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Cannabis: The exit drug

As the epidemic of opioid addiction escalates, one option exists that can help those struggling find a non-addictive way to manage pain: marijuana.

Gary Cardot was no stranger to opioids when his younger brother and sister died within a year of each other from opioid overdose. A former heroin user, Cardot wishes his siblings had access to the substance he credits with keeping him clean for 16 years: cannabis.

Gary Cardot, a medicinal marijuana advocate

“There’s no doubt in my mind that my sister and brother would still be here if cannabis had been legalized,” says Cardot, now a married father of four and the co-owner of the Funky Phoenix, a salvage art studio in Pittsfield, Massachusetts.

Following an arrest, Cardot completed a 15-month Christian recovery program. But for five years after his release, he battled an emotional state he likens to PTSD, the result of both the addiction and being incarcerated.

Desperate for relief, he smoked marijuana. “I felt guilty,” he recalls. “But even just that first dose changed the way I was thinking.”

As the opioid epidemic kills hundreds of people per day and costs more than $500 billion a year—more than gun violence and traffic accidents—many people, like Cardot, are looking for answers. They’re finding them in cannabis, which can (and should) be used to control pain and curb opioid addiction.

Avoiding addiction

The rise of opioids in the 1990s—formed by the perfect storm of an aging population of baby boomers seeking treatment for pain, the pharmaceutical industry’s marketing push of synthetic painkillers, and the lack of health-care coverage for substance abuse—is perhaps the country’s worst-kept secret. Prescriptions peaked in 2012, with more than 255 million dispensed—81.3 per 100 people. Though the number dropped to 214 million by 2016, opioid-overdose deaths rose to a high of 49,068 one year later.

Opioids block pain signals by binding to receptors in the brain and spinal cord while releasing the “happy” hormone, dopamine. Over time, the body becomes reliant on the drugs to manage pain and prolong the euphoric state.

Chatham Police Chief Peter Volkmann

Virtually no corner of the country remains untouched by the opioid crisis—even Chatham, New York, a tiny town of rolling former farmlands located 30 minutes southeast of Albany. In 2016, Chatham Police Chief Peter Volkmann founded Chatham Cares 4 U, a program that helps residents find treatment without fear of judgment or arrest.

Volkmann estimates that 80 percent of the 200-plus people he has connected with recovery resources suffer from opioid addiction. But there’s more to be done.

“As we’ve filled in a gap to get people into treatment, we now need to address the gap that happens after,” Volkmann explains. “Marijuana absolutely has a place in treatment, especially for pain.”

The cannabis alternative

Dr. Matthew Roman

According to the Centers for Disease Control’s 2016 guidelines, non-opioid pain relievers are more effective in treating most types of chronic pain. Thanks to cannabinoids, chemical compounds that disrupt pain signals between the body and the brain, cannabis is poised to become a powerful ally in treatment.

Of the cannabis plant’s more than 45 cannabinoids, the best known is tetrahydrocannabinol (THC), a natural analgesic. In addition, the plant contains cannabidiol (CBD) and terpenes, strong analgesics and anti-inflammatories. CBD also modulates the psychotropic effects of THC.

Dr. Matthew Roman, founder and CEO of Nature’s Way Medicine marijuana clinics in Philadelphia and Wilmington, Delaware, says, “Unlike opiates, marijuana doesn’t bind to opiate receptors. It allows the nerves to communicate with one another and regulate the intensity of pain signals that are sent to the brain, without significant side effects.”

In a 2017 review of more than 10,000 human studies, the National Academies of Science and Medicine concluded that cannabis is safe and effective for chronic-pain management. Further, U.S. states that have passed medical-cannabis laws have seen a 23 percent decrease in prescription-opioid hospitalizations, and an approximately 25 percent drop in opioid mortality rates—a stark dissent to the idea that cannabis is a “gateway drug.”

Dr. Richard Clark Kaufman is the chief science officer of NanoSphere Health Sciences in Denver, Colorado, which is developing precision-dose delivery systems for cannabis. “It’s a myth that cannabis is addicting,” he says. “It doesn’t cause any of the symptoms of withdrawal. And it leads to significantly improved quality of life for many chronic-pain patients.”

As Roman puts it, “It’s a gateway-out drug.”

Dr. Adie Poe, a neuroscientist who has studied the interaction between cannabis and opioids for the last 13 years and who speaks at length on the topic in the documentary “The Exit Drug”, echoes this sentiment: “There is overwhelming evidence—irrefutable evidence—that cannabis is a safe and effective gateway to getting out of opioid abuse. Cannabis is an effective and safe substitute for pain-relieving drugs, like prescription opioid analgesics.”

Alleviating withdrawal and ending the stigma

So far, limited research has been conducted on using cannabis to treat withdrawal. Funding is hard to come by, since the U.S. government considers cannabis a Class 1 drug—the same as heroin—and holds a medical patent on it.

But preliminary studies demonstrate that the action of cannabis is almost immediate and has longer-lasting positive effects, while allowing the patient to remain functional. Cannabis also greatly reduces anxiety and negative moods, both triggers for drug relapse. In fact, a single dose of CBD can inhibit anxiety and drug cravings.

Still, the greatest challenge to cannabis use is its stigma. “When you hear the word marijuana, you don’t think ‘medication’; you think ‘recreational drug,’” says Volkmann. “But we can’t arrest our way out of this crisis, and we can’t spend our way out. We’ve got to connect people back to the community, to support them as they’re making efforts to help themselves.”

Cardot is leading his own call for change. Acquaintances refer friends to him for recovery resources, and he recently founded the Canna-Friendly Business Association, a collective of local businesses where customers can buy or be educated about cannabis products.

“I want people to know they don’t have to feel bad about needing help,” he says.

This content was produced by Boston Globe Media's Studio/B in collaboration with the advertiser. The news and editorial departments of The Boston Globe had no role in its production or display.