Opioids, while essential for managing pain in some cases, have become a devastating force across the United States, leaving a trail of addiction and loss in their wake. The physical dependence and life-threatening risks tied to these drugs wreak havoc on families and communities every year. Despite signs of stabilization, the staggering numbers behind the opioid crisis reveal that it remains one of the nation’s most persistent and deadly epidemics.
How severe is the opioid crisis? Preliminary data from the Centers for Disease Control and Prevention (CDC) reveal a grim reality: 110,469 drug overdose deaths were recorded in the U.S. in 2023, with synthetic opioids accounting for a staggering 70 percent. To put it in perspective, opioids claim more American lives in a single year than the Vietnam War, which cost 58,220 American soldiers over nearly two decades. The death toll also surpasses American casualties in the Korean and Iraq wars combined, highlighting the relentless and tragic scope of this epidemic.
A Veterans Journey
Dylan Roe, a retired Marine from Utah, turned to medical cannabis to reclaim his life after powerful opioids prescribed by his doctors began to consume it.
“I served eight years in the Marine Corps infantry from 2011, and I got out just shy of September 2018. I went and fought in war twice in this place called Sangin, Afghanistan,” Roe told Salt Baked City. “Ironically, it’s actually where the Taliban had their poppies grown and the locals harvested them.”
During his service, an 80-pound IED explosion left Roe with debilitating pain that forever altered his life. Honored with a Purple Heart for his sacrifices, he was honorably discharged from the military—but along with his accolades came prescriptions for powerful opioids like oxycodone, oxymorphone, and hydromorphone. “They were killing me,” Roe recalled. “The painkillers were killing me. So I made the decision to get off the painkillers in October 2018.”
Roe returned all of his painkillers to his pharmacist and began carefully transitioning to a medical cannabis regimen. By replacing each pill with cannabis products, such as substituting a vape cartridge for a painkiller, he gradually weaned himself off opioids. “I tried to replicate their treatment plan as much as possible, and it worked out relatively well. So, I’ve been 100% opioid-free since I started. I’ve been in pain, but it’s just a mindset now.”
His nightmarish detox would take about four months to overcome. “I wanted to understand who I was without all these pills,” Roe said, acknowledging that medical cannabis doesn’t cure everything overnight. “It wasn’t like a silver bullet, but it made living a lot easier.”
As Utah grapples with opioid addiction, year after year, the crisis appears to have leveled out on a local level and is on a downward trend in this state over the past several years. Is there a catalyst behind the falling rates of opioid use in Utah—which at first glance neatly aligns with the rollout of medical cannabis in the state? One report aims to learn more about the phenomenon, with real-time data from actual medical cannabis patients who say they were able to reduce or drop opioid use after gaining access to medical cannabis.
Researchers, doctors, and medical cannabis industry stakeholders explained to Salt Baked City how the data is mounting, showing a phenomenon taking place in Utah as medical cannabis rises and opioid use falls in the Beehive State among patients dealing with various types of pain.
An Illustration of Opioids and Medical Cannabis in Utah
The report, in collaboration with Dragonfly Wellness and Management Science Associates, Inc. (MSA), sheds light on the way medical cannabis is impacting how Utahns tackle pain, providing an alternative or adjunctive therapy in Utah. What they found is stunning, including a significant drop in opioid use in medical cannabis patients.
While the report has merit, researchers remind us that it requires more scientific rigor to make claims such as any solid association between the drop in opioid use, deaths, and the rollout of medical cannabis in Utah. Still, you can’t ignore the numbers.
Since 2018—the year voters in Utah approved the right to use medical cannabis—opioid-related prescription deaths have fallen steadily, according to the most recent data from the Utah Department of Health and Human Services. In 2018, 264 opioid-related deaths were recorded in the state, falling each year until 2022, the most recent data available, when 166 opioid-related deaths were recorded. Utah’s at its lowest point in terms of opioid-related deaths since 2003.
However, Utah remains among the states struggling the most with opioid addiction. Attorney General Sean Reyes, who set up the Utah Opioid Task Force in 2017, stressed that Utah once ranked 4th in the nation for drug overdose deaths—with opioids taking the lion’s share of people’s lives due to drug overdoses.
As long as cannabis remains classified at the federal level as a Schedule I drug—the most restrictive category of drugs—it will remain difficult for patients dealing with pain to discuss medical cannabis with any given practitioner, as most doctors remain ignorant about the endocannabinoid system and its purposes.
“We still have these arguments about whether cannabis is effective or not,” Dragonfly Chief Growth Officer Narith Panh told Salt Baked City with an expression of exasperation. “Even in this state, it’s considered medicine by the state, yet it is policed as if people don’t actually believe that. And people need to know—is it medicine or is it not? You tell me it’s OK, yet you make me jump through all of these hoops. What are you actually telling people?”
Researchers and analysts aim to expose the phenomenon of patients who are able to lower the use of opioids with the help of medical cannabis. The new report, “Impact of Cannabis on Opioid Prescriptions in Chronic Pain: Insights from Recent Research in Utah,” was presented at a recent Medical Cannabis Policy Advisory Board meeting on Nov. 19, 2024.
The retrospective cohort study recruited 186 medical cannabis patients with pain who qualified and were identified by the International Classification of Diseases codes. Pain types were classified according to guidelines from the International Association for the Study of Pain (IASP).
In general, researchers are able to understand a rise or fall in opioid use in individual patients in terms of Morphine Milligram Equivalents (MME) showing the amount of opioids that were taken. Of those 186 medical cannabis patients with chronic pain, 157 patients (84.4%) showed a decrease in MMEs per month after starting to treat themselves with medical cannabis, representing a 53.1% reduction—significant by any parameter. Specifically, the average use of opioids in the period before cannabis use was 3,832 MME/month, falling to an average of 1,798 MME/month after treating themselves with cannabis. In other words, they found over a 50% reduction in opioid use among those patients.
The results from the study, in alignment with previous studies, suggest that medical cannabis can perform as an effective adjunctive therapy for chronic pain, leading to a significant reduction in opioid use. On Nov. 19, Dragonfly Wellness and MSA presented their findings at the Medical Cannabis Policy Advisory Board meeting.
How the Report Came About
While Panh was speaking about cannabis products in Las Vegas, Nevada, talking about Utah’s medical program and how proud of it he is and about having access to medical cannabis products, by happenstance, he ran into associates of MSA who said they could provide the data he needed.
“I’m having a really difficult time telling a story providing data to people,” Panh said, explaining his decision to gather data. “But since cannabis isn’t FDA-approved, we end up just talking in circles. We’re trying to make policy, but we don’t have data. We can’t get the data because cannabis is a Schedule I drug. Instead, we just keep reusing and recirculating the same studies that use synthetic THC—Marinol, Sativex, all these other drugs that we know don’t work as efficaciously as the entourage effect from cannabis. So that’s really kind of the story of how MSA got connected.”
MSA is an analytics company working across a spectrum of industries, with a lot of focus on pharmaceuticals, and it was founded in 1963. The data they provide is intended to help entities with difficult decision-making and problem-solving.
Some hope medical cannabis can help reduce opioid use in Utah as it provides an entirely new branch of medicine, with the magic taking place in the endocannabinoid system. Unfortunately, most family doctors in Utah don’t even know what the endocannabinoid system is, as it wasn’t part of the curriculum in medical school.
What are some of the peculiarities of Utah’s medical cannabis system? Medical cannabis patients in Utah have to deal with fees a bit steeper than in other medical cannabis states, a confusing EVS system, but most of all, discrimination at every corner—discrimination for using medical cannabis to treat chronic pain, even though it’s much less dangerous than opioids, which have the power to stop breathing if the amount is too high. Panh needed data to show people that it’s actually possible to wean off or reduce opioid use with the help of medical cannabis.
One purpose of the report is to help demystify medical cannabis for pain, as many doctors are unwilling to recommend it.
Cannabis: The Right Tool for the Right Job
There are numerous kinds of pain, and in many cases, people need opioids. But you have to use the right tool for the right job: acetaminophen for a headache, ibuprofen for inflammation-related pain, naproxen sodium for moderate arthritis-related pain, or a painkiller for something more serious. Sometimes opioids aren’t the answer.
An alternative is desperately needed, and medical cannabis is currently being explored as a treatment for certain types of pain or as an adjunctive therapy coupled with fewer opioids. Research is pointing to medical cannabis as a way to battle neuropathic pain in particular.
A growing number of studies have found that medical cannabis can be helpful in treating neuropathic pain, which is a specific type of chronic pain caused by damaged nerves. And guess what? Opioids don’t even work for neuropathic pain in many cases. It’s a tidbit of information medical operators want legislators to know. Medical cannabis also shows promise in treating pain associated with multiple sclerosis and other specific pain types.
Utah’s qualifying conditions for a medical cannabis recommendation are codified in Utah Code 26B-4-203. These include chronic pain, which is defined as any pain lasting longer than two weeks, and pain is the number one qualifying condition in Utah. Go figure.
Using medical cannabis to reduce opioid use is nothing new to cannabis patients. Anecdotally speaking, many patients who grapple with chronic pain say they’ve weaned off opioids with the help of medical cannabis. But try telling that to a next-door neighbor in a state with a high Mormon population. It’s a challenge operators are dealing with every day. The stigma lingers.
“No one’s talking about this,” Panh said. “Nobody’s saying that cannabis is saving lives. In fact, they’re saying the opposite—that it’s dangerous, that we need to get it off the street and protect our kids. It’s addictive. And none of these things are true. None of them. So what’s some real data that we can stand behind? I expected this data to be scrutinized, but I was surprised at how well this data was received at the recent board meeting.”
Panh explained how confirmation bias impacts the way doctors perceive cannabis in Utah, as many researchers seek out data to support their own bias about the so-called dangers of cannabis.
Researchers React to the Results
Researchers were able to present the report to the Medical Cannabis Policy Board, and it was well-received in an environment often defined by local politics.
“I’ve been in cannabis sales for about nine years now, and I’ve been a member of the National Cannabis Industry Association in their government relations department,” said Madeline Grant, Business Development Manager at MSA. “So it’s open to a lot of federal lobbying and looking at business with work in 280E banking and comprehensive bills as well.”
Grant, who introduced the report to the Medical Cannabis Policy Board based in Utah, said there are still a lot of people afraid to try cannabis as an alternative to opioids or as an adjunctive therapy—especially in this state.
“They want to get off of it, but they don’t have an alternative,” Grant said. “So that’s what we’re really excited to explore and try to help understand and see, what products and what cannabis ratios are helping, which is just interesting to see. We haven’t already seen that in the cannabis space.”
To get an idea of how Utah’s medical cannabis system differs from those in other states, MSA associates set out to learn more. Utah’s pharmacies are armed with licensed pharmacists, for instance, who are better adept at addressing things like cannabis’s interactions with other drugs—something that a budtender at a recreational state cannot do. MSA associates also learned about battling opioids as a selling point to legalizing medical cannabis in the state in the first place.
“We talked to operators in Utah to explain that to us,” Grant said. “We learned a lot about the state and it being a legislative priority to look at opioids and combat the opioid epidemic. So I think this goes hand-in-hand with what the state is looking for in terms of alternatives. We have evidence, so far, to show that medical cannabis is helping.”
Grant was joined in presenting the report by Dr. Jenniffer Lucero, a research analyst who studied at the Boston Medical Center and Boston University in Massachusetts.
“I’m a medical doctor, and my experience is in primary care and emergency medicine,” Lucero told Salt Baked City. “Right now I’m working in medical research, primarily conducting observational studies regarding cannabis and its effectiveness in reducing other medications that have a potential for abuse—especially focusing on opioids and benzodiazepines that are used for insomnia or for anxiety. We are looking into other conditions as well, including asthma and dementia.”
MSA and Dragonfly’s report shows a significant reduction in opioid use among over 84% of patients. Is it a coincidence that numbers of opioid-related deaths have fallen since 2018?
“I think it might have to do something with cannabis and remission [of opioid-related deaths] in Utah, since there is some previous research here and in other states that are associating a reduction in over those cases in states that have medical cannabis,” Lucero said, but added they cannot make claims about a correlation without studying a larger pool of medical cannabis patients and gathering more data. “So in that sense, I don’t think it’s a coincidence. I think there’s more evidence about it that is worth looking into.”
Battling Opioids with Medical Cannabis
The federal government remains largely detached from recognizing the life-saving potential of medical cannabis, including its role in addressing the opioid crisis. The CDC acknowledges studies that show reductions in opioid use following the rollout of medical cannabis in several states, yet it also cites research finding no correlation. As a result, the CDC concludes there is “limited evidence” to support the notion that medical cannabis can effectively combat the opioid epidemic in America.
While the results are inconclusive in the sense that a larger sample pool size is needed, the results of the report align with what you see around the country in other states with medical cannabis. “We cannot be sure about it until we have stronger evidence about that in the sense that we cannot make an association,” Lucero stipulated.
It’s not the first medical cannabis state MSA has conducted research on the matter. In 2023, MSA partnered with Vireo Health of Minnesota to examine Minnesotan medical patients in the state’s programs, focusing on several hundred patients from Vireo Health locations in the state. Patients in the state are also claiming to wean off of or reduce opioids with the help of medical cannabis.
Although Lucero does not believe the rollout of medical cannabis is solely responsible for the decline in opioid-related deaths, she acknowledges that providing these alternatives is making a meaningful impact.
“I think there have been many efforts for education for physicians and the community in general,” Lucero said. “The problem with opioids started with prescriptions. So, educating a physician to look for other alternatives for the treatment of certain conditions related to chronic pain, especially, is really important. And I think right now it’s difficult for physicians to make recommendations to patients because there is not much available evidence and there is no easy way to obtain that. So, traditionally, we rely on clinical trials, and once they are published, we’re able to make recommendations based on that.”
Since cannabis remains classified as Schedule I, most researchers are limited to questionnaires, mouse models, or other limited ways of conducting research other than using rare FDA-approved medicines like Sativex or Epidiolex.
“But in the case of standard cases, it’s a Schedule I substance,” Lucero said. “It’s not so easy to conduct clinical trials, especially when you’re trying to make associations. It’s difficult because there are ethical reasons as well, but you can conduct clinical trials such as in other treatments. And so it’s important that we use something that we have available and it’s really reliable, which is real-world data. The data is there, and we have data from medical records and data from patients, race, and stress that we have available to analyze because at the end, a clinical trial, what you do is collect data and then you can analyze them. And in this sense, we have the data already available. We just have to manage that and use that.”
How Effective is Medical Cannabis for Pain?
Lirit Franks, PhD, a Research Development Associate at the University of Utah’s Division of Epidemiology, emphasizes the complexity of treating pain but notes that for certain types, the “entourage effect” may hold the key. This phenomenon describes the synergy of cannabis compounds—THC, CBD, terpenes, and others—working together, often yielding more effective results than THC or CBD alone. Although not affiliated with the Dragonfly Wellness and MSA report, Franks highlights the potential of this interaction in addressing specific types of pain, particularly where traditional treatments fall short.
“Although there is a general consensus that cannabis is mildly or moderately effective for treating some forms of pain, especially neuropathic or with multiple sclerosis, the question is actually very complex,” Franks told Salt Baked City. “There are multiple modalities by which pain occurs, dozens of underlying conditions causing pain, and almost every study is conducted with different products, under differing circumstances, and with varying levels of scientific credibility.”
Franks, who collaborates with the Program of Addiction Research, Clinical Care, Knowledge, Advocacy (PARCKA) and the Center for Medical Cannabis Research (CMCR) at the University of Utah, is optimistic about ongoing efforts to pinpoint what makes medical cannabis effective for pain. “Published studies consistently show that dosage matters—higher isn’t always better—and that an equal or higher THC:CBD ratio tends to be more effective,” Franks explained. “At the University of Utah, we’re researching current patients to better understand the factors that influence whether cannabis works for pain.”
You don’t need a study to grasp what many Utahns already know firsthand. Nearly everyone seems to have a story—a neighbor, a relative, or even themselves—of battling opioid addiction or losing someone to an overdose. As the devastating consequences of opioids become undeniable, more people are turning to medical cannabis for relief. With mounting evidence and real-world experiences, it’s becoming clear that medical cannabis is playing a growing role in reshaping Utah’s fight against the opioid epidemic.
This article originally appeared in the Winter issue of Salt Baked City Magazine.
