Hostname: page-component-76fb5796d-wq484 Total loading time: 0 Render date: 2024-04-26T01:53:00.964Z Has data issue: false hasContentIssue false

Cannabis as a Gateway Drug for Opioid Use Disorder

Published online by Cambridge University Press:  01 January 2021

Abstract

Cannabis use in some individuals can meaningfully introduce de novo risk for the initiation of opioid use and development of opioid use disorder. These risks may be particularly high during adolescence when cannabis use may disrupt critical periods of neurodevelopment. Current research studying the combination of genetic and environmental factors involved in substance use disorders is poorly understood. More research is needed, particularly to identify which adolescents are most at risk and to develop effective interventions addressing contributing factors such as trauma and psychiatric comorbidity.

Type
Symposium Articles
Copyright
Copyright © American Society of Law, Medicine & Ethics 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Williams, A.R., “Medical and Recreational Marijuana Policy: From Prohibition to the Rise of Regulation,” in Marijuana and Mental Health, ed. Compton, M. (Washington, DC: American Psychiatric Publishing Inc., 2016): 39-69; Williams, A.R., Olfson, M., Kim, J.D., Martins, S.S., and Kleber, H.D., “Older, Less Regulated Medical Marijuana Programs Have Much Greater Enrollment Rates,” Health Affairs 35, no. 3 (2016): 480-488.Google Scholar
Humphreys, K. and Saitz, R., “Should Physicians Recommend Replacing Opioids with Cannabis?” JAMA 321, no. 7 (2019): 639-640.CrossRefGoogle Scholar
Williams, A.R., Santaella-Tenorio, J., Mauro, C., Levin, F.R., and Martins, S.S., “The Effect of Medical Marijuana Laws and Regulations on Adolescent and Adult Recreational Marijuana use and Cannabis use Disorder,” Addiction 112, no. 11 (2017):1985-1991.CrossRefGoogle Scholar
Volkow, N.D., Swanson, J.M., Evins, A.E., et al., “Effects of Cannabis use on Human Behavior, Including Cognition, Motivation, and Psychosis: A Review,” JAMA Psychiatry 73, no. 3 (2016): 292-297, available at <doi: 10.1001/jamapsychiatry.2015.3278> (last visited April 13, 2020).CrossRefGoogle Scholar
Szalavitz, M., “Once and for All, Marijuana is Not a Gateway Drug,” Vice News, October 13, 2015.Google Scholar
Kandel, E.R. and Kandel, D., “A Molecular Basis for Nicotine as a Gateway Drug,” New England Journal of Medicine 371, no. 21 (2014): 932-943.CrossRefGoogle Scholar
Committee on Substance Abuse, American Academy of Pediatrics, “Marijuana: A Continuing Concern for Pediatricians,” Pediatrics 104, no. 4 (1999): 982-985.CrossRefGoogle Scholar
Williams, A.R., “Performance Measures and Quality Improvement for the Opioid Epidemic,” in Opioid Addiction: An American Crisis, eds. Compton, M. and Manseau, M.W. (American Psychiatric Publishing Inc., 2018).Google Scholar
Leslie, D.L., Ba, D.M., Agbese, E., Xing, X., and Liu, G., “The Economic Burden of the Opiod Epidemic on States: The Case of Medicaid,” American Journal of Managed Care 25, no. 13 Supp. (2019): S243-S249.Google Scholar
Koob, G.F., “Neural Mechanisms of Drug Reinforcement,” Annals of the New York Academy of Science 654 (1992): 171-91.CrossRefGoogle Scholar
Wise, R.A., “Dopamine and Reward: The Anhedonia Hypothesis 30 Years On,” Neurotoxity Research 14, no. 2-3 (2008): 169-183.CrossRefGoogle Scholar
Lopez-Quintero, C., de los Cobos, J.P., Hasin, D., et al., “Probability and Predictors of Transition from First use to Dependence on Nicotine, Alcohol, Cannabis, and Cocaine: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC),” Drug and Alcohol Dependence 115, no. 1-2 (2011): 120-130.CrossRefGoogle Scholar
Volkow, N.D., Koob, G.F., and McLellan, A.T., “Neurobiologic Advances from the Brain Disease Model of Addiction,” New England Journal of Medicine 374, no. 4 (2016): 363-371.CrossRefGoogle Scholar
Koob, G.F., “Neurobiology of Addiction,” Textbook of Substance Abuse Treatment, 5th Edition, Eds. Galanter, M., Kleber, H. D., Brady, K. T. (American Psychiatric Publishing, 2015).Google Scholar
Williams, A.R., Olfson, M., and Galanter, M., “Assessing and Improving Clinical Insight among Patients in ‘Denial,’” JAMA Psychiatry 72, no. 4 (2015): 303-304.Google Scholar
See Volkow et al. 2016, supra note 13.CrossRefGoogle Scholar
See Koob 2015, supra note 14.Google Scholar
Kendler, K.S., Myers, J., and Prescott, C.A., “Specificity of Genetic and Environmental Risk Factors for Symptoms of Cannabis, Cocaine, Alcohol, Caffeine, and Nicotine Dependence,” Archives of General Psychiatry 64, no. 11 (2007): 1313-1320; Agrawal, A. and Lynskey, M.T., “Candidate Genes for Cannabis use Disorders: Findings, Challenges and Directions,” Addiction 104, no. 4 (2009): 518–532.CrossRefGoogle Scholar
See Koob 2015, supra note 14; also Lopez-Quintero (2011), supra note 12.Google Scholar
Hien, D.A., Cohen, L.R., Miele, G.M., Litt, L.C., and Capstick, C., “Promising Treatments for Women with Comorbid PTSD and Substance Use Disorders,” American Journal of Psychiatry 161, no. 8 (2004): 1426-1432.CrossRefGoogle Scholar
Dube, S.R., Felitti, V.J., Dong, M., et al., “Childhood Abuse, Neglect, and Household Dysfunction and the Risk of Illicit Drug Use: The Adverse Childhood Experiences Study,” Pediatrics 111, no. 3 (2003): 564-572.CrossRefGoogle Scholar
National Institute on Drug Abuse, National Institute of Health, “Part 1: The Connection Between Substance Use Disorders and Mental Illness,” NIDA (February 2018), available at <https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness> (last visited April 14, 2020).+(last+visited+April+14,+2020).>Google Scholar
Fischer, B., Russell, C., Sabioni, P., van den Brink, W., Le Foll, B., et al., “Lower-Risk Cannabis Use Guidelines: A Comprehensive Update of Evidence and Recommendations,” American Journal of Public Health 107, no. 8 (2017): e1e12, doi: 10.2105/AJPH.2017.303818.Google Scholar
See Kandel and Kandel, supra note 6.Google Scholar
Id.; p.935, Figure 2.Google Scholar
See Koob 2015, supra note 14.Google Scholar
Orr, C., Spechler, P., Cao, Z., et al., “Grey Matter Volume Differences Associated with Extremely Low Levels of Cannabis Use in Adolescence,” The Journal of Neuroscience 39, no. 10 (2019): 18171827.CrossRefGoogle Scholar
Miller, M.L. et al., “Adolescent Exposure to Δ9-tetrahydrocannabinol Alters the Transcriptional Trajectory and Dendritic Architecture of Prefrontal Pyramidal Neurons,” Molecular Psychiatry 24, no. 4 (2010): 588-600; Szutorisz, H. et al., “Cross-Generational THC Exposure Alters the Developmental Sensitivity of Ventral and Dorsal Striatal Gene Expression in Male and Female Offspring,” Neurotoxicology Teratology 58 (2016): 107-114.CrossRefGoogle Scholar
Biscaia, M., Fernandez, B., Higuera-Matas, A., et al., “Sex-Dependent Effects of Periadolescent Exposure to the Cannabinoid Agonist CP-55,940 on Morphine Self-Administration Behaviour and the Endogenous Opioid System,” Neuro-pharmacology 54, no. 5 (2008): 863873; Singh, M.E., McGregor, I.S., and Mallet, P.E., “Perinatal Exposure to delta(9)-tetrahydrocannabinol Alters Heroin Induced Place Conditioning and Fos-Immunoreactivity,” Neuropsychopharmacology: Official Publication of the American College of Neuropsycho-pharmacology 31, no. 1 (2006): 58–69.Google Scholar
Pistis, M., Perra, S., Pillolla, G., et al., “Adolescent Exposure to Cannabinoids Induces Long-Lasting Changes in the Response to Drugs of Abuse of Rat Midbrain Dopamine Neurons,” Biological Psychiatry 56, no. 2 (2004): 8694.CrossRefGoogle Scholar
Mitchell, M.R., Berridge, K.C., and Mahler, S.V., “Endocannabinoid-enhanced ‘liking’ in Nucleus Accumbens Shell Hedonic Hotspot Requires Endogenous Opioid Signals,” Cannabis and Cannabinoid Research 3, no. 1 (2018): 166-170.CrossRefGoogle Scholar
Ellgren, M., Spano, S.M. SM, and Hurd, Y.L., “Adolescent Cannabis Exposure Alters Opiate Intake and Opioid Limbic Neuronal Populations in Adult Rats,” Neuropsychopharmacology 32, no. 3 (2007): 607615; Tomasiewicz, H.C., Jacobs, M.M., Wilkinson, M.B., et al., “Proenkephalin Mediates the Enduring Effects of Adolescent Cannabis Exposure Associated with Adult Opiate Vulnerability,” Biological Psychiatry 72, no. 10 (2012): 803–810.CrossRefGoogle Scholar
See Ellgren et al., 2007 supra note 34.Google Scholar
Cadoni, C. et al., “Strain Dependence of Adolescent Cannabis Influence on Heroin Reward and Mesolimbic Dopamine Transmission in Adult Lewis and Fischer 344 Rats,” Addiction Biology 20, no. 1 (2013): 132-142.CrossRefGoogle Scholar
Hurd, Y.L. et al., “Trajectory of Adolescent Cannabis Use on Addiction Vulnerability,” Neuropharmacology 76, no. 00 (2014): 1-22.Google Scholar
Cooper, Z.D. et al., “Impact of Co-administration of Oxycodone and Smoked Cannabis on Analgesia and Abuse Liability,” Neuropsychopharmacology 43, no. 10 (2018): 0, 1-10.CrossRefGoogle Scholar
Voelker, R., “States Move to Substitute Opioids with Medical Marijuana to Quell Epidemic,” JAMA 320, no. 23 (2018): 2408-2410, doi: 10.1001/jama.2018.17329.CrossRefGoogle Scholar
See Humphreys and Saitz, supra note 2Google Scholar
Williams, A.R. and Hill, K.P., “Cannabis and the Current State of Treatment for Cannabis Use Disorder,” FOCUS: The Journal of Lifelong Learning in Psychiatry 17, no. 2 (2019): 98-103.Google Scholar
Olfson, M. et al., “Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States,” American Journal of Psychiatry 1, no. 175 (2018): 47-53.CrossRefGoogle Scholar
See Humphreys and Saitz, supra note 2.Google Scholar
Caputi, T.L. and Humphreys, K., “Medical Marijuana Users are More Likely to Use Prescription Drugs Medically and Non-medically,” Journal of Addiction Medicine 12, no. 4 (2018): 295299.CrossRefGoogle Scholar
Bachhuber, M.A., Saloner, B., Cunningham, C.O., and Barry, C.L., “Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States 1999-2010,” JAMA Internal Medicine 174, no. 10 (2014):1668-1673.CrossRefGoogle Scholar
Shover, C., Davis, C., Gordon, S., and Humphreys, K., “Association Between Medical Cannabis Laws and Opioid Overdose Mortality has Reversed Over Time,” Proceedings of National Academy of Science USA 116, no. 26 (2019): 12624-12626, doi 10.1073/pnas.1903434116.CrossRefGoogle Scholar
Cooper, Z. and Williams, A.R., “Cannabis and Cannabinoid Intoxication and Toxicity;” in Cannabis Use Disorder, eds. Montoya, I. and Weiss, S. (Springer Publishing Inc., 2018).Google Scholar
Di Forti, M., Marconi, A., Carra, E., et al., “Proportion of Patients in South London with First-Episode Psychosis Attributable to Use of High Potency Cannabis: A Case-Control Study,” The Lancet Psychiatry 2, no. 3 (2015), available at <http://dx.doi.org/10.1016/S2215-0366(14)00117-5> (last visited April 14, 2020).Google Scholar
Fine, J.D., Moreau, A.L., Karcher, N.R., et al., “Association of Prenatal Cannabis Exposure with Psychosis Proneness Among Children in the Adolescent Brain Cognitive Development (ABCD) Study,” JAMA Psychiatry 76, no. 7 (2019): E1-E3.CrossRefGoogle Scholar