug Policy Alliance told PotNetwork News in an exclusive interview. “Unfortunately, I feel like the way the media is depicting it is kind of over-inflating its findings and what it was aiming to do.”
(Dr. Sheila Vakharia/ Source: The Drug Policy Alliance)
Dr. Vakharia, whose Ph.D. is in Social Welfare, is a Researcher in the Office of Academic Engagement for the Drug Policy Alliance. As she told PotNetwork News, her role is to help the organization stay abreast of the latest research relating to their work in such things as marijuana reform, harm reduction, policy advancement, and criminal justice reform.
Her goal, she stressed, is to make sure the Drug Policy Alliance advocates for evidence-based and evidence-informed policies.
“What are the key elements that keeps folks going back to their drugs of choice, perhaps the drugs that they have problematic or complicated relationships with is that they find themselves triggered to use or find themselves in situations that kind of remind them of their substance use or make them crave their substance, whether it's through watching something on TV or witnessing someone who's using or being in a situation that reminds them of their use,” Dr. Vakharia explained, diving into the heart of the study.
“What this very modest study was trying to do was to get at that very element that drives some people to go back and use,” she continued. “That element of being triggered to use because you saw something that reminded you of your drug use.”
Again, Dr. Hurd’s team treated no one’s addiction, nor did they wean anyone off of heroin using CBD. Forty-two drug-abstinent test subjects — people who had already kicked the habit — were shown triggering images such as baggies, needles, and other paraphernalia and given CBD (or a placebo) to see how it would affect their cravings while viewing said triggers.
And it was useful, to an extent.
“The study was trying to look at whether CBD could help mitigate or minimize one of the key characteristics of addiction for some people — being triggered by content that reminds them of use,” Dr. Vakharia explained. “It wasn't really about treating the addiction altogether or treating someone's opioid use altogether and developing strategies, tools, skills, to stop using and then maintaining that over time.”
“In no way was this study aiming to do something that lofty,” she continued.
“...the current findings provide direct evidence in support of the gateway hypothesis…”
Perhaps no one researcher exemplifies the cannabis community’s frenetic and bipolar relationship with science than Dr. Yasmin Hurd.
Nearly fifteen years ago, Hurd published a small, exploratory study showing a possible link between adolescent cannabis use and increased sensitivity to heroin later in life — it’s the so-called “gateway theory” of drug use, that cannabis use leads to harder drugs.
Twelve rats were given THC (or a placebo) at a time in their life equivalent to human adolescence, followed by daily doses of heroin, with the THC group developing a stronger addiction.
In the heady, underground days of the pre-cannabis media circa 2006, journalists who discussed the findings did so by dismissing its central premise; virtually screaming “reefer madness” while stamping their feet and sticking their fingers in their ears.
“On close inspection, Hurd’s research, published in the journal Neuropsychopharmacology, doesn’t show otherwise,” wrote Slate’s Ryan Grim. “For the most part, it’s a blow to the gateway theory,” he continued, arguing that the rats in both the THC and the control groups were just as likely to develop a heroin use disorder.
The Chronicle’s Jordan Smith, at the time, was blunter.
Reporting on a speech by the then-deputy director for demand reduction at the White House Office of the National Drug Control Policy, Bertha Madras, who used Hurd’s study as an example of the gateway theory, Smith wrote, “Finally, the real news: Madras is full of shit.”
And to be fair, it was a small study — 12 rats in a controlled laboratory setting hardly make for settled science. But, then again, neither do 42 humans.
“In summary, the current findings provide direct evidence in support of the gateway hypothesis that adolescent cannabis exposure contributes to greater heroin intake in adulthood,” concluded Dr. Hurd and her team in a study that, as it should have called for further research.
Select parts of Dr. Hurds more recent study were absent from media reports as well.
An industry branded in opposition to Big Pharma, the canna-journo class neglected to mention test subjects were given Epidiolex — the $32,000-a-year, FDA approved, CBD drug developed by Big Pharma corporation GW Pharmaceuticals.
“What we know is that due to lack of real regulation and oversight in the kinds of CBD products that are allowed to be sold over-the-counter that we often don't really know the content of what's actually in there, the actual concentration, what the additives are,” Dr. Vakharia told PotNetwork News, adding that the use of Epidiolex was a net benefit for the study, strengthening the findings by allowing everyone to receive the same formulation.
“Even if you order online, we still we still have a long ways to go in terms of packaging and regulation and oversight when it comes to that industry,” she continued.
But most reporters never made the distinction, allowing media consumers to believe that Extreme Bathbomb CBD Gummy Drops, or whatever the latest market-driven craze is can now cure dope sickness.
“It's also worth noting that subjects in the Mount Sinai study were administered fairly large doses of CBD, which could have cost as much as $50 in the current medical cannabis market, based on typical per-milligram prices,” wrote Forbes columnist Janet Burns, a freelance writer and host of cannabis news podcast The Toke.
“Everyday sufferers of anxiety, pain, and more serious illnesses may use anywhere between 5 and 200 milligrams per day, and numerous researchers believe that in some patients, a lower dose of cannabidiol may be more efficacious than a higher one,” she continued in one of the more dangerous sentences ever committed to print.
But, in the end, the results of the study do speak for themselves. And cannabidiol did reduce test subjects craving for heroin.
Except when it didn’t.
“The effect of CBD on cue-induced craving was not reflected in the at-home, general craving self-reported Heroin Craving Questionnaire scores, in which no significant effects were evident,” noted the study’s discussion section in a portion that was also not reflected in any article written by anyone.
In other words, while successful in a controlled lab setting, once the test subjects went home for the night, they reported no effect from the CBD.
“If they weren't statistically significant, it just goes to show that what was happening in the lab was more impactful or people were able to report that,” Dr. Vakharia told PotNetwork News. “It could be that the kinds of stimuli that they were exposed to outside in their day-to-day lives were so different and varying that they may still be getting triggered in those other ways because they might be seeing the people that they associate with substance use.”
She continued: “In this in this lab setting, they’re just watching generic videos of strangers or paraphernalia. That's not their own. When your home in the room that you actually used in, of course, perhaps your cravings are still going to be pretty strong potentially.”
Dr. Vakharia went on to mention that even the placebo group saw improved responses over time.
“Even for folks who didn't get the CBD intervention over the course of the four sessions, even they were less triggered over time just from the practice of having to be exposed to [the stimuli].”
“...tunnel vision when they focus upon their drug of choice…”
Although Ben Adlin’s sleight of hand was impressive, his prestige left audiences wanting for more; yet another rabbit pulled out of another hat.
“We’ve known for a while now that the availability of medical cannabis is associated with lower opioid prescription and overdose death rates,” Adlin wrote, attempting to misdirect audience attention from CBD to cannabis by trotting out that same tired trope of a statistic. “What’s been less clear is whether cannabinoids can reliably help individuals disrupt problem drug use.”
But now, here’s the thing.
As of this writing, researchers have found that states with medical marijuana programs may not have fewer deaths from opioid use disorder — they may, in fact, have more. Or, it was noted, medical marijuana more likely has no causal connection to opioid deaths at all.
But outside of the mainstream media, one would be hard-pressed to find this in the cannabis news. Neither Tom Angell nor Bruce Barcott nor Ben Adlin has shared a peep.
What little response there has been in the community has been dismissive at best.
“Overbroad statistical methodology is never a good basis for making public policy. Straw man. The costs of #marijuana Prohibition far outweigh the meager benefit of satisfying @learnaboutsam's totalitarian fantasies,” the organization wrote, apparently noting that those suffering from opioid use disorder were no longer important to the cause.
Others were quick to point out conflicting studies, including Dr. Hurd’s.
And that’s unfortunate because as Dr. Richard Saitz, professor and chair of the department of community health sciences, Boston University School of Public Health told PotNetwork News last month, science should be separate from legislation.
“I think we need to separate discussions about legalization and regulation from efficacy, risks, and safety,” Dr. Saitz told PotNetwork News. “We should evaluate the latter dispassionately, so we get the right answers.”
With slick marketing campaigns, companies like WeedMaps turn single data points into scientific breakthroughs. Cannabis research, like Dr. Hurd’s, is no longer an incremental step towards a more significant body of knowledge so much as it justifies a predetermined truth — lest it is vilified otherwise.
After all, as Ben Adlin wrote, “we’ve known for a while now...”
But what we’ve known for a while now is rarely discussed among cannabis advocates while predetermined truth leaves those of us with opioid use disorder stigmatized — vulnerable populations sometimes desperate for help.
Methadone and buprenorphine work.
“There are decades of evidence showing that buprenorphine and methadone are the gold standards of treatment for opioid use disorder and that while promising evidence is promising and exciting, in no way should that be seen as replacing or supplementing proven strategies and medications for these disorders,” Dr. Vakharia told PotNetwork News. She stressed the fact that while the Drug Policy Alliance advocates for marijuana reform, the organization's first responsibility is to evidence-based treatments.
“We as an organization do not really advocate for opioid use disorder trajectories that do not involve evidence,” she noted. “Medications such as buprenorphine or methadone … reduce the likelihood of a lethal overdose by over 50 percent and ... reduce the likelihood of returning to street heroin or fentanyl.”
Dr. Vakharia continued: “I think that one of the challenges of a lot of organizations that are pushing singly for marijuana reform is that they're so invested in pushing forth this substance — and there are many potential benefits to it — but I think that people can sometimes get a little tunnel vision when they focus upon their drug of choice and the increasing body of evidence that shows that it can support a variety of health conditions.”
“Because in that tunnel vision of seeing the research that shows promise in particular areas people can sometimes forget the broader conversation and dialogue that we need to be having about where marijuana fits into the broader scheme of treatments and potential substitution medications for substance use disorder,” she concluded.