It’s not a gateway, it’s the exit drug

by Dr. Adie Wilson-Poe

Opioid withdrawal is one of the most horrific experiences a human body can endure. But how do people get to this point of extreme suffering?

Opioids cause long-lasting changes in the brain and body. With repeated use, the body develops tolerance, meaning larger doses are needed to get the desired effect. The body adapts, and still larger doses are required. This phenomenon was once referred to as “chasing the dragon,” but the exact same concept applies when looking for pain relief, too.

In this state of high tolerance, the body and brain have become so accustomed to the presence of opioids that if they’re suddenly removed, horrific symptoms — chills, nausea, excruciating pain and mental anguish, severe restlessness — begin to appear. At this point, the person is forced to consume opioids not for euphoria or pain relief, but just to ward off the effects of trying to quit. This is physical dependence, defined by the presence of withdrawal.

How do people escape this vicious cycle? Unfortunately, some never do. In the United States alone, 115 people die every day from an opioid overdose¹⁹. Half of these deaths are from prescription pain relievers, and the rest from illicit opioids like heroin and fentanyl. (Of the latter group, 80% made the switch directly from prescription drugs because their medication was either too expensive or too hard to get.)

Even for those who manage to escape opioid addiction and live to tell the tale, relapse is extremely common. Decades of addiction research tell us we really only have two decent relapse prevention tools. First, drugs that substitute for the drug of abuse (such as methadone, buprenorphine, and Suboxone), which curb withdrawal but the person is never fully free from opioid dependence. And second is social support, including meaningful connections with other people.

Fortunately, during this dire time, another option has emerged.

A new tool in the battle against addiction

For decades, we’ve known that cannabinoids (the unique molecules found within the cannabis plant) lessen opioid withdrawal symptoms in animals¹¹. We’ve seen similar anecdotal reports in humans, and thousands of people have turned to cannabis to help get through the worst of their opioid cravings and withdrawals.

For example, extremely high doses of cannabis can produce heavy sedation and long-lasting sleep, which is useful to addiction treatment facilities that commonly use medical sedation to get patients through the awful first few days of opioid withdrawal.

While MUCH more investigation by scientists and doctors is needed, there are some additional pieces to this interesting puzzle.

Better mood leads to easier recovery

One of the biggest triggers for relapse to drug use is negative mood or anxiety. CBD alone has powerful anti-anxiety effects, which have been repeatedly demonstrated in both animals and humans for years. In preliminary studies at Mt. Sinai hospital in New York, renowned researcher Yasmin Hurd has shown that even a single dose of CBD can inhibit the anxiety that leads to drug craving and relapse in opioid users¹⁶.

Think of it this way: In our daily lives, we all experience fluctuations in our mood — sometimes a bit higher than usual, sometimes a bit lower. But with chronic drug use, that “baseline” continually drifts downward, and despite attempts to restore it with drugs, it never gets back to normal. Cannabis is “rewarding” in that it produces euphoria and promotes positive mood, so it could be a critical tool that helps return mood to a more normal baseline. This means fewer days of heightened anxiety that would normally trigger relapse.

It’s really in the long-term phase of addiction recovery that cannabis has the greatest potential to improve well-being. Although decades of addiction research have accurately correlated cannabis use with the use of “harder” drugs like heroin, correlation is not causation. In other words, cannabis is not the “gateway” drug that it’s been demonized to be. Rather, it could very well be a humane “exit” from the human suffering that is opioid withdrawal, dependence, and addiction.